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User`s Guide

1. EP RO Et RP RN be 237 About Reports Se 237 Displaying and Hiding the Report Work 238 Viewing Report Versions tuas Seed eee dais eva ge eee eia 238 Printing a oes DE aS S Ua 239 Saving a Report as a Series of DICOM 239 Adding Image to Report ek Mea ee aes 239 Adding Patient Information to a Report EA REO ag 240 Adding Interpretations to Cardiac 240 Adding Visualizations and Observations to an Obstetric Report 241 EnVisor Series User s Guide M2540 30000 ug 02 Adding Visualizations and Observations to a Gynecologic Report 242 Adding Comments to a Report 243 Generating Obstetric Trending Graphs wo oves De RES 243 Measurements in Image Review and 244 About Measurements in Image Review and 244 Performing a Labeled Measurement a Calculation in Image Review 244 Performing an Unlabeled Measurement in Image Review 245 Editing Measurements in Image Reviews oov EE RA Eee s 246 Manipulating Measurements in a 246 Importing and
2. QUAD cm Length AFI dimension quadrant QUAD2 fcm j Length AFI dimension quadrant 2 QUAD3 cm Length AFI dimension quadrant 3 QUAD4 dimension 4 R Follicle 1 16 Dist Length Diameter of right ovarian follicle 1 16 R ovary DV WEE ovary diastolic WEE R ovary Mean Right ovary mean velocity R ovary SV Right ovary systolic velocity lewh Remi Renal fem iee Renal enh aL m fadus length ROH em fiee hig EnVisor Series User s Guide 185 M2540 30000 ug 02 ROL m fiee Ra earn lenge ROW m ieem Right ovarian width S C SV cm2 Velocity Measure the systolic velocity for the and RI calculation TC traced cm Circumference Traced thoracic circumference TDap cm Length Anterior posterior thoracic diameter TDtrv Transverse thoracic diameter TL fem Lew Tibia length TTD Transverse trunk diameter UL m eneth Uia Tenth Umbilical DV cm s Velocity Measure the diastolic velocity of the umbilical artery Umbilical Mean cm s Velocity Measure the mean velocity of the umbilical artery Umbilical SV cm s Velocity Measure the systolic velocity of the umbilical artery Uterine DV cm s Velocity Measure the diastolic velocity of the uterine artery Uterine Mean cm s Velocity Measure the m
3. a S es EE 1 4 78 12 4 19 1 13 4 110 3 144 15 4 112 1 Jeanty Philippe Odstetrical Ultrasound McGraw Hill 1983 56 GA CRL via Osaka Gestational age wk day via Osaka University using crown rump length CRL range 0 8 6 5 cm The following table lists the standard deviation in days CRL 0 87 7 1 30 8 2 04 9 3 00 4 12 5 30 12 6 49 13 EnVisor Series User s Guide 320 M2540 30000 ug 02 Nobuaki Mitsuda et al Image Diagnosis of Fetal Growth Obstetrical and Gynecological Practice in Japanese 1988 37 10 1459 70 GA CRL via Rempen Gestational age wk day via Rempen using crown rump length CRL range 0 27 8 cm The following table lists the standard deviation SD in days for each value CR 50 CR 5 5 CR 5 L L L L N 0 6 oJ 0 A 6 0 5 6 0 Oo 6 0 0 N w gt N w o 0 EnVisor Series User s Guide 321 M2540 30000 ug 02 1 0 6 German Society for Gynecology and Obstetrics March 1991 Issue 15 Vol 1 pp 23 28 GA CRL via Robinson The formula for gestational age wk da
4. 141 Activating Body Markers During Dual Imaging and Freeze 142 Analysis t5 td etibebsbctse E ML Eb RR 143 About visa qutm e a s ee RUE awe ie 143 General Analysis Ses 143 uo aleve ee gent OMe aaa ON Naa as 143 Changing Analysis nes siet edi cedes 143 Improving Measurement Accuracy 1 0 cece cece eee 144 About Mathematical Quantities Calculated from Primitives 147 About PISA Measurements and Calculations de eed 149 Formulas Used for Quick Calcs 124 n on etae nier Bes tur e eod Se 150 Formulas Used in Reports 150 Doppler Trace a2 2 Vee eae 151 EnVisor Series User s Guide M2540 30000 ug 02 X About Doppler Trac s at det ud 151 About Automatic Doppler 152 Activating Automatic Doppler 153 Using Automatic Doppler CHA e NH 154 Performing a Manual Doppler Trace 154 Using Automatic Doppler Trace Soft Keys 2 24 ots aa Cece hee E RES 155 Automatic Doppler Trace 155 Automatic Doppler Trace Calculations
5. Philips requires that you use Super VHS SVHS tapes for VCR recordings Using a Panasonic MD 835 VCR You must assign a Record key to a Panasonic MD 835 VCR before you can use it EnVisor Series User s Guide M2540 30000 ug 02 begin recording press the Record key that you assigned to the VCR Press it again to pause the recording Note A counter on the imaging screen advances to indicate that the VCR is recording e record verbal comments press the Mic key Press it again to turn the micro phone off and mute your conversation To control the playback of the tape use the VCR soft keys To display the VCR soft keys press the VCR key To pause the tape during playback press the Freeze key or the Pause soft key To resume play press the Freeze key again or the Play soft key e To adjust the volume during playback turn the Volume rotary control Note Philips requires that you use Super VHS SVHS tapes for VCR recordings Using Other VCRs To use any VCR other than a Panasonic MD 835 VCR attach the VCR input to the video output of the system To record use the keys on the VCR as directed in the VCR user s manual To playback any VCR other than a Panasonic MD 835 VCR on the system press the VCR key press the External Video soft key and use the keys on the VCR as directed in the user s manual return to live imaging press the External Video soft key again Note Philips requires
6. Pulsatility index using time averaged mean of the peaks VAR RL Resi index VA PI Pulsatility index using time averaged mean of the peaks Volume Calculation Label Volume Ellipsoid 3 axis volume Three Axis 21 6 EnVisor Series User s Guide M2540 30000 ug 02 OB GYN Calculations All OB GYN calculations are listed in the following table See Appendix A for the for mula inherent approximations and assumptions and clinical references for each cal culation Label Formula Meaning A B A to B Ratio Ratio Generic velocity ratio AC Abdominal circumference AFI Amniotic Fluid AFI Amniotic fluid index Index CI BPD OFD cI Cephalic Index Cephalic index Ductus Venosus Pulsatility index using time averaged mean of the siiis Ductus Venosus S D MN to D Ratio pe Systolic to diastolic EMEN EFW AC BPD Hadl iic BPD via Estimated fetal Hadlock weight via AC and BPD Hadlock Normal fetal weight percentiles EFW AC BPD Sh EFW AC BPD via i Estimated fetal Shephard weight via AC and BPD Shephard Normal fetal weight percentiles EnVisor Series User s Guide 217 M2540 30000 ug 02 EFW AC FL Hadl EFW AC FL via i Estimated fetal Hadlock weight via AC and FL Hadlock Normal fetal weight percentiles EFW AC HC FL Ha EFW AC HC FL via i Estimated fetal dl Hadlock weight via AC HC and FL Hadlo
7. tes 2 pes 47 16 5 19 3 220 167 123 3 126 0 128 5 Jeanty Philippe Odstetrical Ultrasound McGraw Hill 1983 58 GA BPD via Osaka Gestational age wk day via Osaka University using biparietal diameter BPD range 1 3 9 4 cm 318 EnVisor Series User s Guide M2540 30000 ug 02 BPD 1 33 1 72 2 09 2 46 2 82 3 18 3 52 3 86 BPD 117 16 39 125 18 43 133 Nobuaki Mitsuda et al Image Diagnosis of Fetal Growth Obstetrical and Gynecological Practice in Japanese 1988 37 10 1459 70 GA BPD via Tokyo Gestational age wk day via Tokyo University using biparietal diameter BPD range 2 0 9 47 cm BPD 2 00 2 40 2 76 3 10 3 38 3 72 405 656 pe j 439 jesa 874 35 Masahiko Mizuno et al Assessment of Fetal Growth using Ultrasound Measurements Nichidoku Iho Japanisch Deutsche Medizinische Berichte in Japanese 1989 34 3 537 544 EnVisor Series User s Guide 319 M2540 30000 ug 02 GA CRL via Jeanty Gestational age wk day via Jeanty using crown rump length CRL range 0 5 5 4 cm CRL GA CRL CRL GA CRL 1 5 5 ies 4 ET NE ee ea
8. DR ERA E A REEE ERE 247 About Importing and Exporting 0 1b RUD AD ordo ed 247 Importing a Patient Study in DICOM Format 249 Exporting the Current Patient Study in DICOM Format 250 Studies s ossa prada iate duele Ea NO e diee erae 250 Exporting an Image in PC vn reo Ae huc e SEG CR 252 Exporting Images in PC Pormdte s cue gis ee Ee eI E E ERE 253 Exporting a Report in PC Format 8 55 254 Exporting Data to a Third Party 254 Stress 257 About Stress Echocardiography ag eed eee 257 Stress Echo Setups ov Sat ety a dieti tet 258 About Stress Echo Setup uu comer suede nual e tains 258 Creating a Stress Echo Presets dosi epe AU IU A cite ae sies ia 258 Modifying a Stress Echo 260 About Stress Echo 8 ERA ERES 261 About Stress Echo Acquisition Methods 22 eene 262 Using a VCR During a Stress Echo 262 Using the Timer During a Stress Echo 263 Stress Echo Acquisition es PES ee a
9. 2D Mode Description The transducer is transmitting and receiving over a range of 1 6 to 4 3 MHz The dark portion near the T indicates that the Fusion setting is optimized for Texture Tissue Harmonic Imaging The transducer is transmitting at 1 9 MHz and is receiving at 3 8 MHz The circle around the R indicates that the Fusion setting is optimized for Resolution The transducer is transmitting at 2 1 MHz and is receiving at 4 2 MHz The circles around the T and the R indicate that the Fusion setting is optimized for Texture and Resolution This icon is used for enhanced Pulse Inversion settings that are available only with the EnVisor HD series Note The transmit and receive frequencies depend on the current preset and trans ducer Resizing and Repositioning an Image You can resize an image If an image is not full size you can change its position Resizing an Image To resize an image 62 EnVisor Series User s Guide M2540 30000 ug 02 1 Press the Select key until Size is highlighted on the bottom right corner of your imaging screen 2 Use the trackball to change the size of the image Note You cannot resize the 2D image if you are in Color Mode Color Power Angio or Zoom Repositioning an Image To reposition an image 1 Press the Select key until Position is highlighted on the bottom right corner of your imaging screen 2 Use the trackball to reposition the image Note P
10. 5 approve the measurement and perform another press the Measure key To approve the measurement and exit Measurements press the Enter key The measurement turns white to indicate that it is complete Performing Protocol Measurements When you perform one of the measurements in a set of protocol measurements and press the Enter key the next measurement in the protocol sequence is initiated If you do not want to perform the next measurement press the Del key above the Measure key Using Labeled Measurement Soft Keys To change any of the settings listed below press the oval key below the soft key label Explain Text Use the Explain Text soft key to display a short definition of the current measurement The Explain Text soft key is only available when you are performing a labeled measurement Fetal ID Use the Fetal ID soft key to identify by letter which fetus the measurement applies to The Fetal ID soft key is available only in OB GYN presets when Fetal Count in the Patient Identification window equals two or three Keyboard Entry Use the Keyboard Entry soft key to enter a measurement value using the keyboard 160 EnVisor Series User s Guide M2540 30000 ug 02 Left Mid Right Use the Left Mid Right soft key to specify the side of the anatomy being measured The values for the Left Mid Right soft key depend on the current preset Menu Use the Menu soft key to specify whether the Measurements or Calculations
11. By JIE EnVisor Series User s Guide 147 M2540 30000 ug 02 148 Ellipse Circumference when B 4 4 44 t xz 16 where 4 MajorLength 5 2 MinorLength 2 Mean Pressure Gradient The mean pressure gradient measurement PG mean in mmHg is proportional to the integral of the square of the Doppler spectral instantaneous velocity V in centime ters per second over time t in seconds The integral is approximated by the follow ing formula N _ 4 10 0001 2 i l Vix t where T is the total time interval the sum of all t time increments 4 is the approxi mate units conversion factor for the Bernoulli formula and 10 000 is the scaling fac tor from centimeters to meters squared Slope The slope measurement is derived from the length and the time measurement primi tives using a simple slope formula EnVisor Series User s Guide M2540 30000 ug 02 Velocity The velocity value is the product of the frequency primitive measurement and the cosine of the angle of blood flow The blood flow angle is a control set by the system operator The setting of this control varies by clinical application There are some uncertainties and assumptions in the setting of this control Unpredictable high veloc ity jet directions and tortuous vessel directions sometimes prevent use of a clinically accurate blood flow angle Velocity Time Integral The velocity time integral or flow
12. FL 95th FL 220 58 s3 9 373 995 413 2 178 201 s 27a ass 400 a2 3 3 18 3 205 1227 5 7 27 7 299 132 1 EnVisor Series User s Guide 324 M2540 30000 ug 02 Jeanty Philippe et al Estimation of Gestational Age from Measurements of Fetal Long Bones Journal of Ultrasound Medicine February 1984 3 75 79 GA FL via Osaka Gestational age wk day via Osaka University using femur length FL range 0 9 7 2 cm FL 0 94 1 26 1 57 1 88 2 18 2 47 2 75 Nobuaki Mitsuda et al Image Diagnosis of Fetal Growth Obstetrical and Gynecological Practice in Japanese 1988 37 10 1459 70 GA FL via Tokyo Gestational age wk day via Tokyo University using femur length FL range 3 2 7 1 cm Masahiko Mizuno et al Assessment of Fetal Growth using Ultrasound Measurements Nichidoku lho Japanisch Deutsche Medizinische Berichte in Japanese 1989 34 3 537 544 EnVisor Series User s Guide 325 M2540 30000 ug 02 GA FTA via Osaka Gestational age wk day via Osaka University using fetal trunk area FTA range 5 6 87 0 2 5 6 7 3 9 2 11 3 13 5 15 8 18 4 Nobuaki Mitsuda et al Image Diagnosis of Fetal Growth Obstetrical and Gynecological Practice in Japanese 1988 37 10 1459 70 GA GSD via Rempen Gestational age wk day via Remp
13. t is a representative myocardial wall thickness with the formula Reichek N et al Anatomic Validation of Left Ventricular Mass Estimates from Clinical Two Dimensional Echocardiography Initial Results Circulation February 1983 Vol 67 No 2 pp 348 352 Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 pp 358 367 Wyatt H L et al Cross sectional Echocardiography Analysis of Models for Quantifying Mass in the Left Ventricle in Dogs Circulation 1979 Vol 60 pp 1104 1113 LVmass AL dl LVmass AL d BSA LVmass C d 0 8 1 04 IVS 47 LVID 4 LVPW P LVID 3 0 6 EnVisor Series User s Guide 335 M2540 30000 ug 02 Devereux R B et al Echocardiographic Assessment of Left Ventricular Hypertrophy Comparison to Necropsy Findings American Journal of Cardiology 1986 Vol 57 pp 450 458 Sahn D et al The Committee on MMode Standardization of the American Society of Echocardiography Recommendations Regarding Quantitation in MMode Echocardiography Results of a Survey of Echocardiographic Measurements Circulation 1978 Vol 58 No 6 pp 1072 1083 LVmass C dl LVmass C d BSA LVOT Area The calculated area LVOTArea of the Left Ventricular Outflow Tract is LVOTArea pi 4 x LVOTDiam Hagen Ansert Sandra L Textbook of
14. 284 Removable ne rs teen yah deo tla an ab Lois de rect ends 285 Transducer Supplies edu ean eis PRA eA NOUS Pu elg PRU 286 VCR Supplies and 287 Vos quoe vs Aa o BR GE PA A ACRAS 289 Appendix Formulas Used for 301 EnVisor Series User s Guide XVIL 2540 30000 02 Using Online Help Using Online Help The EnVisor Series Online Help window displays three tabs along the top of the left pane to help you navigate to specific topics Click che tab to view the contents of the online Help e Click the tab to search for topics by keyword e Click the tab to search the entire online Help Some words and phrases appear in blue text If you click these words a popup win dow is displayed with more information To make the popup window disappear click anywhere EnVisor Series User s Guide 1 M2540 30000 ug 02 Online Help Icons The online Help uses the following icons to help you identify online Help compo nents and to navigate to topics quickly Icon Description D A book icon on the Contents tab represents a major set of topics Click a closed book to reveal the underlying topics A topic icon on the Contents tab represents an online Help topic Click a topic icon in the left pane of the EnVisor Serie
15. Trapezoidal Imaging adds additional imaging area by changing a linear transducer s rectangular image to a trapezoidal shape The extended field of view is often useful in vascular and small parts presets Trapezoidal Imaging is not available in Zoom U D Invert Use the U D Invert soft key to reverse the up down orientation of the image A small open circle called a transducer orientation dot appears at the top of a noninverted image An orientation dot appears on the bottom of an inverted image U D Invert is available only in live imaging and is not available with linear or TEE transducers or when a spectral trace is live About Fusion Settings Fusion settings control the transmit and receive frequencies for the transducer Each fusion setting is optimized for one or more of the following e Penetration e Texture e Resolution R Fusion settings apply to 2D Mode and Tissue Harmonic Imaging You can choose from a maximum of five fusion settings if you have an EnVisor HD or an EnVisor C HD Otherwise you can choose from a maximum of three settings The number of available fusion settings depends on the transducer you are using Fusion Icons A fusion icon appears on the lower left corner of the imaging screen This icon sum marizes information about the fusion setting The following table shows examples of the icon or icons used for each imaging mode EnVisor Series User s Guide 61 M2540 30000 ug 02
16. 156 Measurements s Ad sre s cte ah LA 156 About 156 Labeled D ttn oque Jof ed 159 Unlabeled opto rd 190 Caleilationsa vec a qus hia eels Ra E ed Ave pda ted 195 About Calculations ER DEN EP e VECES 195 Performing Calculations 44 ure RA Piedra ve gag Pus 195 Creating a User Defined Calculation Using a Formula 196 Creating a User Defined Calculation Using a 197 Editing a User Defined Calculations 2o stet t Lc 198 Deleting a User Defined Calculation 22 222 2 634 RR IR RERAEIRIS 199 About Volume ER E P pav 199 Cardiac Volumes 2 ni a et fou ae tata quel M tu tA C ADI 199 T reecDistan e Volumes cesio aeua Cune eod o bue De ad eei 201 OnecDistance Volumes 454 OUT E RIO CHI AH ds S 201 Calculations by Exam Lypez cite eee oe NA V EE ges 201 Patient Studies Image Review and Reports 223 About Patient Studies Image Review and Reports 223 Using the Select Key in Image Review and 223 Patient SEV Gay NE IP CEN EE LE 223 About Patient Studies 25 4038 views dea eke Ceu P
17. Measurements A Prospective Study American Journal of Obstetrics and Gynecology 1985 151 3 333 337 EFW AC HC FL via Hadlock The formula for the estimated fetal weight grams via Hadlock using abdominal circumference range 10 0 37 0 cm head circumference range 10 0 40 0 cm and femur length range 1 0 8 0 cm is 10 1326 00032 amp AC XFL 0 010XHC 0 0438 AC 0 158 FL 312 EnVisor Series User s Guide M2540 30000 ug 02 Hadlock et al Estimation of Fetal Weight with the Use of Head Body and Femur Measurements A Prospective Study American Journal of Obstetrics and Gynecology 1985 151 3 333 337 EFW BPD AD FL via Tokyo The formula for the estimated fetal weight grams via Tokyo using biparietal diameter range 3 1 10 0 cm abdominal diameter anterior posterior range 5 0 15 0 cm abdominal diameter transverse range 5 0 15 0 cm and femur length range 1 0 8 0 is 107 x BPDy 3 42 x ADapx ADtrvx FL Norio Shinozuka et al Formulas for Fetal Weight Estimation by Ultrasound Measurements Based on Neonatal Specific Gravities and Volumes American Journal of Obstetrics and Gynecology 1987 157 5 1140 5 EFW BPD FTA FL via Osaka The formula for the estimated fetal weight grams via Osaka using biparietal diameter range 3 1 10 0 cm fetal trunk abdominal area range 20 0 180 0 and femur length range 1 0 8 0 cm is 1 25647 x BPDy 3 50665 x FTA
18. Metric The Boyd body surface area BSA m2 formula given a metric weight Wig range 0 5 160 0 kg is 0 8168 0 01541og 1000 W BSA 0 0004688 1000 Wys E Note Log function uses base 10 English The Boyd body surface area BSA m2 formula given an English weight Wy range 1 1 350 0 lbs is 0 8168 0 015410 454 55W BSA 0 0004688 454 55 Wr Note To enter the BSA use the keyboard Boyd Edith The Growth of the Surface Area of the Human Body originally published in 1935 by the University of Minnesota Press Greenwood Press Westport Connecticut 1975 p 102 Cephalic Index The Cephalic Index unitless formula is BPD OFD x 100 The CI BPD OFD values for a normal human are 75 9 81 0 EnVisor Series User s Guide 306 M2540 30000 ug 02 Bezjian Alex A Normal and Abnormal Fetal Growth presented at the Advanced Ultrasound Seminar Lake Buena Vista Florida January 1982 Dorland Illustrated Medical Dictionary 27th ed Philadelphia W B Sanders Co 1988 p 830 Hadlock et al Estimating Fetal Age Effects on Head Shape on BPD American Journal of Roentgenology 1981 137 83 85 Circumference NA Lyit Y liii 1 where L j is the line segment length between point i and point j and where N is the total number of points in the enclosed shape Note The points on the circumference are assumed to be traced sufficiently close so that th
19. Panasonic MD 835 VCR You can also use the following plain papers printer with your system HP LaserJet 1200 model number C7044A HP LaserJet 1300 model number Q13344A HP Deskjet 5550 model number C6487C HP Deskjet 940c model number C6431A You can also use other VCRs and analog video input printers with your system To use another VCR you must purchase the External Video VCR Ready option Notes Philips does not recommend the use of video input printers The printers recom mended above provide superior results e To learn how to connect peripherals to your system see the EnVisor Series Get ting Started Guide EnVisor Series User s Guide M2540 30000 ug 02 e The ability to print to a networked DICOM printer is a component of the DICOM Basic option e Philips requires that you use Super VHS SVHS tapes for VCR recordings Printers About Printers You can purchase the following optional printers to use with your system Sony Digital Graphic Printer UP D895MD black and white printer Sony Digital Color Printer UP D21MD You can also use the following plain paper printers with your system HP LaserJet 1200 model number C7044A HP LaserJet 1300 model number Q13344A HP Deskjet 5550 model number C6487C HP Deskjet 940c model number C6431A Notes You must assign a Record key to a printer or a VCR before you can use it Philips does not recommend the use of video input printers
20. Press the Label key Use the trackball to position the cursor over the label or the arrow Press the Enter key Press the Del key above the Label key Note If you do not select a label or an arrow pressing the Del key erases all labels and arrows Using Label Soft Keys To change any of the settings listed below press the oval key below the soft key label Arrow Use the Arrow soft key to place an arrow on the imaging screen EnVisor Series User s Guide 137 M2540 30000 ug 02 138 Home Use the Home soft key to move the cursor to the default position Long Trans Use the Long Trans soft key to place the word Long or Trans at the cur rent cursor position If one of these words appears in the label the Long Trans soft key changes that word to the other word Long or Trans Lt Mid Rt Use the Lt Mid Rt soft key to place the word Lt Mid or Rt at the current cursor position If one of these words appears in the selected label the Lt Mid Rt soft key changes that word to another word in the list Lt Mid or Rt Set Home Use the Set Home soft key to make the current position of the cursor the default position Modifying a Label Menu You can modify the menu of labels available for the current preset You can add delete and change the order of labels To modify a label menu 1 Press the Setup key The Setup window opens 2 Click the Label tab The Label window opens 3 Add delete or rearrange th
21. 5 6 Press the Setup key The Setup window opens Click the Mode tab The Mode window opens For PW Doppler specify an Optimum cursor angle setting The choices are 0 50 55 60 and 65 degrees Specify the Doppler scale units Your options are m s kHz and cm s Note If you choose m s or cm s the spectrum is measured as a velocity If you choose kHz the spectrum is measured as a frequency Click Apply Click Close About the Scrolling of the Spectral Trace You can control whether the spectral trace is scrolling or nonscrolling Scrolling trace While the trace is live it moves from right to left with new data appearing at the right margin Nonscrolling trace An erase bar slides from left to right across the trace with new data appearing just to the left of the erase bar Controlling the Scrolling of the Spectral Trace To control the spectral trace IL 2 Press the Setup key The Setup window opens Click the Mode tab The Mode window opens 78 EnVisor Series User s Guide M2540 30000 ug 02 3 Fora scrolling trace select the Scrolling Trace check box For a nonscrolling trace clear the Scrolling Trace check box 4 Click OK About the Spectral Trace Format You can specify the format of the Doppler display which is how the spectral trace and the 2D reference image appear on the imaging screen You have four options Small over large The small 2D reference imag
22. Operator Variability A skilled sonographer can reduce the largest potential component of measurement variability namely operator variability With training and experience a sonographer learns how to acquire the best view and image quality for each type of measurement Identification of anatomical structures and correct consistent cursor placement are needed Screen Pixel Resolution The ultrasound screen is composed of an array of roughly square picture elements known as pixels The measurement pixel resolution error is assumed to be 1 pixel The pixel error is significant for small dimensions Using Zoom minimizes pixel reso lution error which is 0 23 or better of the full scale screen EnVisor Series User s Guide M2540 30000 ug 02 Speed of Sound Ultrasound imaging algorithms assume that the speed of sound in tissues is 1540 M sec However the speed of sound varies for different tissues Within soft tissues the error is typically within 2 of the speed of sound but may be as high as 5 particu larly if fatty tissue is present in the measurement area Sphygmomanometer Error Some pressure calculations require manual entry of blood pressure The system assumes that the pressures you enter are perfect However sphygmomanometer errors are typically 5 10 mmHg Sweep Speed Time measurement errors are larger when slower display sweep speeds are used Labeled Measurements About Labeled Measurements You choos
23. Press the MMode key again or press the Enter key e If you are in a cardiac preset move the 2D reference line to the anatomy of inter est with the trackball Press the MMode key The MMode trace appears with the 2D reference image This is MMode Trace 2 To change the travel speed of the scrolling trace use the Sweep soft key 3 change the appearance of your image use the soft keys 4 To review the MMode trace press the Freeze key and use the trackball to scroll forward or backward 5 exit press the MMode key or press the 2D key Using MMode Soft Keys To change any of the settings listed below press the oval key below the soft key label Colorize Use the Colorize soft key to assign a colorization map that replaces the gray scale map to improve contrast resolution The choices are Sepia Rainbow Thallium and Wheat In MMode and Doppler Mode the Colorize soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted Compress Use the Compress soft key to adjust the compression of returning echos which affects the grayscale display Increasing Compress softens the image Decreasing Compress produces a high contrast image The compression setting appears on the right side of the imaging screen Focal Zones Use the Focal Zones soft key to add focal zones Focal zones are the areas where the image is most cl
24. Small Parts Vascular Application Package Option General Imaging Vascular Cardiac Cardiac General Imaging OB GYN General Imaging General Imaging Vascular Selecting a Preset Before you begin an exam check to see if the correct preset is active If it is not select the appropriate preset To select a preset 1 Press the Preset key A menu appears with the current exam type at the top and all of the presets for that exam type listed below Presets that you created appear above default presets 2 Do one of the following To choose one of the presets of the current exam type highlight the preset with the trackball and press the Enter key or the Select key Or 3 To choose a preset of another exam type click the exam type at the top of the menu A list of exam types appears 30 EnVisor Series User s Guide M2540 30000 ug 02 4 Click the appropriate exam type 5 Click the preset Creating a Preset You can create a new preset based on a default preset or on a preset that you created previously To create a preset 1 Select a preset that you want to use as a starting point for your preset Modify any settings that you want to change for your preset Press the Preset key 2 3 4 Press the Save Preset soft key 5 Click Create New 6 Type the name of the preset you want to create 7 Click Save Note You can also create a new preset in the Setup
25. The printers recom mended above provide superior results learn how to connect peripherals to your system see the EnVisor Series Get ting Started Guide e You can print the images in a study to a networked DICOM printer if you have the DICOM Basic option and if a DICOM print server SCP has been properly configured e You cannot assign a Record key to DICOM printer Warning If you plug a plain paper printer into a power source other than the system power supply you must use a medical grade isolation transformer to insure patient safety EnVisor Series User s Guide M2540 30000 ug 02 277 278 Changing Settings for an Attached Printer To change the paper size page orientation or copy count for a printer that is attached to your system 1 Press the Setup key The Setup window opens 2 Click the Peripherals tab The Peripherals window opens 3 Click the name of the printer 4 Click the name of the printer again to highlight it 5 Press the Select key 6 Specify settings for the paper size page orientation and copy count 7 Click OK 8 Click Apply 9 Click Close VCRs About VCRs You can purchase the optional Panasonic MD 835 VCR to use with your system You can also use other VCRs with your system To use other VCRs you must pur chase the External Video VCR Ready option Notes To learn how to connect peripherals to your system see the EnVisor Series Get ting Started Guide
26. Time Type Performed By or Referring Physician Use the trackball to move the icon over the patient study that you want to open and do one of the following Quickly press the Enter key twice Press the Enter key and click Open Study Press the Select key use the trackball to highlight Open and press the Enter key Searching for a Patient Folder A patient folder contains all of the patient studies for one patient To search for a patient folder 1 Press the Review key to enter Image Review Click ay The Search for Patient Folder window opens Do one of the following To search type the last name or MRN in the Search for field and choose Last Name or MRN from the drop down menu To list all of the patient folders saved on your system type an asterisk EnVisor Series User s Guide M2540 30000 ug 02 Click Search Now Click a column header to sort by MRN or Patient Name Move the trackball over the patient folder you want to open and do one of the following Press the Enter key and click Open Folder Press the Select key use the trackball to highlight Open and press the Enter key The studies in the folder are listed 7 Move the trackball over the study you want to open and do one of the following Press the Enter key and click Open Study Press the Select key highlight Open Folder with the trackball and press the Enter key Moving a Patient Study To move a patient study to anothe
27. click Clear filter 4 Do one of the following e Click the name of the patient and click OK or press the Patient key The Patient Identification window opens and is populated with the patient s demographic information e Ifthe patient s name does not appear in the Patient Selection window click Man ual Entry A blank Patient Identification window opens Notes EnVisor Series User s Guide M2540 30000 ug 02 If you click Manual Entry the HIS will not be updated when the exam is com plete and the patient s billing information will need to be updated manually Before you use Modality Worklist you must specify the Modality Worklist server Modality Worklist is a component of the DICOM Advanced option Setting Up Modality Worklist If you set up Modality Worklist a list of scheduled patients appears when you press the Patient key If you select an MPPS server the list of scheduled patients will be updated when you complete a study To set up Modality Worklist 1 8 9 Press the Setup key The Setup window opens Click the System tab The System window opens Click DICOM The DICOM Setup window opens Click the Servers amp Roles tab The Servers amp Roles window opens In the Roles area click Modify Select the Modality Worklist server from the MWL SCP drop down menu Select the Modality Performed Procedure Step server from the MPPS SCP drop down menu Note If you do not select an MPP
28. dot like texture Spectral Invert Use the Spectral Invert soft key to invert the spectral display so that positive values representing blood movement toward the transducer are shown beneath the Doppler baseline and negative values representing blood movement away from the transducer are shown above Spectral Invert also swaps the stereo audio channels Spectral Invert is only available when the spectral trace is live Steer Use the Steer soft key to specify the PW cursor line angle for linear transducers e When Left or Right is selected the PW sample gate position is restricted to a sub set of the full image area determined by the PW cursor line angle When Center is selected the PW cursor line runs vertically through the Doppler gate e When Auto is selected Intelligent Doppler is on This automatically moves the PW cursor line whenever the angle to flow arrow is moved to maintain an opti mum cursor angle between the angle to flow arrow and the direction of blood flow Sweep Use the Sweep soft key to control the travel speed of the ECG or the auxiliary trace U D Invert Use the U D Invert soft key to reverse the up down orientation of the image A small open circle called a transducer orientation dot appears at the top of a noninverted image An orientation dot appears on the bottom of an inverted image U D Invert is available only in live imaging and is not available with linear or TEE transducers or when a spectral
29. et al Experimental Studies to Define the Geometry of the Flow Convergence Region Echocardiography 1992 Vol 9 No 1 43 50 Utsunomiya T et al Regurgitant volume estimation in patients with mitral regurgitation initial studies using the Color Doppler Proximal isovelocity surface area method Echocardiography 1992 vol 9 No 1 63 74 EnVisor Series User s Guide 342 M2540 30000 ug 02 to Qs Ratio Dey V9 Dy Wy where Dp represents the diameter of the effective flow area of the main pulmonary artery Ds represents the diameter of the effective flow area of the aortic valve Vp represents maximum velocity of the pulmonary flow and Vs represents the maximum velocity of the aortic flow Cloez J L Schmidt et al Determination of Pulmonary to Systemic Blood Flow Ratio in Children By a Simplified Doppler Echocardiographic Method Journal of the American College of Cardiology April 1988 Vol 11 No 4 pp 825 830 RI Resistivity Index The formula for resistivity index RI uzitless given a maximum velocity V nax cm s and minimum velocity V nin cm s for a vessel is RI Vmax Vmin Vmax Burns RN The Physical Principles of Doppler and Spectral Analysis Journal of Clinical Ultrasound November December 1987 Vol 15 No 9 p 586 RV Sys Press 2 TR D RApress Stevenson J G Comparison of Several Noninvasive Methods for Estimation of Pulmonary Artery Pressure Journal
30. press the Freeze key to freeze both images Press the Freeze key again to unfreeze the active frozen image which is labeled with an open circle When a 3D movie is playing in 3D Mode press the Freeze key to stop the movie Fusion Press the Fusion key to cycle through fusion frequency settings available for the selected transducer and the mode Fusion settings apply to 2D Mode and Tissue Har EnVisor Series User s Guide 13 M2540 30000 ug 02 14 monic Imaging The icon on the lower left corner of the imaging screen summarizes information about the fusion setting Help Press the Help key at any time to open or close the EnVisor series online Help Keyboard Use the keyboard to type information into fields and to type labels titles and Quick Text onto the imaging screen To type a character that appears on the bottom right corner of a keyboard key press the World key labeled with a globe and the keyboard key at the same time To type a character that appears on the top right corner of a keyboard key press the World key the shift key and the keyboard key at the same time Label Press the Label key to display the Label soft keys and choose a label to place on the imaging screen In 3D Mode or Panoramic Imaging press the Label key to display the Title soft key which allows you to place a title above the image Left In live imaging press the Left key to enter Dual Imaging The live image is on the left and th
31. use the Compress soft key to adjust the compression of returning echos which affects the grayscale display Increasing Com press softens the image Decreasing Compress produces a high contrast image In CW or PW Spectral Doppler use the Compress soft key to adjust the dynamic range or compression of the Doppler signals that appear Higher compression makes the trace look softer lower compression gives the trace more contrast Delay Use the Delay soft key to specify the delay in milliseconds from the time the R wave occurs until the reference image is updated It is available only when an ECG trace appears on the imaging screen and the spectral trace is live It is not available in Duplex or Triplex or with a nonimaging transducer If you do not want the reference image to be updated press the up arrow on the Delay soft key repeatedly and choose the 2D Hold On setting EnVisor Series User s Guide 73 M2540 30000 ug 02 74 Filter Use the Filter soft key to remove audible signals and Doppler displays of fre quencies below the selected level Filter is only available when the spectral trace is live Focal Zones Use the Focal Zones soft key to add focal zones Focal zones are the areas where the image is most clearly focused If you have an EnVisor HD or EnVisor C HD you can choose up to eight focal zones depending on the current imaging depth and the transducer you are using Otherwise you can choose up to four focal zones
32. you are using Trapezoidal Imaging you can choose no more than four focal zones Using multiple focal zones decreases the frame rate EnVisor Series User s Guide 8 M2540 30000 ug 02 82 Each time you press the Focal Zones soft key you increase the number of focal zones or the space between them When you reach the maximum number of focal zones pressing the Focal Zones soft key gives you one focal zone The Focal Zones soft key is not available with sector transducers In Zoom pressing the up arrow on the Focal Zones soft key adds focal zones it does not increase the space between focal zones L R Invert Use the L R Invert soft key to reverse the left right orientation of the image If you are in a noncardiac preset a small open circle called a transducer orien tation dot appears in the upper left corner of a noninverted image A transducer orien tation dot appears on the right of an inverted image In cardiac presets the location of the transducer orientation dot is reversed L R Invert is only available in live imaging and is not available when a spectral trace is live Map Use the Map soft key to specify the postprocessing grayscale map In MMode and Doppler modes the Map soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted Map is not available when a spectral trace is live Patient Temp Use the Patient T
33. 129 M2540 30000 ug 02 130 scroll through the image loop press the Select key until Image is highlighted on the bottom right corner of the imaging screen scroll through the trace press the Select key until Trace is highlighted on the bottom right corner of the imaging screen 4 Move the trackball to the right or the left to scroll forward or backward frame by frame 5 Optional To save the frame to the patient study press the Acquire key 6 return to live imaging press the Freeze key again Using Quick Review Soft Keys When you are in Quick Review other soft keys appear depending on the mode If you are in MMode PW Doppler or CW Doppler the soft keys apply to the image when Image is highlighted on the bottom right corner of the imaging screen The soft keys apply to the trace or the spectrum when Trace is highlighted To change any of the settings listed below press the oval key below the soft key label Edit End Use the Edit End soft key to reposition the end of a Quick Review loop Edit End is not available in PW Doppler CW Doppler or MMode Edit Start Use the Edit Start soft key to reposition the beginning of a Quick Review loop Edit End is not available in PW Doppler CW Doppler or MMode Playing Back a Quick Review Loop You can repeatedly play back a Quick Review loop if you are in 2D Mode Color Power Angio or Color Mode 1 While in live imaging press the Freeze key T
34. 132 Color Power Angio 2501 2 vu aC ated o eiu dec d ute et 133 Annotations suo s trout Reunion optat hig gears tng Gn ink a Lewd quu ote dede 135 About Anhotationna pee bs baba vere d doe eese tA p babe dg 135 135 EnVisor Series User s Guide XH M2540 30000 ug 02 Labels ss nan Statut teow hit A Pak pune 135 About Labels cou Ge urs ereptus e 135 Placing a Label on the Imaging 135 Typing Label the Imaging 136 Modifyinga Label 136 Placing an Arrow on the Imaging 136 Moving or Deleting a Label or an 137 Using Label Soft Keys usos 54 Scd Ma 137 Modifying a Label Nen ote oes Leo o Ate od 138 Body Em 138 About Body Markets 205 tend eae Ao eut erede tue tee wes 138 Placing a Body Marker on the Imaging 139 Choosing Body Marker v Ex EU Ee TU VE thee EN NES 139 Moving a Body Marker or the Transducer 139 Rotating or Specifying the Shape of the Transducer 140 Using Body Marker Soft Keys eU cue wu sus ee a oe we eee eke 140 Using Body Markers and Dual Imaging at the Same Time
35. 200 consecutive loops one per heart cycle are acquired A memory gauge appears on the top left corner of the imaging screen It shows how many loops of the possible 200 have been acquired When you have acquired enough loops for the first view press the Enter key to begin acquiring loops for the second view Alternatively you can press the View soft key to begin acquiring loops for a differ ent view Note If you do not press the Enter key or the View soft key all loops will be labeled with the same view You can relabel these loops after the multi cycle acqui sition ends To pause the acquisition at any time press the Acquire key again To resume the acquisition press the Acquire key again EnVisor Series User s Guide M2540 30000 ug 02 4 When all of the views are acquired press the Acquire key to pause the acquisition and then press the End Acquire soft key to view the loops in Image Review Acquiring Images Outside of a Stress Echo Protocol You can temporarily leave the Stress Echo protocol so that you can acquire additional loops or frames such as images in Color Mode or PW Doppler outside of the Stress Echo protocol To acquire images outside of the stress echo protocol 1 To pause the protocol press the Pause Protocol soft key 2 Acquire images in any mode 3 To return to the Stress Echo protocol press the 2D key and then press the Stress Echo option key The Stress Echo soft keys appear 4 Press
36. A small open circle called a transducer orientation dot appears at the top of a noninverted image An orientation dot appears on the bottom of an inverted image U D Invert is available only in live imaging and is not available with linear or TEE transducers or when a spectral trace is live Update Use the Update soft key to specify how often in 500 millisecond increments from 500 to 7000 milliseconds the reference image is updated Update is available only when no ECG trace appears on the imaging screen and the spectral trace is live It is not available in Duplex or Triplex or with a nonimaging transducer If you do not want the reference image to be updated press the up arrow on the Update soft key repeatedly and choose the 2D Hold On setting Note If you are in Color CW Doppler or Color Power Angio CW Doppler the soft keys available to you depend on the term that is highlighted on the bottom right cor ner of the imaging screen e CW Doppler soft keys appear when Line is highlighted e Color Mode soft keys or Color Power Angio soft keys appear when Size or Posi tion is highlighted About Nonimaging CW Doppler If you are using a nonimaging transducer that supports CW Doppler you are auto matically in CW Spectral Doppler You do not need to press the CW key When you use a nonimaging transducer no reference image appears Note The Spectral key is inactive when you are using a nonimaging transducer Duplex and Triplex About
37. American Journal of Cardiology 1985 Vol 56 pp 989 993 Maximum Pressure Gradient Mitral Regurgitation 4 MRmax vel C 10 7 Stamm Brad et al Quantification of Pressure Gradients Across Stenotic Valves by Doppler Ultrasound Journal of the American College of Cardiology 1983 Vol 2 No 4 pp 707 718 Maximum Pressure Gradient Mitral Valve 4 MVpeak vel L 100 Yoganathan Ajit P et al Review of Hydrodynamic Principles for the Cardiologist Applications to the Study of Blood Flow and Jets by Imaging Techniques Journal of the American College of Cardiology 1988 Vol 12 pp 1344 1353 EnVisor Series User s Guide M2540 30000 ug 02 357 Maximum Pressure Gradient Pulmonary Insufficiency max vef 00 Masuyama et al Continuous wave Doppler Echocardiographic Detection of Pulmonary Regurgitation and Its Application to Noninvasive Estimation of Pulmonary Artery Pressure Circulation 1986 Vol 74 No 3 484 492 Maximum Pressure Gradient Pulmonic Valve Simplified Bernoulli PAV2 2 A 100 7 Yoganathan Ajit P et al Review of Hydrodynamic Principles for the Cardiologist Applications to the Study of Blood Flow and Jets by Imaging Techniques Journal of the American College of Cardiology 1988 Vol 12 pp 1344 1353 Mean Pressure Gradient Full Bernoulli AoV2 trace LV V1 trace Yoganathan Ajit P et al Review of Hydrodynamic Principles for
38. Calculations All vascular calculations are listed in the following tables which appear in alphabetical order See Appendix A for the formula inherent approximations and assumptions and clinical references for each calculation 214 EnVisor Series User s Guide M2540 30000 ug 02 Stenosis Calculations Label Area Sten Meaning Percent area stenosis Percent diameter stenosis Diam Sten Stenosis 1 Diameter velocity ratio Ratio A to B Ratio Carotid Calculations Label ICA CCA Diastolic CA CCA Ratio Diastolic ratio Internal carotid artery diastolic velocity to common carotid artery diastolic velocity ratio ICA CCA Systolic ICA to CCA Ratio Systolic ratio Internal carotid artery systolic velocity to common carotid artery systolic velocity ratio Meaning EnVisor Series User s Guide 21 5 M2540 30000 ug 02 Flow Volume Calculation Diameter via diameter Resistivity Index and Pulsatility Index Calculations Label Formula Formula Type CCA RI fs Resistivity index CCA PI Fo Pulsatility index using time averaged mean of the peaks ECA RI Resistivity index ECA PI ef Pulsatility index using time averaged mean of the peaks ICA RI Resistivity index ICA Fo Pulsatility index using time averaged mean of the peaks SCA RI Resistivity index SCA
39. Display In Thumbnails you can view all of the images in the order they were acquired all of the images of the same view or all of the images in a stage To specify the type of dis play use the trackball to select Display Stages Display Views or Show Sequence from the Stress Display drop down menu EnVisor Series User s Guide M2540 30000 ug 02 269 270 Selecting the Preferred Stress Echo Loop After you acquire Stress Echo loops they appear in Image Review which is where you select the preferred loop The default preferred loop is indicated with a check mark in the lower left corner of the image To choose another loop to be the preferred loop select the check box in the lower left corner of the image All of the loops are still saved except any loops you marked for deletion You may change the preferred loop at a later time The preferred loop is the loop that you see when you are in the View Stages Stress Dis play in Thumbnails Note When you export a Stress Echo study only the preferred loops are exported Relabeling Views You can change the name of the view associated with a loop To relabel a Stress Echo view do one of the following while in Stress Echo review 1 Use the trackball to move the cursor over the loop 2 Press the Select key 3 Use the trackball to highlight Relabel Views 4 Use the trackball to highlight the correct view name 5 Press the Enter key Or 1 Use the trackball to move the
40. Duplex and Triplex Duplex enables you to simultaneously display a live 2D image and a PW Doppler spectral trace Triplex enables you to simultaneously display a live 2D image with color or angio and a PW Doppler trace Notes EnVisor Series User s Guide 83 M2540 30000 ug 02 84 Duplex and Triplex only available with transducers that support PW Doppler Duplex and Triplex are not available with cardiac presets Being in Duplex and Triplex limits the Doppler pulse repetition frequency which limits the maximum velocity of blood flow that can be measured without aliasing When you are in Duplex or Triplex the displayed velocity scale may automatically be reduced Using Duplex Duplex enables you to simultaneously display a live 2D image and a PW Doppler spectral trace To use Duplex 1 2 While in 2D Mode CW Doppler or PW Doppler press the Plex key Do one of the following To exit Duplex but remain in spectral Doppler press the Plex key again To exit spectral Doppler press the key for any imaging mode Note If you are in Duplex and you press the Color or Angio key you enter Triplex Using Triplex Triplex enables you to simultaneously display a live 2D image with color or angio and a PW Doppler trace To use Triplex 1 2 3 While in CW Doppler or PW Doppler press the Color or Angio key Press the Plex key Do one of the following To exit Triplex but remain in spectral Dopp
41. ERG 273 Tionsd cets Cea ee E wa ouch CA QUAE A Rte Ae 273 About S ed diu eee ee aia DAE 273 Ir a RE 274 ace dom online ele o rA i 274 Browsing a Floppy Disk an Optical Disk ora 274 Clearing a Floppy Disk or an Optical Disk 275 Formatting a Floppy Disk or an Optical 275 li eir PD MEE 276 Penphlerals e aso N e EIN EP e Le b vau IA ROSEO Edd 276 About Peripherals is Sede e urea eR RN Nux E 276 EnVisor Series User s Guide ii M2540 30000 ug 02 XV Printeris dcs elut ELS nan Da uw eC GS ell teh Parii 277 NOIRS aiea a a E he a dae ee a e R 278 Foot Switcher a a 280 About the Poot Switehy 259224395 any EX aes ae eee Ge c EE aes 280 Configuring the Foot Switch i ite cuoi e ERR de XA es 281 Supplies and 281 About Supplies and Accessories css ore ERR he ETIN S e 281 Cablesand Power Cords ps cuotas eie e e p eed E e UE es 282 Miscellaneous ue cca Atrei 282 Physio Supplies e Sends yet 283 Printer Supplies and
42. If you are using Trapezoidal Imaging you can choose no more than four focal zones Using multiple focal zones decreases the frame rate Each time you press the Focal Zones soft key you increase the number of focal zones or the space between them When you reach the maximum number of focal zones pressing the Focal Zones soft key gives you one focal zone The Focal Zones soft key is not available with sector transducers In Zoom pressing the up arrow on the Focal Zones soft key adds focal zones it does not increase the space between focal zones Frequency Use the Frequency soft key to specify the transducer frequency used for color angio or Doppler data The Frequency soft key is available only for transducers with multiple flow or Doppler frequencies The Adaptive Flow setting is available for some transducers if you have an EnVisor HD or an EnVisor C HD Adaptive Flow changes the flow frequency to an optimal frequency for that transducer for the selected focal zone Adaptive Flow is only avail able in Color Mode and Color Power Angio In PW Doppler the Frequency soft key is only available when the spectral trace is live Gate Use the Gate soft key to adjust the width of the PW sample volume gate L R Invert Use the L R Invert soft key to reverse the left right orientation of the image If you are in a noncardiac preset a small open circle called a transducer orien tation dot appears in the upper left corner of a noninverted ima
43. Image is highlighted Compress In CW or PW Doppler Preview use the Compress soft key to adjust the compression of returning echos which affects the grayscale display Increasing Com press softens the image Decreasing Compress produces a high contrast image In CW or PW Spectral Doppler use the Compress soft key to adjust the dynamic range or compression of the Doppler signals that appear Higher compression makes the trace look softer lower compression gives the trace more contrast Delay Use the Delay soft key to specify the delay in milliseconds from the time the R wave occurs until the reference image is updated It is available only when an ECG trace appears on the imaging screen and the spectral trace is live It is not available in Duplex or Triplex or with a nonimaging transducer If you do not want the reference image to be updated press the up arrow on the Delay soft key repeatedly and choose the 2D Hold On setting Filter Use the Filter soft key to remove audible signals and Doppler displays of fre quencies below the selected level Filter is only available when the spectral trace is live Focal Zones Use the Focal Zones soft key to add focal zones Focal zones are the areas where the image is most clearly focused If you have an EnVisor HD or EnVisor C HD you can choose up to eight focal zones depending on the current imaging depth and the transducer you are using Otherwise you can choose up to four focal zones If
44. MMode MMode Cardiac Cardiac output Cardiac output Output MMode MMode CO Cardiac Cardiac output Cardiac output Output MMode MMode CO Cardiac Cardiac output Cardiac output Output MMode MMode CO Cardiac Cardiac output Cardiac output Output MMode MMode CO Cardiac Cardiac output Cardiac output Output MMode MMode CO Cardiac Cardiac output Cardiac output Output MMode MMode CO Cardiac Cardiac output Cardiac output Output MMode MMode EDV Cardiac output Cardiac output MMode EF Ejection EF Fraction EnVisor Series User s Guide M2540 30000 ug 02 Ejection fraction 213 EF Teich Ejection fraction EF Ejection EF Fraction Ev Volume eeg ome ome LA to Ratio LVmass C d LVmass C d Mass Left ventricular mass via the cubic formula at end diastole LVmass C dl LVmass C dl Mass index Left ventricular mass via the cubic formula at end diastole indexed by body surface area MMAR MMAR GCE RVSP TR RV Sys Press Pressure Right ventricular systolic pressure via TR SV bp el Stroke Volume 2D Stroke volume Stroke volume 2D SV Cubed Stroke Volume 2D Stroke volume Stroke volume 2D SV Teich Stroke Volume 2D Stroke volume Stroke volume 2D dimension to pec root ratio Vascular
45. Mitral flow PI PI 2t PI max vel PA dec slope Pulmonic flow TV PI 2t PI 2t max v TV dec slope Tricuspid flow PI 2t Decel slope Other flow Note Position the crosshair along the deceleration slope as far away as possible from the peak velocity point for the most accurate calculation Hate L et al Non invasive Assessment of Atrioventricular Pressure Halftime by Doppler Ultrasound Circulation 1979 Vol 60 pp 1096 1104 EnVisor Series User s Guide 341 M2540 30000 ug 02 Proximal Isovelocity Surface Area PISA MR ERO Mitral valve effective regurgitant orifice area cm2 MR flow rate MR max vel MR flow rate Mitral valve regurgitation flow rate cm3 sec MR PISA x MR alias vel MR PISA Mitral valve regurgitation proximal isovolumic surface area cm2 2x x MR PISA radius MR RF Mitral valve regurgitant fraction 76 volume x 100 MR volume Mitral valve regurgitant volume ml MRERO x MR VTI Enriquez Sarano M Effective Regurgitant Orifice Area A Noninvasive Doppler Development of an Old Hemodynamic Concept Journal of the American College of Cardiology 1994 Vol 23 No 2 443 51 Gardin J Doppler Color Flow Proximal Isovelocity Surface Area PISA An Alternative Method of Estimating Volume Flow Across Narrowed Orifices Regurgitant valves and Intracardiac Shunt Lesions Echocardiography 1992 Vol 9 No 1 39 41 Shandas R
46. Preview press the Spectral key to display the CW or the PW Doppler spectral trace respectively Otherwise press the Spectral key to display the PW Doppler spectral trace When a Doppler spectral trace is displayed press the Spectral key to choose whether the spectral trace or the image is live The soft keys change depending on which ele ment is live and they affect the element that is live EnVisor Series User s Guide M2540 30000 ug 02 TGCs Move the TGC Time Gain Compensation slide controls to the right or left to adjust the amplification of the returning 2D signals at a specific image depth The topmost TGC slide control controls the amplification at the face of the transducer For linear and curved linear transducers align the TGC slide controls in the middle and make minor adjustments as necessary For sector transducers in cardiac presets align the TGC slide controls in a diagonal line from the top left to the bottom right THI Press the THI key to select Tissue Harmonic Imaging Press it again to return to 2D Mode The icon on the lower left corner of the imaging screen indicates the mode and the fusion setting Trackball Use the trackball to move and resize objects on the imaging screen The possible func tions of the trackball for the current mode transducer and preset are listed on the bottom right corner of the imaging screen The active trackball function is high lighted and its associated imaging s
47. When making small length measurements use the maximum permissible display magnification for the most accurate calculations LVLd diff LVLd diff is the MOD long axis at end diastole length percentage difference between apical 4 and apical 2 views 100 max LVAd ap2 MOD LVAdap4 MOD min LVAdap2 LVAda max LVAd ap2 MOD LVAd ap4 MOD MOD Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 pp 358 367 LVLs diff LVLs 96 diff is the MOD long axis length at end systole percentage difference between apical 4 and apical 2 views 100 max LVAsap2 MOD LVAsap4 MOD min LVAsap2 LVAsa max LVAs ap2 MOD LVAsap4 MOD i MOD Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 pp 358 367 EnVisor Series User s Guide 334 M2540 30000 ug 02 LVmass AL d 5 5 TS where A represents LVAd sax epi the LV epicardial SAX area at the level of the papillary muscle tips at end diastole A represents LVAd sax PM the LV endocardial SAX cavity area at the level of the papillary muscle tips at end diastole L represents LVLd apical the LV long axis length at end diastole via apical four chamber or two chamber views
48. a label 3 Type the label 4 Optional You can move edit or delete the label EnVisor Series User s Guide M2540 30000 ug 02 To move a label use the trackball to move the cursor over the label press the Enter key and move the label with the trackball Press the Enter key again to reposition the label To edit a label use the trackball to move the cursor over the label until the cursor starts to blink Use the backspace key to remove characters Then type new char acters To delete a label use the trackball to move the cursor over the label Press the Del key If you press the Del key without moving the cursor over a label all labels are deleted 5 When you are finished press the Label key again Magnifying a Panoramic Image To enlarge or reduce the size of the panoramic image press the up or the down arrow on the Depth key or perform this procedure 1 If the cursor appears on the imaging screen press the Enter key to remove the cur sor from the imaging screen If Pan and Rotate appear on the bottom right corner of the imaging screen press the Zoom key Zoom is highlighted on the bottom right corner of the imaging screen To enlarge the image move the trackball up or to the right To reduce the size of the image move the trackball down or to the left Moving a Panoramic Image Around the Imaging Screen To move the panoramic image around the imaging screen 1 If the cursor appears on
49. about color flow along the entire MMode reference line appears in the MMode trace Optional To change the travel speed of the scrolling trace use the Sweep soft key EnVisor Series User s Guide M2540 30000 ug 02 4 Optional To change the appearance of your image use the soft keys 5 Optional To review the MMode trace press the Freeze key and use the trackball to scroll forward or backward 6 exit press the MMode key or the 2D key Note If you want you can press the MMode key before pressing the Color key Using Color MMode Soft Keys The soft keys available to you depend on the term that is highlighted on the bottom right corner of the imaging screen e MMode soft keys appear when Line is highlighted e Color Mode soft keys appear when Size or Position is highlighted MMode Zoom About MMode Zoom When you are in MMode you can magnify a portion of the reference image by enter ing MMode Zoom In MMode Zoom the MMode trace represents only the information in the zoom box Using MMode Zoom To use MMode Zoom press the MMode key twice and the Zoom key twice You can press these keys in any order The first time you press the MMode key you enter MMode Preview Move the MMode reference line to the anatomy of interest with the trackball The second time you press the MMode key the MMode trace appears with the reference image Note If you are in a cardiac preset the MMode trace appears
50. all of the studies for one patient Patient Study A patient study includes demographic infor mation images quantitative values and a summary of findings Penetration Penetration is a fusion setting that is used to achieve image information at deeper depths The Penetration setting can be helpful in scanning patients with larger body habitus Preset A preset is a group of settings that optimizes the system for a specific type of exam Pre sets establish many initial settings such as gain value color map filter and items on the Label and Measurement menus Pulse Inversion Pulse Inversion settings are Tissue Har monic Imaging settings available only with the EnVisor HD series PW Sample Volume Gate The PW sample volume gate is the area in which the velocity is measured in PW Dop pler The information is displayed in the PW spectral trace Quad Cycle Acquisition In Stress Echocardiography quad cycle acquisition stage four consecutive loops one per heart cycle are acquired and saved to the study EnVisor Series User s Guide 296 M2540 30000 ug 02 Quick Review allows you to interrupt live Quick Review imaging and scroll through a loop scroll through a trace or cause a loop to play back You can place a Quick Text label on the imaging screen anytime Simply position Quick Text the cursor with the four arrow keys and start typing The report w
51. and click the following icon es The study is saved on your system EnVisor Series User s Guide M2540 30000 ug 02 Before the study is closed you are asked whether not you want to save your changes Note study takes several seconds to close e When you create or open a patient study the active study is closed before the new study is opened Image Review About Image Review At any point you can press the Review key to review all of the images you acquired In Image Review you can view frames and loops delete frames and loops from the patient study edit loops and close the study You can also edit Stress Echo loops spec ify the preferred Stress Echo loop and relabel Stress Echo views in Image Review Entering Image Review You enter Image Review when you take one of the following actions e You press the Review key e You press the Acquire key if you clicked the Switch to Thumbnails after acquire completes check box in the Acquisition setup window e You acquire all of the loops for a view or a stage in a Stress Echo study Using the Select Key in Image Review In Image Review press the Select key at any time to view the options that are cur rently available to you To choose an option highlight the option with the trackball and press the Enter key About Thumbnails In Image Review you can view images in a grid format called Thumbnail To return to Thumbnails when you are viewing a full
52. apical cm Area Left ventricular short axis area at epicardium at end diastole cm Area Left ventricular short axis area at mitral valve level at end diastole cm Area Left ventricular short axis area at papillary muscle level at end diastole 168 EnVisor Series User s Guide M2540 30000 ug 02 LVAs 2 LVAs 4 LVAs apical LVAs sax MV LVAs sax PM LVIDd LVIDs LVLd apical LVLs apical LVOT diam o m Area Left ventricular long axis area at end systole apical two chamber cm Area Left ventricular long axis area at end systole apical four chamber Area Left ventricular area at end systole apical cm Area Left ventricular short axis area at mitral valve level at end systole cm Area Left ventricular short axis area at papillary muscle level at end systole m Height Left ventricular internal diameter at end diastole m Height Left ventricular internal diameter at end systole m Length Left ventricular length at end diastole apical m Length Left ventricular length at end systole apical o o o o o m Length height Left ventricular outflow tract diameter EnVisor Series User s Guide 169 M2540 30000 ug 02 LVPWd cm Height Left ventricular posterior wall dimension at end diastole LVPWs cm Height Left ventricular posterior wall dimension at end systole MM R R int Time MMode or 2D R R interva
53. as it declines from the max velocity Note Position the crosshair along the deceleration slope as far away as possible from the peak velocity point for the most accurate calculation Hatle L et al Non invasive Assessment of Atrioventricular Pressure Halftime by Doppler Ultrasound Circulation Vol 60 1979 pp 1096 1104 MVA P1 2t 220 MVPlt Note Use points as far apart as possible on the deceleration slope and the maximum permissible strip chart speed for the most accurate calculation EnVisor Series User s Guide 339 M2540 30000 ug 02 Goldberg Barry B Kurtz Alfred B Atlas of Ultrasound Measurements Year Book Medical Publishers Inc 1990 p 65 Stamm R Brad et al Quantification of Pressure Gradients Across Stenotic Valves by Doppler Ultrasound Journal of the American College of Cardiology 1983 Vol 2 No 4 pp 707 718 Ovarian Volume Length x Width x Thickness x 0 523 Andolf Ellika et al Ultrasound Measurement of the Ovarian Volume Acta Obstet Gynecol Scand 1987 66 387 389 Area Stenosis The percentage of stenosis 5 96 formula given a true lumen area Ayre cm and the residual lumen area cm is S 100 true residual A true 7 Diagnostic ranges 0 2090 normal 20 60 mild 60 8090 moderate 80 90 severe 90 99 critical 100 occluded Jacobs Norman M et al Duplex Carotid Sonography Criteria for Stenosis Accurac
54. ate nA Sed iia At 55 Abaut Imdene Modes s asi tara aa rdiet utes bl 55 General Imaging Information ser teo Ta yaa edt AE EN EHE 55 About Imaging Modes zer Pere XN NA REA MES 55 Exam ouest cuve ex hers etu EUREN NUR OE EAE 55 Acquiring limage cR da A ocd BOS Beas 55 Setting the Length ofa 1304 x a enters ict Meares 56 Specifying Acquisition 56 Printing in Live Imaging 57 Chancinethe Insc ges eade MU SORE Odd dS 57 DID WISE tients boheme ede a eta ee nee 58 About2D Mode frye eas oie ee ate Pee eS ee tie Pt a et seu 58 Using vero a ai eg alters ERU Ep s EP ER 58 Using 2D Mode Soft Keys iu ir eque dates ques NO RU Pare eoe ad 59 About Euston Settings ooh coy eo ee ee Gee aay ESPERE PUES 61 Resizing and Repositioning an 62 Movinga Reference Lune oe csaka edes a edo as E el pM x 63 Tissue Harmonic ieee sede eee tenes 63 About Tissue Harmonic Imaging 22su9 63 Using l issue Harmonic Imaging cu vo see toe RA RR RIA EE oe te A EE 64 Using Tissue Harmonic Imaging Soft 64 WIM GU wie eae ae ee Sete eae V IE dI EL tt 66 About MMoede besides PENES ME
55. auxiliary trace ECG Invert or Aux Invert Use the ECG Invert or the Aux Invert soft key to invert the displayed ECG or auxiliary input trace ECG Position or Aux Position Use the ECG Position or the Aux Position soft key to move the ECG or auxiliary trace higher or lower on the imaging screen Select ECG or Select Aux Use the Select ECG or the Select Aux soft key to change the Gain the Position and the Invert soft keys from ECG to Aux Sweep Use the Sweep soft key to control the travel speed of the ECG or the auxiliary trace Changing Physio Settings You can choose whether the ECG physio input the auxiliary physio input or the ECG and the auxiliary physio inputs appear on the imaging screen You can also con trol the R wave source and the R wave beep To change physio settings 1 Press the Setup key The Setup window opens 2 Click the Physio tab The Physio window opens 3 Select either the Display ECG check box or the Display Aux check box or both to specify which input or inputs appear on the imaging screen 4 Select the appropriate option buttons to turn the R wave source on or off and to turn the R wave beep on or off EnVisor Series User s Guide 27 M2540 30000 ug 02 5 Click Apply 6 Click Close 28 EnVisor Series User s Guide M2540 30000 ug 02 Customizing Your System Customizing Your System You can customize your system in many ways to make it more useful for you You can create pres
56. characters Then type new characters EnVisor Series User s Guide 99 M2540 30000 ug 02 100 To delete the label use the trackball to move the cursor over the label Press the Del key If you press the Del key without moving the cursor over a label all labels are deleted 5 When you are finished press the Label key Changing 3D Image Display Settings While you are reviewing a 3D image you can change settings that affect the image display Image Filter smooths structures in the 3D image and can enhance the appearance of the 3D image The values are e No 3D Filter Great structural detail e Normal Good compromise between structural detail and a smooth display e Heavy Smooth image artifact and some noise removed Massive Very smooth image Image Length When the Scan Geometry soft key setting is Length Image Length adjusts the length of the 3D image Image Angle When the Scan Geometry soft key setting is Fan Image Angle adjusts the width of the 3D image Making this adjustment reduces distortion Intensity adjusts the brightness of the 3D image Texture uses gradient shading to highlight the surface shape of structures when the value is 0 and texture shading to highlight the gray values and textures in the volume when the value is 100 Choosing an intermediary value uses a combination of gradi ent and texture shading Threshold makes dark areas of the 3D image invisible to separate the object
57. cursor over the view name in the upper left corner of the loop 2 Press the Enter key 3 Use the trackball to highlight the correct view name 4 Press the Enter key Viewing all the Stress Echo Loops for a View If you acquire more than one loop for a view only the preferred loop is visible in Thumbnails when you are in the Show Stages Stress Display EnVisor Series User s Guide M2540 30000 ug 02 click of the preferred image All of the loops you acquired for that view are displayed To view all of the loops you acquired for that view on the lower left corner Playing Back Stress Echo Loops To play back one Stress Echo loop in Thumbnails use the trackball to move the cur sor over the image and do one of the following Press the Enter key twice Press the Enter key and click Play To play back all of the Stress Echo loops for a stage or a view 1 In Thumbnails select Display Stages or Display Views from the Stress Display drop down menu 2 Use the trackball to move the cursor over the first image and do one of the follow ing e Press the Enter key twice Press the Enter key and click Play Performing Wall Motion Scoring After a Stress Echo study you can perform wall motion scoring for each wall segment Graphics showing the wall scores automatically appear in the report Note To enter scores for wall segments you must be in Image Review and you must be in a cardiac preset To perform wall mo
58. drop down menu when you click one image a series of two four six or nine sequential images is automatically selected To play back more than one image when Random is selected from the Image Display drop down menu 1 In Image Review click H 2 Use the trackball to move the cursor over the first image 3 Press the Enter key 4 Repeat steps 2 and 3 for additional images 5 Click Play EnVisor Series User s Guide M2540 30000 ug 02 To play back more than one image when 2 up 4 up 6 up or 9 up is selected from the Image Display drop down list 1 In Image Review click i 2 Use the trackball to move the cursor over the first image 3 Press the Enter key One or more consecutive images are automatically selected For 2 up two images are selected for 4 up four images are selected and so on 4 Click Play To view the previous image click gt gt To view the next image click gt Controlling the Playback of Loops in Image Review While you are playing back a loop or loops in Image Review you can control the loop playback Freezing and Playing a Loop To freeze the playback of a loop click To continue playing back the loop click gt Changing the Playback Speed To change the playback speed use the Loop Speed slide control Note The default playback speed is 100 Selecting a Frame in a Loop To select a frame in a loop To freeze the playback click EnVisor Series Use
59. following Click the Measure button Click the Keyboard button to manually enter a measurement Position the caliper with the trackball Press the Enter key to anchor each caliper and display the next caliper To approve the measurement press the Enter key To see the results box close or move the Perform Measurements window Performing an Unlabeled Measurement in Image Review To perform an unlabeled measurement on an image in Image Review 1 2 a In Image Review click i8 Use the trackball to move the cursor over the image Press the Enter key twice EnVisor Series User s Guide M2540 30000 ug 02 245 If you are viewing a loop click the icon to freeze the loop If necessary use the Frame Select slide control to choose a frame Press the Measure key Use the trackball to highlight the type of measurement and press the Enter key Position the caliper with the trackball oo N A Press the Enter key to anchor each caliper and display the next caliper 10 To approve the measurement do one of the following e Fora linear measurement press the Enter key e Fora trace or volume measurement press the Enter key twice Editing Measurements in Image Review You can edit measurements or calculations on images from studies that you saved on your system but not on images from studies that you imported Note You cannot delete a measurement in Image Review after you approve it You can however
60. grouped with other controls with related functions For instance the Doppler controls are grouped in the lower left corner EnVisor Series User s Guide M2540 30000 ug 02 Using the System Control Panel TGC a Power i Volume r EL 1i L a amm 4 i P 3 992 e 5 c ba oF op a gt ofa NS n m r M M _ M E pum 0 a m LM gt SS 2 lt LJ No 5 28 u c ae E BM e E cam EN M o Fes nm m DN M lt D CT f i a 8 A 2 oa i g 4 LGC on 9 JT Freeze e GAN ELD 2 Gain EnVisor Series User s Guide M2540 30000 ug 02 10 The system control panel contains the following keys rotary controls and slide con trols 2D Press the 2D key to exit the current imaging mode or application and return to 2D Mode The previous 2D Mode settings are restored 2D GAIN Turn the 2D GAIN rotary control to adjust the gain or overall brightness of a 2D or MMode image The 2D GAIN rotary control is located under the 2D key and is labeled GAIN Acquire In live imaging Stress Echocardiography and Quick Revi
61. icon The study is saved on your system EnVisor Series User s Guide M2540 30000 ug 02 Note To save a study to a disk you must export the study by clicking the following icon Restarting a Patient Study To continue or restart a patient study that is saved on your system 1 Press the Patient key 2 Click Restart The Search for Study window opens 3 Do one of the following information you know about the patient such as the or last name and click Search e To list all patient studies saved on your system select All Dates from the Study Date drop down menu and click Search 4 Click a column header to sort by MRN Name Time Type Performed By or Referring Physician 5 Use the trackball to move the icon over the patient study that you want to restart 6 Press the Enter key 7 Click OK The Patient Identification window appears populated with the selected patient s demographic information 8 Click OK Searching for a Patient Study To search for a patient study EnVisor Series User s Guide M2540 30000 ug 02 225 226 Press the Review key to enter Image Review The Search for Study window opens Do one of the following Type information you know about the patient such as the MRN or last name and click Search To list all patient studies select All Dates from the Study Date drop down menu and click Search Click a column header to sort by MRN Patient Name
62. if necessary Adjust the Baseline Doppler Gain and Scale rotary controls if necessary Optional To change the appearance of your image use the soft keys DW C GBS Optional If you re using a linear transducer use the Angle rotary control to steer the angio box 8 To exit press the Angio key or press the 2D key Using Color Power Angio Soft Keys To change any of the settings listed below press the oval key below the soft key label B W Suppress Use the B W Suppress soft key to force the width and position of the 2D image to match the width and position of the color or angio window Reducing the size of the window increases the frame rate B W Suppress is available only with sector and curved linear transducers Density Use the Density soft key to specify the number of color or angio interroga tion lines Use Density in conjunction with the Packet soft key EnVisor Series User s Guide 89 M2540 30000 ug 02 90 Increasing Density decreases the frame rate Decreasing Density increases the frame rate Filter Use the Filter soft key to remove extraneous color information due to tissue motion rather than blood flow Increasing Filter decreases low velocity information and noise Decreasing Filter increases sensitivity to low velocity information Frequency Use the Frequency soft key to specify the transducer frequency used for color angio or Doppler data The Frequency soft key is available only for trans
63. indicates that you will hold the transducer in one place and tilt it from one side to the other Smooth Use the Smooth soft key to soften or sharpen the 2D image Higher settings make the image softer Lower settings make the image sharper Changing the Default 3D Settings To change the default settings for 3D Mode attributes 1 Press the Setup key The Setup window opens 2 Click the 3D tab The 3D window opens 3 Choose default settings for Scan Geometry Scan Direction Scan Length Scan Angle and Region of Interest ROI 4 Click Apply 5 Click Close 3D Image Review About 3D Image Review After you acquire the 3D dataset the 3D image appears on the imaging screen You can then manipulate the 3D image using the system control panel keys and the soft keys To display or hide the cursor in 3D Image Review press the Enter key When the cur sor is hidden the trackball function is highlighted on the bottom right corner of the imaging screen EnVisor Series User s Guide 95 M2540 30000 ug 02 96 The default trackball functions are Orbit and Rotate You can press the Zoom key to change the trackball functions to Zoom and Pan Note If you want to acquire another 3D dataset while you are reviewing a 3D dataset press the Acquire soft key to exit 3D Image Review Using 3D Image Review Soft Keys To change any of the settings listed below press the oval key below the soft key label Archive Use the
64. keys above the system control panel and below the monitor The functions of the soft keys change depending on the mode the application the preset and the transducer The function of each soft key is described above the soft key on the bottom of the imaging screen To use a soft key press the up or the down arrow on the key to choose or change the selection that appears above the key on the imaging screen Next and Previous Soft Keys When more than five soft keys are available the far right soft key becomes the Next soft key To see the second level of soft keys press the Next soft key When the second level of soft keys is displayed the Previous soft key appears Press the Previous soft key to see the primary level of soft keys If You Do Not See a Soft Key That You Need If the soft key that you are looking for does not appear e Press the Next soft key to see if it appears in the second level of soft keys e Press the Select key to change the word that is highlighted on the bottom right corner of the imaging screen In some modes such as Color MMode and Duplex the soft keys change depending on the active function of the trackball EnVisor Series User s Guide M2540 30000 ug 02 Using the Trackball the Enter Key and the Select Key The trackball the Enter key and the Select key work together somewhat like a com puter mouse Moving the trackball is like moving the mouse Pressing the Enter key is like pressing the left but
65. linear transducer use the Angle rotary control to steer the 2D image 6 exit press the key for any other imaging mode Using 2D Mode Soft Keys To change any of the settings listed below press the oval key below the soft key label Biopsy Use the Biopsy soft key to initiate the biopsy feature Biopsy has three set tings e Off Turns the Biopsy feature off e Needle Two guide lines appear that outline the area in which the biopsy needle path is most likely to be Gun One guide line appears that shows the anticipated path of the biopsy nee dle The Biopsy soft key is only available when you are in 2D Mode and a noncardiac pre set and are using a transducer that supports biopsy Warnings See the EnVisor Series Transducer Guide for important information about using biopsy capable transducers Biopsy guide lines are intended as guides only Never use biopsy guide lines as an absolute reference e Biopsy guide lines do not take into account the possible bending of the needle Colorize Use the Colorize soft key to assign a colorization map that replaces the gray scale map to improve contrast resolution The choices are Sepia Rainbow Thallium and Wheat In MMode and Doppler Mode the Colorize soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted Compress Use the Compress soft key to adj
66. measurements called primitives to produce other measurements and calculations Depth In 2D Mode for noncardiac presets when you press the Measure key a free crosshair appears on the image and the system reports the depth at that point in the image The depth is displayed in centimeters as a measurement primitive in the results box The depth is calculated from the apex for sector transducers or from the scanning edge of the footprint for linear transducers to the center of the free crosshair A verti EnVisor Series User s Guide 145 M2540 30000 ug 02 146 cal tic mark appears at the origin point of the depth measurement and there is no line connecting this point with the free crosshair Frequency The frequency measurement is calibrated using a frequency source traceable to the National Institute of Science and Technology NIST The accuracy of this calibration is considerably greater than 99 There is no need to recalibrate this measurement given the high level of initial accuracy and the knowledge that drift due to equipment age or thermal issues should not be a routine concern Length The system assumes that the speed of sound is 1540 m sec and that this speed is homogeneous in all tissues Several books on ultrasound cite differences in the speed of sound based on the type of tissue One source says that sound speeds can range from 1500 to 1600 m sec These differences would produce an inaccuracy of up to 4
67. of the American Society of Echocardiography June 1989 Vol 2 pp 157 171 Yock Paul G and Popp Richard L Noninvasive Estimation of Right Ventricular Systolic Pressure by Doppler Ultrasound in Patients with Tricuspid Regurgitation Circulation 1984 Vol 70 No 4 pp 657 662 EnVisor Series User s Guide M2540 30000 ug 02 343 S to D Ratio The formula for the systolic to diastolic ratio r unitless given the systolic velocity v cm s and the end diastolic velocity vq cm s is Ameriso S et al Pulseless Transcranial Doppler Finding in Takayasu s Arteritis Journal of Clinical Ultrasound September 1990 18 592 6 Stroke Volume 2D SV EDV ESV where the stroke volume SV ml the end diastolic volume EDV ml and the end systolic volume ESV ml are SV ESV e ICE Evers SV Bullet EDV Bule ESV Bullet SV MOD sp2 EDV MOD sp2 ESV MOD sp2 SV MOD sp4 EDV MOD sp4 ESV MOD sp4 SV MOD bp EDV MOD bp ESV MOD bp SV mod Simp EDV mod Simp ESV mod Simp SV Cubed EDV Cubed ESV Cubed SV Teich EDV Teich ESV Teich Gorge G et al High Resolution Two dimensional Echocardiography Improves the Quantification of Left Ventricular Function Journal of the American Society of Echocardiography 1992 5 125 34 Roelandt Joseph Practical Echocardiology vol 1 of Ultrasound in Medicine Series ed Denis Whi
68. or soft key always check the position of the trans ducer Goal I need to increase the penetration Possible Actions Press the Fusion key to try the P Penetration setting Press the down arrow on the Focus key to lower the position of the focal zones Increase the gain by turning the 2D GAIN rotary control clockwise Move the bottommost TGC slide controls to the right Increase the power by turning the Power rotary control clockwise Note After adjusting any control always check the position of the transducer Goal I need to improve the resolution Possible Actions Press the Fusion key to try the R Resolution setting Use the Focus key to move the focal zone to the area of interest If you are using a linear or a curved linear transducer use the Focal Zones soft key to increase the number of focal zones Adjust the compression with the Compress soft key If you are using a linear trans ducer adjust the Angle rotary control to achieve the optimal angle for the 2D structure Resize the image with the trackball to make it narrower EnVisor Series User s Guide M2540 30000 ug 02 e Increase the persistence with the Persist soft key Note After adjusting any control or soft key always check the position of the trans ducer Goal I want the fluid filled structures to have fewer echoes Possible Actions e Decrease the gain by turning the 2D GAIN rotary control counterclockwise e Move the TG
69. or standard paper will significantly degrade the print quality Printer Accessories You can order the following accessories to use with your printers Color Printer Adaptor Kit M2540 86010 Printer tray allows you to place a black M2540 00800 and white printer on top of the color printer Strap bracket kit 2540 86020 Strap bracket M2540 00815 Removable Media You can order the following removable media to use with your system Part Number Description 3 5 floppy diskette Use a high density HD 1 44 MB floppy diskette CD R diskette 700 MB CD R certified 40x media 3 5 magneto optical diskette MOD 540 MB rewritable ISO IEC 15041 You can purchase these diskettes from a computer or office supply store You can also order the MOD from Philips M2540 80101 EnVisor Series User s Guide 285 M2540 30000 ug 02 Transducer Supplies To order transducer accessories in the United States contact the Philips Medical Sup plies Center at 1 800 225 0230 In Canada call 1 800 387 3154 In other countries contact your local Philips sales representative You can also go to the following Philips web site for the latest ordering information www medical philips com transducercare You can order the following ultrasound gels and TEE accessories to use with transduc ers Description Part Number Ultrasound Gel 8 5 oz bottles case of 12 40483A 5 liter bottl
70. over the endpoint press and hold the Enter key and move the trackball 8 Click OK Reports About Reports A report is automatically generated about a patient while you conduct an exam At any point during a study you can view the automatically generated report by pressing the Report key A report includes e Patient demographic information e Measurement and calculation information e Cardiac wall motion scoring information e Images that you add to the report e Obstetrical trending graphs Note The entire report is not visible on the screen at one time You must use the scroll bars to the right of and below the report to view the entire report Report Work Area When you press the Report key the report appears on the left and the report work area appears on the right The report work area displays information about the study and allows you to make changes to patient information measurements finding codes comments and obstetrical graphs Measurements and Calculations in a Report When you perform a labeled measurement or calculation the information is automat ically added to the report Unlabeled measurement information is only added to the report if you acquire the image EnVisor Series User s Guide M2540 30000 ug 02 237 238 All instances of each measurement appear in the work area In general the five most recent instances of each measurement appear in the report The others are enclosed in parentheses in the
71. rounding tissue before you acquire the 3D dataset e Before you acquire the 3D dataset decrease the Persist soft key for higher spatial resolution especially for fast movements during the scan Increase the Persist soft key for smoother appearance EnVisor Series User s Guide M2540 30000 ug 02 When you are reviewing a rendered 3D image press the Render Mode soft key to choose MaxIP to find the silhouette of the fetal face and use the Trim tool to sculpt away surrounding tissue When you are reviewing a rendered 3D image press the Render Mode soft key to choose X Ray to display bones such as the spine of the fetus Acquiring a 3D Dataset Before you use 3D Mode you must assign an option key to 3D Mode When you use 3D Mode you must first acquire a series of 2D images called the 3D dataset To acquire the 3D dataset 1 2 3 4 5 6 10 Press the 3D option key to start 3D Mode Optimize the image Use the soft keys to change the appearance of your image To specify the scanning method press the Scan Geometry soft key To specify the scanning direction press the Scan Direction soft key To set the scanning length or angle press the Scan Length or the Scan Angle soft key Begin moving the transducer using the method specified by the Scan Geometry soft key at a constant speed Note Be sure to scan in the direction specified by the Scan Direction soft key and to use the method specified by the
72. screen EnVisor Series User s Guide 97 M2540 30000 ug 02 98 4 If the cursor appears on the imaging screen press the Enter key to remove the cur sor from the imaging screen If Rotate and Orbit appear on the bottom right corner of the imaging screen press the Zoom key Zoom and Pan appear on the bottom right corner of the imaging screen Press the Select key until Pan is highlighted To move the 3D image around the imaging screen move the trackball Magnifying a 3D Image To enlarge or reduce the size of the 3D image you can either press the up or the down arrow on the Depth key or perform this procedure 1 If the cursor appears on the imaging screen press the Enter key to remove the cur sor from the imaging screen If Zoom and Pan do not appear on the bottom right corner of the imaging screen press the Zoom key Zoom and Pan appear on the bottom right corner of the imaging screen Press the Select key until Zoom is highlighted To enlarge the image move the trackball up or to the right To reduce the size of the image move the trackball down or to the left Using the Trim Tool in 3D Mode You can remove any undesirable tissue from a 3D image with the trim tool 1 4 5 Press the Trim soft key The trim tool a crosshair appears on the imaging screen Use the trackball to move the trim tool to the area that you want to remove from the image Press the Enter key to begin tracing the a
73. sp4 LVAd ap4 LVAd apical LVLd apical 180 EnVisor Series User s Guide M2540 30000 ug 02 LVAs ap2 MOD LVAs ap MOD MR max ESV MOD sp2 LVAs ap2 LVAs apical LVLs apical ESV MOD sp4 LVAs ap4 LVAs apical LVLs apical MR max vel MR max PG EnVisor Series User s Guide M2540 30000 ug 02 181 2 PI max vel OB GYN Measurements All OB GYN measurements are listed in the following table Label 2 Beat Pk to Pk AC traced ADap ADtrv BPD CD Cerv 182 ix Two beat peak to peak time interval Traced abdominal circumference Anterior posterior abdominal diameter Transverse abdominal diameter jem length Cervical length EnVisor Series User s Guide M2540 30000 ug 02 Cist magna CLAY m A 55 e m ength Distance cm Length Three axis volume length Distance 2 fem Length Three axis volume length Distance 3 ES per cd Three axis volume WEE DuctusVenosus DV _ Velocity Measure the diastolic velocity of the ductus venosus DuctusVenosus cm s Velocity Measure the mean Mean PI velocity of the ductus venosus DuctusVenosus SV cm s Velocity Measure the systolic velocity of the ductus venosus DV cm Velocity Measure the dia
74. successfully the icon changes to a X An attempt to export the study was made but the export failed f The study is currently open You cannot export a study that is currently open 4 At least one image as been added to the study since the last time the study was viewed Notes When you export a still image any measurements remain on the image When you export a loop all measurements are removed before the loop is exported When you import the study you cannot reactive measurements or perform new measurements e When you export a study some patient demographic information may not be exported export more studies 1 In Image Review click EJ The Search for Study window opens 2 Click Search 3 Use the trackball to move the cursor over the patient study you want to export Optional Press and hold the Control key or the shift key to select more than one study EnVisor Series User s Guide 251 M2540 30000 ug 02 252 OMA 9 Press the Select key Use the trackball to highlight Export or Export DICOM Press the Enter key Choose the destination for the study Note In the Destination drop down menu disk drives are identified with a drive letter and drive name Networked DICOM servers and printers are identified as DICOM PACS or DICOM printer If you have DICOM Media and you are not exporting to a DICOM server select the image format and compression Click Start ex
75. that you use Super VHS SVHS tapes for VCR recordings Using VCR Soft Keys To change any of the settings listed below press the oval key below the soft key label External Video Use the External Video soft key to display VCR images from any VCR other than the Panasonic MD 835 Jog Use the Jog soft key to move forward or backward through the recording frame by frame The Jog soft key appears only when you are using a Panasonic MD 835 VCR EnVisor Series User s Guide M2540 30000 ug 02 279 Play Use the Play soft key to play back what you recorded The Play soft key appears only when the playback is paused or stopped and you are using a Panasonic MD 835 VCR Pause Use the Pause soft key to pause the playback The Pause soft key appears only when the tape is playing and you are using a Panasonic MD 835 VCR FF RW Use the FF RW soft key to rewind or fast forward through the video tape Press the up arrow to fast forward Press the down arrow to rewind The FF RW soft key appears only when you are using a Panasonic MD 835 VCR Search Use the Search soft key to play the recording forward or backward at a high speed The Search soft key appears only when you are using a Panasonic MD 835 VCR Stop Use the Stop soft key to halt the playback of the tape The Stop soft key appears only when the tape is playing and you are using a Panasonic MD 835 VCR Foot Switch About the Foot Switch The foot switch has three pedals Each peda
76. the Default to Doppler Auto Trace check box 4 Click Apply 5 Click Save EnVisor Series User s Guide 153 M2540 30000 ug 02 154 Using Automatic Doppler Trace If you want your system to automatically trace a Doppler spectrum by default when you press the Measure key select the Doppler Auto Trace check box on the Measure ments Setup tab Note Automatic Doppler Trace is not available in cardiac presets To use automatic Doppler trace 1 2 In PW or CW Spectral Doppler press the Freeze key Do one of the following If the Doppler Auto Trace check box is selected press the Measure key once If the Doppler Auto Trace check box is not selected press the Measure key three times The spectrum is automatically traced measurement bars appear on the spectral trace and several calculations appear in the results box Optional To display the soft keys press the Select key Optional To show or hide the waveform press the Waveform soft key To reposition the measurement bars use the soft keys or press the Select key until the name of the measurement bar S D or S1 is highlighted on the bottom right corner of the imaging screen Use the trackball to move the measurement bar To approve the measurement and initiate another automatic Doppler trace mea surement press the Measure key To approve the measurement and exit press the Enter key The measurement turns white to indicate that it is complete Perfor
77. the Unpause Protocol soft key Using the ROI Box in Stress Echo When you are in a Stress Echo protocol a region of interest ROI box appears on the image The area in the ROI box is the portion of the image that is acquired Repositioning the ROI Box To reposition the ROI box 1 Press the Select key until ROI is highlighted on the bottom right corner of the imaging screen 2 Use the trackball to move the ROI box Removing the ROI Box from the Imaging Screen To remove the ROI box from the imaging screen press the Hide ROI soft key Displaying the ROI Box To display the ROI box press the Show ROI soft key EnVisor Series User s Guide M2540 30000 ug 02 267 268 Moving the 2D Reference Line in Stress Echo When you are in a Stress Echo protocol and an ROI box appears on the image the reference line may obscure the acquired image To move the reference line in Stress Echo 1 Press the Stress Echo option key The Stress Echo soft keys appear 2 Press the Hide ROI soft key 3 Press the Select key until Line is highlighted on the bottom right corner of the imaging screen 4 Use the trackball to move the reference line 5 Press the Stress Echo option key The Stress Echo soft keys appear 6 Press the Show ROI soft key Stopping and Resuming a Stress Echo Study You may stop a partially completed Stress Echo study in order to perform another study and then resume the prior Stress Echo study without havin
78. the image The area in the zoom box is magnified the second time you press the Zoom key EnVisor Series User s Guide 300 M2540 30000 ug 02 Appendix A Formulas Used for Calculations A to B Ratio The formula for the ratio unitless given the generic velocity v cm s and the generic velocity vg cm s is I EN by AC Abdominal Circumference Abdominal Circumference cm may be computed by two means if AC traced is present then AC AC traced If the two abdominal diameters and ADap are present then ADap 2 Kurtz Alfred B Goldberg Barry B Obstetrical Measurements in Ultrasound A Reference Manual Year Book Medical Publishers Inc 1988 p 33 Shields J R et al Fetal Head and Abdominal Circumferences Ellipse Calculations Versus Planimetry Journal of Clinical Ultrasound May 1987 15 237 239 Accel Slope Av At where Av is the change in Doppler velocity cm sec and At is the time interval change sec Note Use the maximum possible display magnification for best accuracy AFI Amniotic Fluid Index The Amniotic Fluid Index is AFI QUAD1 QUAD2 QUAD3 QUAD4 Normal range for AFI 8 1 cm 18 0 cm Rutherford S et al Four Quadrant Assessment of Amniotic Fluid Volume Journal of Reproductive Medicine 1987 32 587 589 EnVisor Series User s Guide 301 M2540 30000 ug 02 Angle A If A lt 0 then A Ax
79. the panoramic image Title is only available when you press the Label key About the Accuracy of Panoramic Images If the skin is moved significantly or the tissue is compressed to various degrees by the transducer during the acquisition of a panoramic dataset resulting artifacts can affect the quality and reliability of the rendered panoramic image A panoramic image acquired along a radius smaller than 0 3m such as a neck trans versal or an arm or leg transversal may not correspond to the real anatomy Therefore do not use such an image to make a measurement or a diagnosis based on anatomic geometry Warning If you determine by the above criteria or by your own clinical training or experience that a panoramic image is poorly reconstructed do not use the image to make dimensional measurements If for any reason such as an image is used to make a measurement do not use the measurement to make diagnostic decisions If you have any doubt about image related artifacts or the accuracy of the panoramic image re acquire the panoramic dataset Important Whenever possible perform measurements on a single acquired image frame Panoramic Image Review About Panoramic Image Review After you acquire the panoramic dataset the panoramic image appears on the imaging screen You can then manipulate the panoramic image using the system control panel keys and soft keys To display or hide the cursor in Panoramic Image Review press the Ente
80. the position of the trans ducer Goal I need to improve the angio filling Possible Actions e Increase the gain by turning the Doppler Gain rotary control clockwise e Use the Focus key to place the focal zone at or just below the area of interest e Decrease the scale by turning the Scale rotary control counterclockwise e Decrease the Filter setting with the Filter soft key e Increase the packet size with the Packet soft key Decrease the density with the Density soft key e For slow moving blood or structures increase the persistence with the Persist soft key e Increase the Smooth setting with the Smooth soft key If you are using a linear transducer use the Angle rotary control to adjust the angio box to achieve the optimal angle for the 2D structure e Ifyou are using a multifrequency transducer use the Frequency soft key to select a lower frequency Note After adjusting any control or soft key always check the position of the trans ducer Goal I need to improve the angio resolution Possible Actions e Use the Focus key to place the focal zone at the area of interest e Increase the packet size with the Packet soft key e For small vessels decrease the Smooth setting with the Smooth soft key e Increase the Density setting with the Density soft key EnVisor Series User s Guide M2540 30000 ug 02 e Ifyou are using a multifrequency transducer use the Frequency soft key to select high
81. the ultrasound system meets only drip proof construction requirements and may not be used in the operating room Supplies and Accessories About Supplies and Accessories You can purchase various supplies and accessories to use with your system Supplies are consumable items such as paper Accessories are optional items you can purchase separately such as cables EnVisor Series User s Guide 281 M2540 30000 ug 02 Unless otherwise specified contact your local Philips Sales and Service office to order all parts Cables and Power Cords You can order the following cables and power cords to use with your system Description Part Number Cables LAN external cable M2540 69080 6 USB printer cable 2540 69100 10 USB cable 2540 691 10 Power Cords United Kingdom 2540 60900 Australia Power M2540 60901 European Power M2540 60902 US Canada and Japan 2540 60903 Switzerland M2540 60906 Denmark 2540 60912 South Africa M2540 60917 Israel M2540 60919 Argentina M2540 60920 People s Republic of China M2540 60922 Miscellaneous Accessories You can order the following miscellaneous accessories to use with your system EnVisor Series User s Guide 282 M2540 30000 ug 02 Description Part Number Microphone 9164 0457 Foot switch peripheral kit M2540 40750 Physio Supplies You can order the following trunk cables lead sets and electrodes to use with Physios Descri
82. to systolic ratio unitless given the systolic velocity v cm s and the end diastolic velocity vg cm s is e t Neumyer Marsha M et al The Differentiation of Renal Artery Stenosis from Renal Parenchymal Disease by Duplex Ultrasonography Journal of Vascular Technology Scientific Article October 1989 pp 205 216 308 EnVisor Series User s Guide M2540 30000 ug 02 Decel Slope Av At where Av is the change in vertical dimension Doppler velocity cm sec and At is the time interval change sec Note Use the maximum possible display magnification for the most accurate calculation Derived GA Gestational Age The gestational age computed from that of an earlier exam where PrevExamGA is in weeks and the dates are in days is Prev Exam Current Date Prev Exam Date 7 EDC AUA The estimated date of confinement date given the average ultrasound age date formula is EDC AUA DateToday 40weeks AUA Hagen Ansert Sandra L Textbook of Diagnostic Ultrasonography 3rd ed The C V Mosby Co 1989 p 408 EDC LMP The estimated date of confinement date given the last menstrual period date formula is EDC LMP LMP 40weeks Hagen Ansert Sandra L Textbook of Diagnostic Ultrasonography 3rd ed The C V Mosby Co 1989 p 408 EDV Left Ventricular Volume at End Diastole Biplane Ellipse Formula 8 3x LV Ad MV x LV Ad apical LVID Fol
83. to the Twentieth Week of Gestation American Journal of Obstetrics and Gynecology 1969 103 789 800 GA SL via Tokyo Gestational age wk day via Tokyo University using spine length SL range 4 0 8 5 cm 4 05 4 39 4 71 5 01 5 30 125 16 51 30 17 51 35 847 140 Masahiko Mizuno et al Assessment of Fetal Growth using Ultrasound Measurements Nichidoku lho Japanisch Deutsche Medizinische Berichte in Japanese 1989 34 3 537 544 GA TC via Nimrod The formula for gestational age wk day via Nimrod using thoracic circumference TC range 13 0 35 0 cm is TC 0 44 0 79 Nimrod C et al Ultrasound Prediction of Pulmonary Hypoplasia Obstetrics and Gynecology 1986 68 495 498 GA TL via Jeanty Gestational Age wk day via Jeanty using Tibia Length TL range 1 0 6 9 cm formula is 10 055043 3 1317668 x TL 0 16814056 x TL x TL The following table lists the associated percentiles in weeks for each value 330 EnVisor Series User s Guide M2540 30000 ug 02 TL 5th 50th 5th 50th 50th 95th 95th li 95th B ma ma si 78 304 mire 7 52 2 0 0 9 sa es sra Ws 3 2 5785 325 22 149 179 207 2 293 261 291 30355 8 iB fier aur 6 63335 pes 394 2 9 17 5
84. to the printer you want to use Note You cannot print a report to a networked DICOM printer Saving a Report as a Series of DICOM Images If you want to be able to export a report in DICOM format you can save the report as a series of DICOM images To do so press the Acquire key while you are viewing the report The report appears in Thumbnails as a series of DICOM images When you export the study these images of the report are exported with all of the other images Adding an Image to a Report You can only add a still frame to a report To add a frame to a report 1 In Image Review click i 2 Move the cursor over the image with the trackball 3 Quickly press the Enter key twice 4 Ifyou are viewing a loop click Li to freeze the loop 5 If necessary use the Frame Select slide control to choose the frame you want to add EnVisor Series User s Guide M2540 30000 ug 02 239 240 8 Do one of the following E Click a Press the Select key highlight Put Image in Report with the trackball and press the Enter key Optional Type the caption to accompany the image Click OK Adding Patient Information to a Report You can add or change information about a patient in a report To add or change patient information in a report 1 a gb CES Press the Report key Click the Information tab Move the cursor over a field with the trackball Quickly press the Enter key
85. trace Doppler modes are often used to detect leaks regurgitation stenosis and flow changes Dual Imaging Dual Imaging allows you display two images side by side so that you can compare them You can choose which image is frozen and which is live or you can freeze both images and choose which one is active so that you can review the frames using Quick Review Duplex enables you to simultaneously dis Duplex play a live 2D image and a PW Doppler spectral trace EnVisor EnVisor is the general imaging system in the EnVisor series EnVisor C EnVisor is the cardiac imaging system in the EnVisor series EnVisor C HD EnVisor is the high definition cardiac imag ing system in the EnVisor series EnVisor HD is the high definition general Envisor RIE imaging system in the EnVisor series Exam Type Related presets are organized in categories called exam types A finding code is a predefined diagnostic Finding Code code based on the assessment and diagnosis of a study Focal Caret A focal caret defines a focal zone an area where the image is most clearly focused EnVisor Series User s Guide 292 M2540 30000 ug 02 A focal zone is an area where the image is Focal Zone most clearly focused The foot switch has three pedals Each pedal corresponds to a key on the system control panel The foot switch pedals have different functions in different situations Foot S
86. trace is live EnVisor Series User s Guide 75 M2540 30000 ug 02 76 Update Use the Update soft key to specify how often in 500 millisecond increments from 500 to 7000 milliseconds the reference image is updated Update is available only when no ECG trace appears on the imaging screen and the spectral trace is live It is not available in Duplex or Triplex or with a nonimaging transducer If you do not want the reference image to be updated press the up arrow on the Update soft key repeatedly and choose the 2D Hold On setting Waveform Use the Waveform soft key to display or hide an outline of the maximum and mean of a PW spectral trace The Waveform soft key is only available when the spectral trace is frozen Note If you are in Color PW Doppler or Color Power Angio PW Doppler the soft keys available to you depend on the term that is highlighted on the bottom right cor ner of the imaging screen PW Doppler soft keys appear when Gate is highlighted e Color Mode soft keys or Color Power Angio soft keys appear when Size or Posi tion is highlighted Repositioning the PW Sample Volume Gate To reposition the PW sample volume gate 1 Press the Select key until Gate is highlighted on the bottom right corner of your imaging screen 2 Use the trackball to reposition the PW sample volume gate Turning Adaptive Doppler On or Off Adaptive Doppler reduces the background noise in the spectral trace and in the audio If yo
87. turn Trapezoidal Imag ing on when you are in 2D Mode it remains on if you switch to another mode Trapezoidal Imaging adds additional imaging area by changing a linear transducer s rectangular image to a trapezoidal shape The extended field of view is often useful in vascular and small parts presets Trapezoidal Imaging is not available in Zoom U D Invert Use the U D Invert soft key to reverse the up down orientation of the image A small open circle called a transducer orientation dot appears at the top of a noninverted image An orientation dot appears on the bottom of an inverted image U D Invert is available only in live imaging and is not available with linear or TEE transducers or when a spectral trace is live MMode About MMode In MMode you can learn about the movement of an area of anatomy First you posi tion the MMode reference line in the 2D image on the anatomy of interest Then you can display information about movement along that line in an MMode trace An MMode trace can be helpful when you perform measurements especially heart rate Note MMode is not available with linear transducers in cardiac presets EnVisor Series User s Guide M2540 30000 ug 02 Using MMode To use MMode 1 Do one of the following e Ifyou are in a noncardiac preset press the MMode key to enter MMode Preview An MMode reference line appears on the 2D image Move the MMode reference line to the anatomy of interest with the trackball
88. window opens Click the Large or Medium option button to specify the 2D image size EnVisor Series User s Guide 57 M2540 30000 ug 02 58 4 Click Apply 5 Click Close Resizing and Repositioning a Box To resize an angio color or zoom box 1 Press the Select key until Size is highlighted on the bottom right corner of your imaging screen 2 Use the trackball to change the size of the box 3 reposition an angio color ROI or zoom box 4 Press the Select key until Position is highlighted on the bottom right corner of your imaging screen 5 Use the trackball to reposition the box Note If you change the size or position of an angio or a color box the 2D image will if necessary move or become larger to accommodate it 2D Mode About 2D Mode 2D Mode is the most commonly used imaging mode In 2D Mode the image is dis played in grayscale The 2D key is unique Whenever you press the 2D key you exit the current mode and return to 2D Mode The previous 2D settings are restored Using 2D Mode To use 2D Mode 1 Press the 2D key 2 If necessary adjust the following controls to optimize the image e 2D GAIN rotary control Depth and Focus keys LGC and TGC slide controls 3 change the appearance of your image use the soft keys EnVisor Series User s Guide M2540 30000 ug 02 4 Optional To change the fusion setting press the Fusion key 5 Optional If you re using a
89. work area Viewing Reports for Different Presets Reports contain information related to the current preset For example cardiac reports include cardiac information and obstetrical reports contain obstetrical infor mation If the information you need does not appear in the report change the preset Finalizing a Report When a report is finalized you can no longer make changes to it The next time you open the study a new version of the report is created A report is finalized when you do one of the following Save the report e Create a new patient study e Restart a patient study e Open a different patient study By Click Displaying and Hiding the Report Work Area The report work area appears to the right of the report To hide the report work area click El To display the report work area click El again Viewing Report Versions When you close a study you can no longer make changes to the report Each time you open the study a new version of the report is created EnVisor Series User s Guide M2540 30000 ug 02 To display all of the versions of the report click the following icon e A tab appears for each version of the every report for the current patient The tabs are labeled with the time and date that the report versions were created and the version number To view an earlier version click the tab Printing a Report To print a report press the Report key and the Record key assigned
90. x FL 6 3 Nobuaki Mitsuda et al Image Diagnosis of Fetal Growth Obstetrical and Gynecological Practice in Japanese 1988 37 10 1459 70 EFW BPD HC AC FL via Hadlock The formula for the estimated fetal weight grams via Hadlock using biparietal diameter range 3 1 10 0 head circumference range 10 0 40 0 abdominal circumference range 15 0 40 0 cm and femur length range 1 0 8 0 is 10 15115 0 0436 AC 0 1517 x 000321 AC x FL 0 0008923 BPD Hadlock et al Sonographic Estimation of Fetal Weight Radiology 1984 150 535 540 ESV Left Ventricular Volume at End Systole Biplane Ellipse Formula S 3x LVAs apical x LVAs sax MV LVIDs EnVisor Series User s Guide 313 M2540 30000 ug 02 Folland E D et al Assessment of Left Ventricular Ejection Fraction and Volumes by Real Time Two Dimensional Echocardiography Circulation October 1979 Vol 60 No 4 pp 760 766 Bullet Formula 3 6 LVAs sax MV LVLs apical Folland E D et al Assessment of Left Ventricular Ejection Fraction and Volumes by Real Time Two Dimensional Echocardiography Circulation October 1979 Vol 60 No 4 pp 760 766 Cubed Formula LVIDs Dodge H T Sandler D W et al The Use of Biplane Angiography for the Measurement of Left Ventricular Volume in Man American Heart Journal 1960 Vol 60 pp 762 776 Belenkie Israel et al Assessment of Left Ventricul
91. 0000 ug 02 132 6 Press the Zoom key A zoom box appears on the image Change the size and position of the zoom box with the trackball so that the zoom box contains the area that you want to magnify Press the Zoom key again or press the Enter key The magnified area appears Optional To increase or decrease the magnification factor press the up or the down arrow on the Depth key Optional To change the size or position of the magnified portion of the image press the Select key while the image is live until Size or Position is highlighted on the bottom right corner of the imaging screen Use the trackball to resize or repo sition the magnified portion of the image To exit press the 2D key or the Zoom key Color Zoom About Color Zoom Color Zoom shows color flow in a magnified image Using Color Zoom To use Color Zoom 1 2 Press the Color key Change the size and position of the color box if necessary Press the Zoom key A zoom box appears on the image Change the size and position of the zoom box with the trackball so that it contains the area that you want to magnify Note As you resize and reposition the zoom box the color box moves around the image in order to remain centered inside the zoom box EnVisor Series User s Guide M2540 30000 ug 02 Press the Zoom key again or press the Enter key The magnified area appears Optional Change the size and position of the
92. 0000 ug 02 144 8 9 To save the changes you are about to make to a preset clear the Do not save changes to a preset check box and select a preset from the User presets list or the Philips presets list Specify the Height and Weight Units English or Metric If you are in an OB GYN preset select the Fetal Weight Percentiles check box if you want fetal weight percentiles to appear in the report To configure protocol measurements click Protocol Measurement select the appropriate measurements and click OK To specify which measurements and calculations appear in the menu for each mode click the appropriate button add or remove measurements or calculations and click OK Click Apply or Save Click Close Improving Measurement Accuracy Several factors contribute to measurement accuracy including transducer selection display size crosshair placement and use of ECG trace Crosshair Placement Measurement accuracy and precision ultimately depend on placing the crosshair correctly on the image For best results use consistent techniques use control settings that optimize image quality and avoid artifacts that disguise tissue To use consistent techniques observe the following guidelines For each type of measurement use the same transducer orientation in all examina tions Measure from the leading edge closest to the transducer of an image The A S E MMode standard recommends making length measur
93. 120 5 123 5 149 126 5 129 4 132 3 69 36 9 39 7 14 5 Jeanty Philippe et al Estimation of Gestational Age from Measurements of Fetal Long Bones Journal of Ultrasound Medicine February 1984 3 75 79 GA UL via Jeanty The formula for gestational age wk day via Jeanty using ulna length UL range 1 0 6 4 cm is EnVisor Series User s Guide 33 M2540 30000 ug 02 10 034368 2 8625722 x UL 0 2912470 x UL x UL The following table lists the percentiles in weeks for each value UL 5 50th 95th 5th 50th 50th 95th 95th UL B 2 9 117 7 20 9 23 3 149 128 0 31 1 1341 Jeanty Philippe et al Estimation of Gestational Age from Measurements of Fetal Long Bones Journal of Ultrasound Medicine February 1984 3 75 79 332 EnVisor Series User s Guide M2540 30000 ug 02 Head circumference cm normal range 8 0 cm 36 0 cm can be computed two means if HC traced is present then HC HC traced If the two head diameters BPD and are present then HC Head Circumference BPD2 OFD2 2 Hadlock et al Fetal Head Circumference Relation to Menstrual Age American Journal of Roentgenology August 1982 138 649 53 Kurtz Alfred B Goldberg Barry B Obstetrical Measurements in Ultrasound A Reference Manual Year Book Medical Publishers Inc 1988 p 33 Shields J R et al Fetal Head and Abd
94. 380 Ultraband 5 0 12 0 No No sector MHz intraoperativ e c3540 21321 Ultraband 2 0 5 0 MHz Yes Yes curved linear array C5040 nad CA 5 2 21425A Curved 2 0 5 0 MHz Yes linear array EnVisor Series User s Guide M2540 30000 ug 02 273 No Yes 12 5 50 9898030022 Linear wide 7 5 MHz Yes No 5 No L1038 dd 7 IDA iner 3565 Mae Ys L7535 21359A Linear 5 0 10 0 Yes No MHz 15 6L 21390A Intraoperativ 6 0 15 0 No No e epicardial MHz SEA longies ING T6210 21369A OmniPlane TEE sector C8 4v linear array endovaginal E6509 DI9I4C 21221B Nonimaging 1 9 MHz No No Disks About Disks Floppy disks are most often used to back up and restore presets and other system set tings Optical disks and CD Rs are most often used to store images studies and reports Notes e An optical disk drive is included with the DICOM Media option The CD headphone jack is not functional on the EnVisor series Browsing a Floppy Disk an Optical Disk or a CD R To see the list of contents of a floppy disk an optical disk or a CD R EnVisor Series User s Guide 274 M2540 30000 ug 02 1 Press the Setup key The Setup window opens 2 Click the Floppy Disk Optical Disk or CD tab 3 Click Browse Disk The Browse Disk window opens 4 After looking at the list
95. Archive soft key to save the 3D dataset or the still image to the patient s study The title is saved with a dataset The title and labels are saved with a still image Colorize Use the Colorize soft key to replace the grayscale map with a color map The choices are Gray Amber Beige Sepia and Skin Image Invert Use the Image Invert soft key to reverse the order of the 2D frames and construct a new 3D image Image Invert reverses the left right orientation of the image Movie Use the Movie soft key to display an animation of the 3D image Re acquire Use the Re acquire soft key to leave 3D Image Review to prepare to acquire a new 3D dataset Render Mode Use the Render Mode soft key to change the way the 3D image is dis played The values are e Gradient An image that can be adjusted to display surface shape or textures using the Texture and Brightness settings e X ray An X ray like translucent image adjust the translucency with the Trans parency setting e MaxIP A projection showing only the maximum gray values along the current viewing direction Reset Use the Reset soft key to restore the 3D image to its original state Save to Disk Use the Save to Disk soft key to save the displayed frame to an optical disk or to a floppy disk as a bmp file Title Use the Title soft key to create a title for the 3D image The Title soft key is only available when you press the Label key EnVisor Series User s Gui
96. BPD via Hadlock The formula for gestational age wk day via Hadlock using biparietal diameter BPD range 1 5 cm 10 1 cm is 9 54 1 482 BPD 0 1676 BPD Hadlock E P et al Estimating Fetal Age Computer Assisted Analysis of Multiple Growth Parameters Radiology 1984 152 497 501 GA BPD via Jeanty Gestational age wk day via Jeanty using biparietal diameter BPD range 2 8 7 9 cm The following table lists the percentiles in weeks for each value EnVisor Series User s Guide 217 M2540 30000 ug 02 BPD 5th 50th zl B 5th 50th A 50th 95th 28 io 165 222 239 264 290 Ra 8 ar 7 249 27 30 2 52 2 72 51 75 sos 153 180 73 255 83 309 eps 28 ipsis SS 75 ums 95 161 189 269 5 331 a7 5 77 271 299 325 M40 94 mi ms ms 275 303 33 0 170 197 5 205 231 259 79 280 307 d EE ad s HE te ri oe qo de ns s PESE e RO e
97. C slide controls if necessary 3 4 To change the appearance of your image use the soft keys 5 Optional To change the fusion setting press the Fusion key 6 To exit press the THI key again Using Tissue Harmonic Imaging Soft Keys To change any of the settings listed below press the oval key below the soft key label Biopsy Use the Biopsy soft key to initiate the biopsy feature Biopsy has three set tings e Off Turns the Biopsy feature off e Needle Two guide lines appear that outline the area in which the biopsy needle path is most likely to be One guide line appears that shows the anticipated path of the biopsy nee dle The Biopsy soft key is only available when you are in 2D Mode and a noncardiac pre set and are using a transducer that supports biopsy Warnings See the EnVisor Series Transducer Guide for important information about using biopsy capable transducers EnVisor Series User s Guide M2540 30000 ug 02 e Biopsy guide lines are intended as guides only Never use biopsy guide lines as an absolute reference e Biopsy guide lines do not take into account the possible bending of the needle Colorize Use the Colorize soft key to assign a colorization map that replaces the gray scale map to improve contrast resolution The choices are Sepia Rainbow Thallium and Wheat In MMode and Doppler Mode the Colorize soft key affects the spectrum when Trace is highlighte
98. C slide controls to the left e Decrease the compression with the Compress soft key Ifyou are using a transducer that supports harmonics press the THI key to turn on Tissue Harmonic Imaging e Choose a more contrasty postprocessing map with the Map soft key e Decrease the Smooth setting with the Smooth soft key Note After adjusting any control or soft key always check the position of the trans ducer Goal I want the image to be less contrasty or grainy Possible Actions e Change the grayscale postprocessing map to a softer less contrasty map with the Map soft key e Increase compression with the Compress soft key e Increase the Smooth setting with the Smooth soft key e Press the Fusion key to try other Fusion settings e Increase the persistence with the Persist soft key Note After adjusting any control or soft key always check the position of the trans ducer EnVisor Series User s Guide 111 M2540 30000 ug 02 112 Imaging Tips for MMode Goal I want to reduce noise in the MMode trace Possible Actions e Decrease the gain by turning the Doppler Gain rotary control counterclockwise e Select a map with more contrast using the Map soft key Note After adjusting any control or soft key always check the position of the trans ducer Goal I want to increase the size of the MMode trace Possible Actions e Change the MMode format to Small over large or Full screen Use the Zoom key
99. Diagnostic Ultrasound ed 3 The Mosby CO 1989 pp 73 Maximum Pressure Gradient Short form N max 2 i i 109 where V is the maximum distal velocity in cm sec The short form is clinically applicable in the case of stenosis where V gt 4V Yoganathan Ajit P et al Review of Hydrodynamic Principles for the Cardiologist Applications to the Study of Blood Flow and Jets by Imaging Techniques Journal of the American College of Cardiology 1988 Vol 12 pp 1344 1353 Maximum Pressure Gradient Aortic Flow Full Bernoulli af AoV2 max max 100 4 100 77 336 EnVisor Series User s Guide M2540 30000 ug 02 Yoganathan Ajit P et al Review of Hydrodynamic Principles for the Cardiologist Applications to the Study of Blood Flow and Jets by Imaging Techniques Journal of the American College of Cardiology 1988 Vol 12 pp 1344 1353 Maximum Pressure Gradient Aortic Flow Simplified Bernoulli 4 AoV2 max C 19 Yoganathan Ajit P et al Review of Hydrodynamic Principles for the Cardiologist Applications to the Study of Blood Flow and Jets by Imaging Techniques Journal of the American College of Cardiology 1988 Vol 12 pp 1344 1353 Maximum Pressure Gradient Aortic Insufficiency 4 Almax vel 100 Callahan Mark J et al Validation of Instantaneous Pressure Gradients Measured by Continuous Wave Doppler in Experimentally Induced Aortic Stenosis
100. E um EN ees MR ERA E E 66 EnVisor Series User s Guide M2540 30000 ug 02 Using NINIGe 2i 2 ow dete aie e uel net oS 67 Using MMode Soft zac adest ute Seid ku Geese oan 67 Controlling the Scrolling of the MMode Trace 69 Changing the MMode Botmat s va uie tor ed IPC MW RR SN 69 Color MMode os x uo apie thee PE UG ME ERR S RN Mp V aei 70 MMode Zooms Cavin ek ase adve en hie OS LE ada 71 PW Doppler iss d 288 Se RR edite ERRARE ER A ete D d 72 About PW Doppler s Cesare Madea es eee ER e utet 72 Using PW Ep ple cereos Si ae ceva il ihe Lo ton LE atl 12 Using PW Doppler Soft Keysz 524b b Rd REEL TRE EFE REOR 73 Repositioning the PW Sample Volume 76 Turning Adaptive Doppler or 76 Turning Intelligent Doppler or 77 Changing Doppler Setups cosa 285 ea Yee tua ge hbase sane eun SE CN any TI Controlling the Scrolling of the Spectral 78 Changing the Spectral Trace Format sued ets er nce edna ete se ees 79 CW Dapper acne Oe ete eaten VEG seated afe a eR RU A adis 80 ADOUBC WA Doppler duit coa qe tec Ld 80 Using CW Doppler ekeke ike kk ted RR RA ERROR 80 Using CW Doppler Soft Keys Rd ERR ERRARE 81 About No
101. EnVisor Series User s Guide M2540 30000 ug 02 Typing an Apostrophe a Quotation Mark an Accent a Tilde or a Caret In order to make an apostrophe a quotation mark an accent a tilde a caret appear when you are using the keyboard you must type the character and then press the space bar Backups About Backups It is very important to back up the information on your system in case your system s memory fails for any reason Backing Up Presets and System Settings You need to back up the presets that you create If you do not and your system s mem ory fails you will need to recreate all of the presets you created If you need to create more presets than you can store on your system you can save the presets to a disk and restore them when you need to use them Every time you back up presets your system settings user defined calculations printer and VCR settings and options settings are automatically backed up You can restore one or more of these at any time Backing Up Patient Studies The data in your system s memory is temporary storage You need to save any impor tant patient data and images to an optical disk a CD R or over a network If your system s memory fails and you did not back up the patient studies all patient infor mation and images will be lost Notes e The ability to export data over a network is a component of the DICOM Basic option e An optical disk drive is included wi
102. Gradient CO Cardiac Output Doppler 210 EnVisor Series User s Guide M2540 30000 ug 02 Pressure gradient Pressure gradient Pressure gradient Pressure gradient Pressure gradient Cardiac output Aortic insufficiency maximum pressure gradient simplified Aortic flow maximum pressure gradient simplified bernoulli Aortic flow maximum pressure gradient full bernoulli Aortic flow mean pressure gradient simplified bernoulli Aortic flow mean pressure gradient full bernoulli Aortic flow pressure half time Valve area continuity formula via velocity time integral Valve area continuity formula via maximum velocity Cardiac output via the left ventricular outflow tract MR ERO MR flow rate MR max PG MR mean PG MR RF MR volume MV E A MV max PG MV mean PG MV PI 2t MVA PI 2t PA max PG Proximal Isovelocity Surface Area PISA Proximal Isovelocity Surface Area PISA Maximum Pressure Gradient Mitral Regurgitation Mean Pressure Gradient Maximum Pressure Gradient Mitral Valve Mean Pressure Gradient Maximum Pressure Gradient Pressure gradient EnVisor Series User s Guide 211 Mitral valve effective regurgitant orifice area Mitral valve regurgitation flow rate Maximum pressure gradient mitral regurgitation Mean pressure gradient mitral regurgitation simplified Mitral valve regurgi
103. HD High Definition series includes the EnVisor HD and the EnVisor C HD These systems have the following features Adaptive Doppler setting in PW Doppler and CW Doppler Adaptive Flow frequency setting in Color Mode Eight focal zones rather than four for some transducers Up to five fusion settings rather than three Panoramic Imaging Pulse Inversion settings in Tissue Harmonic Imaging Tissue Doppler Higher frame rates EnVisor Series User s Guide 3 M2540 30000 ug 02 System Components About System Components The system comprises a monitor a system control panel and a cart Monitor Monitor display controls Rotation lock lever Front handle Soft keys Height release handle underneath y P CD drive Transducer holders Physio panel LL Optical disk drive E cem Transducer connectors Floppy disk drive e pm Y A On Off button r WU Reset button N i Wheel lock aw Foot switch 2 1 p Wheel doce Notes e An optical disk drive is included with the DICOM Media option The physio panel is an option and is a component of the cardiac and vascular application packages e Your system may not have the same number or types of transducer connectors The fourth transducer connector is an option EnVisor Series User s Guide M2540 30000 ug 02 The CD headphone j
104. If A gt 180 then A 360 A Where A is the or angle L is the or line angle and Ly is the baseline angle Schuler P Graf R Sonographic Diagnosis of Hip Dysplasia and Hip Dislocation 4 Erg Lig 7 1986 Ecomed Verlag Reprint distributed by Siemens Aortic HR Aortic Heart Rate 60 AorticR R Dorland Illustrated Medical Dictionary 27th ed Philadelphia W B Sanders Co 1988 p 1425 Area N 1 I 1 gt XAY _1 Y 4X X _1 1 Note The points on the circumference are assumed to be traced sufficiently close to obtain an accurate result Area 1 0 V1 VTI 2 Oh J K Prediction of the Severity of Aortic Stenosis by Doppler Aortic Valve Area Determination Prospective Doppler Catheterization Correlation in 100 Patients Journal of the American College of Cardiology Vol 11 No 6 June 1988 pp 1227 1234 EnVisor Series User s Guide 302 M2540 30000 ug 02 Richards K L et al Calculation of Aortic Valve Area by Doppler Echocardiography A Direct Application of the Continuity Equation Circulation Vol 73 No 5 May 1986 pp 964 969 Area V D 2D diam V1 max Oh J K Prediction of the Severity of Aortic Stenosis by Doppler Aortic Valve Area Determination Prospective Doppler Catheterization Correlation in 100 Patients Journal of the American College of Cardiology Vol 11 No 6 June 1988 pp 1227 1234 Richard
105. MES 263 EnVisor Series User s Guide M2540 30000 ug 02 About Stress Echo Acquisition 2 25 eo b Ro RE HELLE EFE AREA 263 Performing a Stress Echo Study s 263 Using Stress Echo Soft a devs tole does dae ey 264 About the View Icon and the Stage View 265 Acquiring Loops for a Single Cycle or a Quad Cycle Acquisition Stage 265 Acquiring Loops for a Multi Cycle Acquisition 266 Acquiring Images Outside of a Stress Echo Protocol 267 Using the ROI Box in Stress Echo eo ese e a Meee 267 Moving the 2D Reference Line in Stress 268 Stopping and Resuming a Stress Echo 268 Stress Echo aa T eee n 269 About Stress Echo Review ooo Dein dre ea ima doa ean dee Breach Sc Bd eo edd 269 Selecting the Preferred Stress Echo 270 Relibeling Views 72 028 SP ePud AERIS 270 Viewing all the Stress Echo Loops fora 270 Playing Back Stress Echo 271 Performing Wall Motion Scoring oso cor met iate Dora te eT RU ar a ett ru 271 Transducers Disks and Denpherdls v eoe t spot e eL o MO ets 273 About Transducers Disks and Peripherals 4s es o e eed RT RI
106. PHILIPS EnVisor Series Ultrasound System User s Guide M2540 30000 ug 02 Rev A I Philips Ultrasound 3000 Minuteman Road Andover MA 01810 1099 USA www medical philips com Copyright 2003 by Philips Electronics North America Corporation All rights reserved Printed in USA EnVisor Series User s Guide i M2540 30000 ug 02 Print History Edition Publication Date Software Revision Edition November 2002 A 0 Edition 2 May 2003 EnVisor Series User s Guide M2540 30000 ug 02 Philips EnVisor Series User s Guide 2003 Philips Electronics North American Corporation All rights are reserved Reproduction in whole or in part is prohibited without the prior written consent of the copyright holder The information in this book is subject to change without notice Warranty The information contained in this document is subject to change without notice Philips Ultrasound makes no warranty of any kind with regard to this material including but not limited to the implied warranties of merchantability and fitness for a particular purpose Philips Ultrasound shall not be liable for errors contained herein or for incidental or consequential damages in connection with the furnishing performance or use of this material This product may contain remanufactured parts equivalent to new in performance or P y P q P parts that have had incidental use Warnings Electrical Shock Hazard Do not remov
107. Right ovarian pulsatility index Right ovarian R Ov RI resistivity index R Ov S D S to D Ratio Ratio Right ovarian systolic to diastolic ratio i Remy dex Restiviy ides ROV Ovarian Volume Volume Right ovarian volume S D i Systolic to diastolic ratio TC Thoracic Thoracic Circumference circumference computed Umbilical Pulsatility index using time averaged mean of the peaks Umble Resistivity index Umbilical S D Systolic to diastolic ratio EnVisor Series User s Guide 221 M2540 30000 ug 02 Uterine Uterine RI Uterine S D UTV Volume using time averaged mean of the peaks Ris Resistivity index Resistivity index Pulsatility index Pulsatility index S to D Ratio Ratio Systolic to diastolic ratio Uterine Volume Volume Uterine volume Volume Ellipsoid Volume 3 axis volume Three Axis 222 About Clinical References for Calculations and Formulas References are provided for many of the calculations and formulas Clinical calcula tions are usually based on studies of large patient populations The formulas that are derived have some uncertainty or inaccuracy based on the correlation coefficient for the study involved In many cases these uncertainties are greater than the inaccuracies of the ultrasound system measurement Clinicians should always be familiar with the clini
108. S server the list of scheduled patients will not be updated Click Done Click OK 10 Click Close EnVisor Series User s Guide 51 M2540 30000 ug 02 52 Notes e Ifyou have any questions about servers ask your network administrator e Modality Worklist is a component of the DICOM Advanced option Changing Modality Worklist Settings You can specify which scheduled patients appear in the Modality Worklist You can either choose from several default queries or you can modify one of the default que ries You can also specify how often your system retrieves patient information from the hospital information system HIS To change Modality Worklist settings 1 Press the Setup key The Setup window opens 2 Click the System tab The System window opens 3 Click DICOM The DICOM Setup window opens 4 Click the Servers amp Roles tab The Servers amp Roles window opens 5 In the Roles area click Modify 6 Click the Advanced button to the right of MWL SCP The Set Modality Worklist Query window opens 7 specify which scheduled patients should appear in the Modality Worklist click the query you want 8 Optional To modify a query click the Edit button to the right of the query 9 Optional To restore the queries to their original settings click Restore Defaults EnVisor Series User s Guide M2540 30000 ug 02 10 To specify how often your system should retrieve information from t
109. Scan Geometry soft key Press the Acquire key or use the foot switch to begin acquiring the 3D dataset If you decide not to complete the acquisition press the Cancel Acquire soft key To complete the acquisition of the 3D dataset press the Acquire key again Imag ing automatically stops if the maximum number of frames are acquired The 3D image is displayed on the imaging screen so that you can view or edit the image EnVisor Series User s Guide 93 M2540 30000 ug 02 94 Defining a 3D Region of Interest To define a region of interest for a 3D image press the ROI soft key If necessary change the size and the position of the region of interest box To remove the region of interest box press the ROI soft key again Using 3D Dataset Acquisition Soft Keys To change any of the settings listed below press the oval key below the soft key label Cancel Acquire Use the Cancel Acquire soft key to discontinue the acquisition of a 3D dataset so that you can modify imaging parameters Compress Use the Compress soft key to adjust the compression of returning echos which affects the grayscale display Increasing Compress softens the image Decreasing Compress produces a high contrast image Map Use the Map soft key to specify the postprocessing grayscale map In MMode and Doppler modes the Map soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference ima
110. The length measurements on the system are verified using AIUM standard phan tom The calibrations are performed using depth settings that give the greatest resolu tion for the phantom length being measured The accuracy of this calibration should be within 5 Time Time measurements can be used for calculations performed in the following areas physio channels MMode and Doppler The time calibration is performed using a time interval signal generator with a calibration traceable to NIST The calibration of the display is not expected to drift Calibration of the time axis should be done by measuring one second pulses at the different sweep speeds The accuracy of these measurements should be within 5 independent of the sweep speed Note These specifications are based on data taken with optimum control settings Accuracy specifications can be obtained at other control settings by repeating the cali bration at the desired settings The depth and sweep speed settings have the greatest impact on measurement accuracy The accuracy of a 1 length and a 3 cm area measurement on a 24 cm depth display is different from the accuracy of the same measurements performed on a 4 cm depth display Measurements taken at a sweep speed of 100 mm second are more accurate than those taken at 25 mm second EnVisor Series User s Guide M2540 30000 ug 02 About Mathematical Quantities Calculated from Primitives Philips performs software testin
111. UN ee ME E 223 EnVisor Series User s Guide XIV M2540 30000 ug 02 Creating a Patient Study lt x bens Ros uta eles ol ned soit ou ne Aedes 223 Editing Patient Demographic Information lees eee eee 224 S ving a Patent Study etur tena dieat bi uod uro staged Sires Awe ee oa tee 224 Restarting a Patient Study age ory Ga oa ae CE MS es dte ES ET S 225 Searching fora Patient 5 ERG EE 225 Searching for Patient Folder oos ee xn ER eS eee Wed 226 Moving a Patient Study s ct Qoae LR ed we Nast PATROL A 227 Deletine a Patent Vs Ves sce Seed EN SA The Scd Ma ed 228 Viewing a Previous Study for the Current Patient 228 Closing a Patient Study iai fun hs bee Et Re 228 mage REVIEW be eRe aia ead da Read S ves 229 About Image dms eo E oaa 229 About BWM DNA s pa PN edu vete WRENS Cha er d es 229 Deleting an Image in Image Review RN EP IM SA PRO qp NES 230 Calibrating an Image in Image Review 0 00 eee eee eee eee 231 Adding a Caption or Flag to an 231 Viewing 3D or Panoramic Images in Image 232 Printing Images Image 233 Playing Back Loops in Image Review izle E 4A RE ER ETE 233 Reports
112. V cm s coms Velocity Volume Measurements Label Units Meaning Aortic Distance Distance Height length or width Aortic Distance 2 Distance Height length or width Aortic Distance 3 Distance Height length or width Distance Distance Height length or width Distance 2 Distance Height length or width Distance 3 Distance Height length or width Renal Distance Distance Height length or width Renal Distance2 Distance Height length or width RenalDistance3 Distance Height length or width 166 EnVisor Series User s Guide M2540 30000 ug 02 Cardiac Measurements All cardiac measurements are listed in the following tables which appear in alphabeti cal order EnVisor Series User s Guide 167 M2540 30000 ug 02 2D Mode Measurements Label IVSd IVSs Left diam LVAd ap2 LVAd ap4 LVAd apical LVAd sax epi LVAd sax MV LVAd sax PM Units Type Meaning cm Height Interventricular septal dimension at end diastole cm Height Interventricular septal dimension at end systole cm Length Flow diameter on left side of heart cm Area Left ventricular long axis area at end diastole apical two chamber cm Area Left ventricular long axis area at end diastole apical four chamber cm Area Left ventricular area at end diastole
113. ack is not functional on the EnVisor series About the Imaging Screen The imaging screen looks somewhat different depending on the mode the applica tion the preset and the transducer The imaging area the soft key labels and the set tings however always remain at the same location Click any area of the imaging screen to learn about that component Patient s name and Transducer medical record number orientation dot Date of birth Institution name Focal caret Dat and time Color bar o Preset Transducer name Output power Fusion setting Gain Dynamic range compression level Map smooth persist Frame rate Imaging depth Acquisition icon Active trackball function Inactive trackball function Fusion icon Soft key labels Imaging area Reference line blue dotted line Adjusting the Monitor Display Every time the ambient light changes adjust the contrast and brightness of the moni tor display To adjust the contrast and the brightness EnVisor Series User s Guide 5 M2540 30000 ug 02 1 Press the Setup key 2 Click the System tab 3 Click Monitor Adjust 4 Follow the instructions on the screen 3 78 To adjust the monitor brightness press the key or the key below the brightness symbol on the front of the monitor e To adjust the monitor contrast press the key or the key below the symbol on the front of the monitor Changing the Ti
114. ages Note When you export a still image any measurements remain on the image How ever when you export a loop all measurements are removed before the loop is exported To export images in PC format 1 In Image Review click H 2 Optional Use the trackball and the Enter key to select one or more images amp Click a 4 Specify whether you want to export all of the images or only the selected images 5 Specify whether you want to export the report EnVisor Series User s Guide M2540 30000 ug 02 253 Specify the avi image quality Choose the destination 6 7 Click Export 8 9 a base file name for the images 10 Click Save Exporting a Report in PC Format You can export a report to a floppy disk an optical disk or a CD R Reports are saved as HTML files When you export a report you can specify whether you want to export all of the images displayed in Thumbnails with the report Note You cannot export a report over a network or to a DICOM printer To export a report 1 Press the Report key 5 m Click 3 Specify whether you want to export all of the images Note The following steps apply only if you export the report without the images If you export the report with the images the Export Images in PC Format win dow opens 4 Choose the destination 5 Type a file name for the report 6 Click Save Exporting Data to a Third Party Application You ca
115. alculation and use the Jeanty calculation the system automatically deselects the Hadlock calculation and marks it with a minus sign Biophysical Profile Total The Biophysical Profile Total formula is Movement Tone Breathing Amniotic Fluid Volume Category ranges 0 2 or NA NA indicates that the category will not contribute to the biophysical profile total Manning EA et al Fetal Assessment Based on Fetal Biophysical Profile Scoring American Journal of Obstetrical Gynecology 1990 162 703 709 BSA via Height and Weight Body Surface Area The following are the BSA calculation formulas Metric The DuBois and DuBois body surface area BSA m2 formula given a metric weight Wig range 0 5 160 0 kg and a metric height H range 15 0 204 0 cm is mm 0 425 0 725 BSA 0 007184 Wy Hom English The DuBois and DuBois body surface area BSA m2 formula given an English weight Wips range 1 1 350 0 lbs and an English height range 6 0 80 0 inches is inches EnVisor Series User s Guide 305 M2540 30000 ug 02 Lbs i 0 725 BSA 0 007184 um 2 54 Hinches Note To enter height and weight press the Patient key DuBois D DuBois A Formula to Estimate the Approximate Surface Area if Height and Weight Be Known Nutrition Sept Oct 1989 Vol 5 No 5 pp 303 313 BSA via Weight Body Surface Area The following are the BSA calculation formulas
116. ality Worklist when you press the Patient key the Patient Selection window opens Plex In 2D Mode CW Doppler or PW Doppler press the Plex key to enter Duplex Press the Plex key again to exit Duplex but remain in CW or PW Spectral Doppler In Color Power Angio or Color CW or PW Doppler press the Plex key to enter Tri plex Press the Plex key again to exit Triplex but remain in CW or PW Spectral Dop pler with Angio or Color Mode on Power Turn the Power rotary control to vary the acoustic power transmitted for the current mode The power setting appears on the right side of the imaging screen Preset Press the Preset key to display the Preset soft keys and the Preset menu Using the Pre set menu and Preset soft keys you can select create modify or delete a preset You can also remove the name of the preset from the imaging screen Probe Press the Probe key to activate the next connected transducer going from top to bot tom The name of the current transducer appears on the right side of the imaging screen The Probe key has no effect if only one transducer is connected EnVisor Series User s Guide M2540 30000 ug 02 PW Press the PW key to enter PW Doppler Preview so that you can position the Doppler sample volume gate Press the PW key again to display the PW spectral trace Record Rec2 Rec3 Before using a printer a VCR or a serial output cable for the first time you need to assign the Record Rec2 or Rec3 k
117. amp Roles window opens 5 In the Roles area click Modify 6 Select the appropriate server from the Storage SCP drop down list 7 Optional Select the appropriate server from the Storage Commit SCP drop down list 8 Click the Advanced button to the right of Storage SCP The Network Export Preferences window opens 9 Click the Auto Store tab 10 Click the appropriate option and press the Enter key Manual export only You must export over a network manually e Batch mode All images are automatically exported over a network when you save or close the study Send as you go Each image is automatically exported over a network when you press the Acquire key 11 Click Done 12 Click OK 13 Click Close Notes The ability to export to a DICOM PACS system or a DICOM printer is a com ponent of the DICOM Basic option Before you turn off your system at the end of each day check the DICOM job manager to make sure that the queue is empty to insure that all studies have been sent to the PACS EnVisor Series User s Guide 43 M2540 30000 ug 02 Changing the Image Format for DICOM Export You can choose the format of images that are exported over a network To change the image format 1 Press the Setup key The Setup window opens 2 Click the System tab The System window opens 3 Click DICOM The DICOM Setup window opens 4 Click the Servers amp Roles tab The Servers amp Roles wind
118. an PG LV VI max LV VI VTI LVOT diam MR alias vel MR max PG MR mean PG MR max vel MR mean vel cm s Maximum velocity Maximum flow volume on left side of heart mmHg Pressure gradient Left ventricular mean pressure gradient Maximum velocity Maximum velocity for continuity formula at 2D diam Velocity time Velocity time integral integral for continuity at 2D diam Left ventricular outflow tract diameter Maximum velocity Aliasing velocity of the proximal convergence zone of the mitral valve regurgitation Pressure gradient Mitral regurgitation maximum pressure gradient Pressure gradient Mitral regurgitation mean pressure gradient Maximum velocity Maximum velocity of mitral regurgitation cm s Mean velocity Mean velocity of the mitral valve regurgitant flow EnVisor Series User s Guide 173 M2540 30000 ug 02 MR VTI Velocity time Velocity time integral integral of the mitral valve regurgitant flow MV A point cm s Maximum velocity Mitral valve A point maximum velocity MV dec slope cm s2 Acceleration Mitral valve deceleration slope MV E point Mitral valve E point maximum velocity MV PI 2t max v Maximum velocity Mitral valve maximum velocity for PI 2t MV V2 VTI Velocity time Velocity time integral integral based on flow distal to the mitral valve Pulmonic deceleration slope PA dec slope PA max PG Press
119. and press the Record key assigned to the printer you want to use Playing Back Loops in Image Review About Playing Back Loops in Image Review You have many options while viewing loops and frames in Image Review e View one full screen frame Play back full screen loop e Play back up to nine images at the same time e Freeze the playback of a loop and select frame within the loop e Change the playback speed of a loop EnVisor Series User s Guide M2540 30000 ug 02 233 234 e Synchronize the playback of multiple loops e Compare images from different studies for the same patient e Edit the end points of a loop Viewing a Full Screen Frame or Playing Back a Loop in Image Review To view a full screen frame or play back a loop when you are in Thumbnails move the cursor over the image with the trackball and do one of the following Quickly press the Enter key twice Press the Enter key and click Play 44 To view the previous loop or frame click gt gt To view the next loop or frame click gt Playing Back More Than Image Image Review You can play back up to nine images at the same time in Image Review The Image Display drop down menu determines how you select the images that are played Ifyou select Random from the Image Display drop down you can select up to nine individual images to play back at once e Ifyou select 2 up 4 up or 9 up from the Image Display
120. anty GA FL Osaka GA FL via Osaka Age Gestational age via FL Osaka GA FL Tokyo GA FL via Tokyo Age Gestational age via FL Tokyo GA FTA Osaka GA FTA via Osaka GA GSD Rempen Gestational age via FTA Osaka Gestational age via GSD Rempen Gestational age via GSD Tokyo GA GSD Tokyo GA GSD via Tokyo EnVisor Series User s Guide 219 M2540 30000 ug 02 GA HC Hadlock GA HC via Age Gestational age via Hadlock HC Hadlock GA HL Jeanty i Gestational age via HL Jeanty GA HL Osaka Gestational age via HL Osaka Gestational age via MSD Hellman GA MSD Hellman GA SL Toyko Gestational age via SL Tokyo GA TC Nimrod Gestational age via TC Nimrod GA TL Jeanty Gestational age via TL Jeanty GA UL Jeanty Gestational age via UL Jeanty HC pen Nee circumference ddl HC AC Ratio of head circumference to abdominal circumference distance volume of the Ist 6th follicle in the left ovary L Follicle Vol 1 16 L Ov PI ag dE ovarian a AE index Left ovarian resistivity index L Ov S D Left ovarian systolic to diastolic ratio EnVisor Series User s Guide 220 M2540 30000 ug 02 LOV Ovarian Volume Volume Left ovarian volume Mean sac diameter Pulsatility index using time averaged mean of the peaks distance volume of the Ist l6th follicle in the right ovary R Ov PI Pulsatility index
121. ar Dimensions and Function by Echocardiography American Journal of Cardiology June 1973 pg 31 Method of Discs Biplane 20 x E 4 P i l where 2 is the th disc diameter of LVAs ap2 5 is the th disc diameter of LVAs ap4 gt St MOD and L is the maximum length from LVAs ap2 MOD or LVAs ap4 MOD Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 p 364 Method of Discs Single Plane Four Chamber L EASES M 5 i l where b is the i th disc diameter of LVAs ap4 MOD and L is the length from LVAs ap4 MOD 3 14 EnVisor Series User s Guide M2540 30000 ug 02 Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 p 364 Method of Discs Single Plane Two Chamber where a is the th disc diameter of LVAs ap2 MOD and L is the length from LVAs ap2 MOD Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 p 364 Modified Simpson s Formula 05 LVAs sax MV 2 LVAs sax LVAs LVAs sax Weyman Arthur E Cross Sectional Echocardiography Lea amp Feb
122. ar gestational age When the system is powered on or you enter a new patient ID the gestational ages are marked by default for selection or deselection All gestational ages are marked for inclusion by EnVisor Series User s Guide M2540 30000 ug 02 303 default except for those biometries that have multiple associated authors In these cases only one is marked on by default This ensures that the AUA never includes gestational age calculations based on the same biometry via different authors The following table lists the gestational age calculations available and their default states in order of precedence Gestational Age Default State GA FL Hadlock GA FL Jeanty GA FL Tokyo GA FL Osaka GA HL Jeanty GA HL Osaka GA TL Jeanty GA UL Jeanty GA TC Nimrod GA CRL Robinson GA CRL Jeant GA CRL Remp GA CRL Tokyo GA CRL Osaka GA BPD Hadlock GA BPD Jeanty GA BPD Tokyo GA BPD Osaka GA HC Hadlock GA AC Hadlock GA MSD Hellman EnVisor Series User s Guide 304 M2540 30000 ug 02 GA GSD Remp GA GSD Tokyo GA AA Osaka GA VL Tokyo If you choose to override the defaults the system enforces mutual exclusion when necessary For example three gestational ages based on biparietal diameter are available one by Hadlock one by Jeanty and one by Rempen The default is the Hadlock calculation If you choose to override the Hadlock c
123. are fully displayed above or below the baseline for example in studies of arterial grafts carotid arteries umbil ical arteries renal arteries and transcranial arteries When initiated on a frozen Doppler spectrum Doppler trace automatically detects the strongest Doppler complex in which the first and succeeding systolic points S and S1 are similar The system marks the first systolic the end diastolic and the succeed ing systolic points with S D and S1 measurement bars A peak trace is drawn in gray EnVisor Series User s Guide M2540 30000 ug 02 along the top of the waveform A mean trace weighted mean or centroid is drawn in black toward the middle of the waveform marking the predominant velocities encountered in the complex as shown in the figure below The peak trace is used to produce a time averaged peak velocity measurement MEAN The mean trace is used to produce a time averaged mean velocity measure ment TAVM You can use your judgment to manually position the S D and S1 points Moving the S bar to another complex selects that waveform to be automatically traced Activating Automatic Doppler Trace If you want your system to automatically trace a Doppler spectrum by default when you press the Measure key activate Automatic Doppler Trace To activate Automatic Doppler Trace 1 Press the Setup key The Setup window opens 2 Click the Measurements tab The Measurements window opens Select
124. aset In 3D Mode the 3D dataset is the series of 2D images that you acquire Information from the 3D dataset is used to create a life like 3D image 3D Mode In 3D Mode you acquire a series of 2D images called the 3D dataset Information from this dataset is used to create a lifelike 3D image 3D Movie A 3D movie is an animation of a rendered 3D image Acquisition icon The acquisition icon is a small open box that appears on the bottom right corner of the imaging screen to the right of the trans ducer frequency and depth when it is possi ble to acquire an image Adaptive Doppler Adaptive Doppler reduces the background noise in the spectral trace and in the audio Adaptive Flow Adaptive Flow changes the flow frequency to an optimal frequency for that transducer for the selected focal zone Angio Box An angio box appears on the image in Color Power Angio The amplitude intensity of flow in the angio box is represented with different hues EnVisor Series User s Guide M2540 30000 ug 02 289 Angle to Flow Arrow The angle to flow arrow appears on the imaging screen in PW Doppler along with the Doppler cursor line Use the Angle rotary control to position the angle to flow arrow parallel to and in the same direction as the blood flow Automatic DICOM Export Automatic DICOM export automatically exports images over a network when you press the Acquire key o
125. ation select the application from the appro priate drop down menu EnVisor Series User s Guide 35 M2540 30000 ug 02 36 5 Click OK 6 Click Close System Settings About System Settings In the Setup window you can change a variety of settings that affect the configuration of your system You can save settings to a preset unless they are system wide settings You cannot save the following system wide settings to a preset Top Border Changes the information that appears on the top of your imaging screen Date Time Corrects the date or the time Locale Changes settings such as language or currency for your location DICOM Changes DICOM settings Monitor Adjust Allows you to adjust the contrast and brightness for the cur rent lighting conditions You can save the following settings on the System tab in the Setup window to a preset LGC profile display TGC profile display Depth marking TEE temperature units Power index Activate body marker during freeze and dual These settings are described below Depth markings controls whether and where the depth markings appear Off No depth markings appear Vertical Depth markings appear on the right side of the imaging screen Both Depth markings appear to the left and the right of the image Left Depth markings appear to the left of the image EnVisor Series User s Guide M2540 30000 ug 02 Right Depth markings appear to
126. ays check the position of the trans ducer Goal I want the color to have less noise flashing or artifacts Possible Actions e Decrease the gain by turning the Doppler Gain rotary control counterclockwise e Increase the Filter setting with the Filter soft key EnVisor Series User s Guide 117 M2540 30000 ug 02 118 e Increase the scale by turning the Scale rotary control clockwise e Resize the color box to make it narrower to remove the source of artifacts e Increase the persistence with the Persist soft key Notes e After adjusting any control or soft key always check the position of the transducer e In cardiac imaging mechanical heart valves occasionally cause unavoidable flash ing artifact Artifact can also be caused by external sources such as lighting other equipment or telecommunications devices Goal I want the color to be less speckled or fragmented Possible Actions e Increase the gain by turning the Doppler Gain rotary control clockwise e Increase the Smooth setting with the Smooth soft key e For slow moving blood or structures increase the persistence with the Persist soft key e Decrease the Density setting with the Density soft key Note After adjusting any control or soft key always check the position of the trans ducer Goal I need to increase the frame rate Possible Actions e Resize the color box to make it smaller e Ifthe scale setting is very low increase the
127. c3 To assign a Record key to a peripheral or to a serial output cable EnVisor Series User s Guide 21 M2540 30000 ug 02 22 4 5 Press the Setup key The Setup window opens Click the Peripherals tab The Peripherals window opens Choose the device from the drop down menu that you want associated with each Record key Click Apply Click Close Note When a Philips representative installs a peripheral he or she types values for the following settings which you may change when you assign a Record key to a periph eral Cycle Time The length of time the Record key is inoperable after you press it to print an image applies only to video input printers Freeze Time The length of time an image is frozen after you press the Record key to allow a printer to capture a frame applies only to video input printers Tape Time The time displayed on the imaging screen when a video tape is inserted into the VCR Using the World Key The World keys are labeled with a globe They appear on either side of the space bar Use a World key to type the characters that appear on the right side of some keys on the keyboard To type a character that appears on the bottom right corner of a keyboard key press the World key and the keyboard key at the same time To type a character that appears on the top right corner of a keyboard key press the World key the shift key and the keyboard key at the same time
128. cal reference provided for each calculation before using the system measurement and analysis data to make a clinical decision EnVisor Series User s Guide M2540 30000 ug 02 Patient Studies Image Review and Reports About Patient Studies Image Review and Reports A patient study includes demographic information images quantitative values and a summary of findings All patient studies for one patient are saved in a patient folder During an exam all of the images you acquire are saved to the patient study and a report is automatically generated At any time you can view all of the images in Image Review by pressing the Review key You can view the report by pressing the Report key Using the Select Key in Image Review and Reports In Image Review and reports press the Select key at any time to view the options that are currently available to you To choose an option highlight the option with the trackball and press the Enter key Patient Studies About Patient Studies A patient study includes demographic information images quantitative values and a summary of findings All patient studies for one patient are saved in a patient folder You can create a new patient study edit information about a patient or restart a patient study by pressing the Patient key Creating a Patient Study Before you begin acquiring images you must create a patient study or restart a patient study If you do not you cannot save the image
129. cale rotary control counterclockwise EnVisor Series User s Guide 119 M2540 30000 ug 02 120 e Decrease the Filter setting with the Filter soft key e Increase the packet size with the Packet soft key e Decrease the density with the Density soft key e For slow moving blood or structures increase the persistence with the Persist soft key e Increase the Smooth setting with the Smooth soft key e Ifyou are using a linear transducer use the Angle rotary control to adjust the color box to achieve the optimal angle for the 2D structure e Ifyou are using a multifrequency transducer use the Frequency soft key to select a lower frequency Note After adjusting any control or soft key always check the position of the trans ducer Imaging Tips for Color Power Angio Goal I want the angio to have less noise flashing or artifacts Possible Actions e Decrease the gain by turning the Doppler Gain rotary control counterclockwise e Increase the persistence with the Persist soft key e Increase the scale by turning the Scale rotary control clockwise e Resize the angio box to make it narrower to remove the source of artifacts e Increase the Filter setting with the Filter soft key Notes e After adjusting any control or soft key always check the position of the transducer e In cardiac imaging mechanical heart valves occasionally cause unavoidable flash ing artifact Artifact can also be caused by external sources
130. can perform measurements and calculations on images from the current study and on images from studies saved on your system You cannot perform measurements on images that you import from a disk You can edit measurements on images from studies that you saved on your system but not on images from studies that you imported You can manipulate the measurements and calculations in the report work area Note The measurements and calculations that appear in Image Review depend on the preset and on the settings on the Analysis Setup tab Performing a Labeled Measurement or a Calculation in Image Review To perform a labeled measurement or calculation on an image in Image Review EnVisor Series User s Guide M2540 30000 ug 02 d S9 109 9v dg 12 13 14 15 In Image Review click 4 Use the trackball to move the cursor over the image Press the Enter key twice If you are viewing a loop click the icon to freeze the loop If necessary use the Frame Select slide control to choose a frame Press the Menu key above the Measure key Select the imaging mode from the Measurement Mode drop down menu Click the Measurements or Calculations option button Select the type of measurement or calculation If you need to specify the fetus or the side of the anatomy being measured press the Report key click the Measure tab and specify the fetus or side Press the Review key to return to the measurement Do one of the
131. ce or Absence of Asynergy American Journal of Cardiology January 1976 Vol 37 pp 7 11 EnVisor Series User s Guide 311 M2540 30000 ug 02 EF Ejection Fraction EDV ESV EDV Pombo J F Left Ventricular Volumes and Ejection by Echocardiography Circulation 1971 Vol 43 480 490 EFW AC BPD via Hadlock The formula for the estimated fetal weight grams via Hadlock using abdominal circumference range 15 5 40 0 cm and biparietal diameter range 3 1 10 0 cm is 1061 11 0 05845x 0 000604 AC 0 007365 x BPD 0 000595x BPD x AC 0 1694x BPD Hadlock E P et al Sonographic Estimation of Fetal Weight Radiology 1984 150 535 540 EFW AC BPD via Shephard The formula for the estimated fetal weight grams via Shephard using abdominal circumference range 15 0 40 0 cm and biparietal diameter range 3 1 10 0 cm is 1000 x 10 17492 0 166 BPD 0 045 AC 0 002645 AC XBPD Shephard et al An Evaluation of Two Equations for Predicting Fetal Weight by Ultrasound American Journal of Obstetrics and Gynecology January 1982 142 1 47 54 EFW AC FL via Hadlock The formula for the estimated fetal weight grams via Hadlock using abdominal circumference range 15 0 40 0 cm and femur length range 1 0 8 0 cm is 101304 005281 x 01938 FL 0004 AC x FL Hadlock E P et al Estimation of Fetal Weight with the Use of Head Body and Femur
132. cessary changes to the calculation Click OK EnVisor Series User s Guide M2540 30000 ug 02 8 9 Click Apply Click Close Deleting a User Defined Calculation You can delete a GA calculation that you created using a formula or a table To delete a user defined calculation 1 Press the Setup key The Setup window opens Click the Analysis tab The Analysis window opens Click User Defined Calculations or User Defined Tables The Calculation Editor or Gestational Age Table Editor window opens Select the calculation you want to delete from the Calculation Name or the Table Name drop down menu 5 Click Delete Calculation or Delete Table 6 To confirm click OK 7 8 9 Click OK Click Apply Click Close About Volume Calculations The methods used to calculate cardiac volumes and radiological volumes are described below Cardiac Volumes You can calculate cardiac volumes in two ways Method of Discs MOD Single plane method EnVisor Series User s Guide 199 M2540 30000 ug 02 Biplane method e Area Length Method Non MOD Method of Discs Area Length Method a 20760310 200 Method of Discs The Method of Discs MOD single plane volume calculation uses one orthogonal plane for area the apical four chamber view or the apical two chamber view and a long axis length The area traces are divided into 20 elliptical disk segments The MOD bi
133. ck Normal fetal weight percentiles EFW B H A F Hadl EFW B H A F via i Estimated fetal Hadlock weight via BPD HC AC and FL Hadlock Normal fetal weight percentiles EFVV BPD AD FL Estimated fetal kyo weight via BPD ADap ADtrv and FL Tokyo EFW BPD FTA FL O EFVWV BPD FTA FL Estimated fetal saka via Osaka weight via BPD FTA and FL Osaka Fetal HR Fetal Heart Rate Fetal heart rate FUAC FLto AC Ratio FLtoACratio FL BPD FL to BPD Ratio Ratio FL to BPD ratio Flow vol Flow volume GA AC Hadl Gestational age via AC Hadlock GA BPD Hadl Gestational age via BPD Hadlock 218 EnVisor Series User s Guide M2540 30000 ug 02 Gestational age via BPD Jeanty Gestational age via BPD Osaka Gestational age via BPD Tokyo GA BPD Jeant pn via Jeanty GA BPD Osaka GA BPD via Osaka GA BPD Tokyo GA BPD via Tokyo GA CRL Jeant GA CRL via Jeanty Gestational age via CRL Jeanty GA CRL Osaka GA CRL via Osaka Age Gestational age via CRL Osaka GA CRL Remp GA CRL via Age Gestational age via Rempen CRL Rempen GA CRL Robin j GA CRL via j Age Gestational age via Robinson CRL Robinson GA CRL Tokyo GA CRL via Tokyo Age Gestational age via CRL Tokyo GA FL Hadl via Hadlock GA FL Jeanty GA FL via Jeanty Gestational age via FL Hadlock Gestational age via FL Je
134. cle Acquisition Stage To acquire loops for a single cycle or a quad cycle acquisition stage 1 Press the Acquire key to begin acquiring loops for the first view of the first stage e Fora single cycle acquisition stage one loop is acquired and is displayed for your review in Image Review e For a quad cycle acquisition stage four loops one per heart cycle are acquired and are displayed for your review in Image Review EnVisor Series User s Guide M2540 30000 ug 02 265 266 The first loop you acquire for each view is by default the preferred loop To change the preferred loop select the check box in the bottom left corner of the loop Press the Review key or the 2D key to accept the loop or the loops and proceed to the next view Press the Acquire key to reject the loop or loops and reacquire the view After you acquire all of the views for a stage do one of the following Press the Review key or the 2D key to accept the loop or loops and proceed to the next stage Press the Acquire key to reject the loop or loops and reacquire any views To add a stage or view press the Setup key Note Although you automatically advance to the next view or stage you can specify which view or stage you want to acquire with the View soft key or the Stage soft key Acquiring Loops for a Multi Cycle Acquisition Stage To acquire loops for a multi cycle acquisition stage 1 Press the Acquire key to begin acquiring loops Up to
135. color box with the trackball Note The color box is limited to the size of the magnified image Color Power Angio Zoom About Color Power Angio Zoom Color Power Angio Zoom shows angio flow in a magnified image Using Color Power Angio Zoom To use Color Power Angio Zoom 1 2 Press the Angio key Change the size and position of the angio box if necessary Press the Zoom key A zoom box appears on the image Change the size and position of the zoom box with the trackball so that it contains the area that you want to magnify Note As you resize and reposition the zoom box the angio box moves around the image in order to remain centered inside the zoom box Press the Zoom key again or press the Enter key The magnified area appears Optional Change the size and position of the angio box with the trackball Note The angio box is limited to the size of the magnified image EnVisor Series User s Guide 133 M2540 30000 ug 02 134 EnVisor Series User s Guide M2540 30000 ug 02 Annotation About Annotation You can annotate an image with a body marker graphic that indicates the part of the anatomy that you are scanning You can also place labels and arrows on an image Using Quick Text You can place text on the imaging screen anytime without pressing the Label key or the Menu key Simply position the cursor with the four arrow keys and start typing If you do not position the cursor the Quick Te
136. cquired and saved to the study e Quad cycle When you press the Acquire key four consecutive loops one per heart cycle are acquired and saved to the study e Multi cycle When you press the Acquire key up to 200 loops one per heart cycle are continuously acquired and saved to the study allowing you to continu ously acquire loops for all views in a particular stage Press the Enter key to pro ceed from one view to the next After you have imaged all of the views press the Acquire key to end the acquisition Press the End Acquire soft key when you are finished with the multi cycle acquisition to enter Image Review Note Only one multi cycle stage is allowed in each protocol Using a VCR During a Stress Echo Study The VCR begins recording when you do one of the following e You press the Record key that is assigned to the VCR e You press the Acquire key to acquire the first view of a VCR stage The VCR stops recording when one of the following occurs e One loop has been acquired for a single cycle VCR stage e Four loops have been acquired for a quad cycle VCR stage e You press the End Acquire soft key during a multi cycle VCR stage EnVisor Series User s Guide 262 M2540 30000 ug 02 Two hundred loops have been acquired for a multi cycle VCR stage e You press the VCR Stop soft key e You press the Record key assigned to the VCR to pause recording Using the Timer During a Stress Echo Study The timer indicates
137. creen elements appear in blue To change the active trackball function press the Select key Use the trackball in conjunction with the Enter key to click an item or choose a menu option Use the trackball to move the cursor over the item or option and press the Enter key In Quick Review when Scroll Image or Trace is highlighted on the bottom right corner of the imaging screen use the trackball to scroll through the image loop or trace frame by frame In Quick Review when Replay is highlighted on the bottom right corner of the imag ing screen use the trackball to change the loop playback speed When making a trace measurement or when using the trim tool in 3D Mode use the trackball to trace the area VCR If a supported VCR is connected press the VCR key to display the VCR soft keys The VCR soft keys control the VCR functions EnVisor Series User s Guide 19 M2540 30000 ug 02 20 If a nonsupported VCR is connected press the VCR key to display the VCR input on the imaging screen Volume Turn the Volume rotary control to adjust the volume of the speaker for CW and PW Doppler and for VCR playback Zoom Press the Zoom key to place a zoom box on an image Press the Zoom key again to magnify the area in the zoom box In 3D Mode or Panoramic Imaging press the Zoom key to change the possible track ball functions displayed on the bottom right corner of the imaging screen Using Soft Keys Soft keys are the oval
138. d by your network administrator Note The default port number 104 is assigned to ultrasound systems at most institutions 7 In the Network settings area click the Network settings button The Internet Protocols TCP IP Protocols window opens 8 Enter the TCP IP parameters specified by your network administrator EnVisor Series User s Guide M2540 30000 ug 02 9 Click OK 10 Click OK 11 Click Close Assigning DICOM Servers You must assign DICOM server before you connect your system to the network Ask your network administrator if you have questions To assign DICOM servers 1 Press the Setup key The Setup window opens Click the System tab The System window opens Click DICOM The DICOM Setup window opens Click the Servers amp Roles tab The Servers amp Roles window opens In the Servers area click New Assign a name to the sever and type it in the Name field Note This name will be used in all dialog boxes and error messages that relate to this server Type the AE Title and Host specified by your network administrator in the respective fields Note You may want to make the AE title the same as the server name Modify the server settings as specified by your network administrator by clicking the up and the down arrows to the right of the settings In the Servers area click Done EnVisor Series User s Guide 41 M2540 30000 ug 02 42 10 To assign each serv
139. d number MRN is a MRN unique alphanumeric identifier assigned to a specific patient In a Stress Echocardiography multi cycle acquisition stage up to 200 loops one Multi Cycle Acquisition per heart cycle are continuously acquired and saved to the study allowing you to con tinuously acquire loops for all views in a particular stage A magneto optical disk or optical disk is a medium density medium cost storage Optical Disk device MODs are available in several densi ties 1x 2x 4x 8x 12x where 1x is equiva lent to 325MB per side The EnVisor series system control panel includes four option keys labeled 1 2 3 Option Key and 4 You must assign an option key to cer tain applications before using them for the first time The output power is displayed on the imag ing screen The output power is made up of Output Power the power index MI TIS TIC or TIB followed by the power level displayed numerically PACS A PACS is a server that stores DICOM complient data EnVisor Series User s Guide 295 M2540 30000 ug 02 Panoramic Dataset A panoramic dataset is the series of 2D image that is compiled to show a larger area of anatomy Panoramic Imaging In Panoramic Imaging you acquire a series of images in 2D Mode These images are called the panoramic dataset This dataset is compiled to show a larger area of anatomy Patient Folder A patient folder includes
140. d on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted Compress Use the Compress soft key to adjust the compression of returning echos which affects the grayscale display Increasing Compress softens the image Decreasing Compress produces a high contrast image The compression setting appears on the right side of the imaging screen Focal Zones Use the Focal Zones soft key to add focal zones Focal zones are the areas where the image is most clearly focused If you have an EnVisor HD or EnVisor C HD you can choose up to eight focal zones depending on the current imaging depth and the transducer you are using Otherwise you can choose up to four focal zones If you are using Trapezoidal Imaging you can choose no more than four focal zones Using multiple focal zones decreases the frame rate Each time you press the Focal Zones soft key you increase the number of focal zones or the space between them When you reach the maximum number of focal zones pressing the Focal Zones soft key gives you one focal zone The Focal Zones soft key is not available with sector transducers In Zoom pressing the up arrow on the Focal Zones soft key adds focal zones it does not increase the space between focal zones L R Invert Use the L R Invert soft key to reverse the left right orientation of the image If you are in a noncardiac preset a small open circle called a transducer orien tation do
141. de M2540 30000 ug 02 Trim Use the Trim soft key to display the trim tool a crosshair on the imaging screen The trim tool allows you to remove any undesirable tissue from a 3D image Undo Use the Undo soft key to cancel the last image manipulation Redo Use the Redo soft key to restore the image manipulation that was most recently canceled Orbiting or Rotating a 3D Image Orbiting a 3D Image To orbit the 3D image like a sphere around its center point 1 Ifthe cursor appears on the imaging screen press the Enter key to remove the cur sor from the imaging screen 2 If Zoom and Pan appear on the bottom right corner of the imaging screen press the Zoom key Rotate and Orbit appear on the bottom right corner of the imaging screen Press the Select key until Orbit is highlighted 4 orbit the image move the trackball Rotating a 3D Image To rotate the 3D image clockwise or counterclockwise turn the Angle rotary control or perform this procedure 1 Ifthe cursor appears on the imaging screen press the Enter key to remove the cur sor from the imaging screen 2 If Zoom and Pan appear on the bottom right corner of the imaging screen press the Zoom key Rotate and Orbit appear on the bottom right corner of the imaging screen 3 Press the Select key until Rotate is highlighted 4 rotate the image move the trackball Moving a 3D Image Around the Imaging Screen To move the 3D image around the imaging
142. de M2540 30000 ug 02 Using Quick Review in Dual Imaging In Dual Imaging you can freeze both images and use Quick Review on the active image To use Quick Review while you are in Dual Imaging 1 Press the Freeze key Both images are frozen The active image is labeled with an open circle The inac tive image is labeled with a solid circle 2 To scroll through the active image frame by frame move the trackball 3 To change which image is active press the control Left or Right for the image that you want to be active 4 To unfreeze the active image press the Freeze key again Quick Review About Quick Review Quick Review allows you to interrupt live imaging and scroll through a loop scroll through a trace or cause a loop to play back e Ifyou are in 2D Mode Color Power Angio or Color Mode you can either scroll through the loop frame by frame or cause the loop to play back repeatedly e Ifyou are in CW Spectral Doppler PW Spectral Doppler or MMode Trace you can scroll through either the image loop or the trace Using Quick Review To use Quick Review 1 While in live imaging press the Freeze key The image freezes on the current frame 2 Ifyou are in 2D Angio or Color Mode press the Select key until Scroll is high lighted on the bottom right corner of the imaging screen 3 If you are in CW Spectral Doppler PW Spectral Doppler or MMode do one of the following EnVisor Series User s Guide
143. delete a measurement in the report work area To edit a measurement in Image Review 1 Use the trackball to move the cursor over the endpoint 2 Press and hold the Enter key The measurement turns blue 3 Move the endpoint with the trackball 4 anchor the endpoint release the Enter key Manipulating Measurements in a Report You can view the image associated with measurements that appear in a report edit delete and label measurements and use the measurements in calculations To manipulate measurements that appear in a report EnVisor Series User s Guide 246 M2540 30000 ug 02 6 Press the Report key Click the Measure tab Use the trackball and the Enter key to highlight the measurement you want to manipulate Press the Select key Use the trackball and the Enter key to highlight one of the following options Delete Displays the associated image if the image was acquired You must con firm that you want to delete the measurement Edit Allows you to type a measurement value Label Allows you to choose a label for an unlabeled measurement Perform Displays the image so you can perform the measurement Relabel Allows you to relabel a measurement Show Image Displays the image associated with the selected measurement Use in Calcs Allows you to use the measurement in a calculation Press the Enter key Notes You can also delete a measurement from the report area by u
144. diameter Distance Distance True or residual diameter AIB Velocity Ratio Measurements Label Units Type Meaning Aortic Velocity A ems Generi veloc Aortic ded Generic velocity Renal Artery Velocity A Renal Artery Velocity B Generic velocity V odyA Mey Generi veloci Velocity B ems Velocity Generic velocity 164 EnVisor Series User s Guide M2540 30000 ug 02 Flow Volume Measurements Label En Units Type Meaning Aortic Flow Diam Distance Flow volume s diameter Aortic Mean Vel cm s Mean velocity Flow volume s mean velocity Flow Diam cm Distance Flow volume s diameter Mean Vel cm s Mean velocity Flow volume s mean velocity Renal Artery Flow Distance Flow volume s Diam diameter Renal Artery Mean cm s Mean velocity Flow volume s mean Vel velocity RAR Measurements Label Meaning Ao SV Aortic systolic velocity RA SV cm s Max velocity Renal systolic velocity Resistivity Index and Pulsatility Index Measurements Label Units Aortic Mean V jes Velocity Aortic MnV ms Velocity Aortic MxV jes Velocity Mean V PI jms Velocity EnVisor Series User s Guide 165 M2540 30000 ug 02 s m mi ee Renal Artery Mean V PI ms Velocity Renal Artery MnV jes Velocity Renal Artery Mx
145. ducers with multiple flow or Doppler frequencies The Adaptive Flow setting is available for some transducers if you have an EnVisor HD or an EnVisor C HD Adaptive Flow changes the flow frequency to an optimal frequency for that transducer for the selected focal zone Adaptive Flow is only avail able in Color Mode and Color Power Angio In PW Doppler the Frequency soft key is only available when the spectral trace is live Map Use the Map soft key to change the set of color hues that are mapped to the range of flow amplitudes Map F represents Directional Angio which uses two differ ent hues to indicate blood flow amplitude toward and away from the transducer Map Invert Use the Map Invert soft key to reverse the colors that represent flow direction switching from the BART Blue Away Red Toward format when Map Invert is off to the RABT Red Away Blue Toward format when Map Invert is on Map Invert is only available in Color Power Angio when Directional Angio is on To turn on Directional Angio select map F with the Map soft key Map Invert is always available in Color Mode Packet Use the Packet soft key to specify the flow packet size which determines the number of times each color or angio scan line is interrogated Increasing Packet increases color or angio sensitivity and decreases the frame rate Decreasing Packet decreases color or angio sensitivity and increases the frame rate Patient Temp Use the Patient Temp soft k
146. e The Time S D Ratio and RI appear in the results box 6 To approve the measurement and initiate another measurement press the Mea sure key To approve the measurement and exit Measurements press the Enter key Calculations About Calculations You can perform many calculations in each preset You can change the calculations available in the Calculations menu and you can create your own calculations for OB GYN presets The calculations available at any one time depend on the preset the mode and the options installed on your system Measurements that you perform and any resulting calculations appear in the results box on the upper right corner of the imaging screen Performing Calculations To perform a calculation EnVisor Series User s Guide 195 M2540 30000 ug 02 1 Press the Menu key above the Measure key The Measurements menu or the Calculations menu appears 2 If the Measurements menu is displayed press the Menu soft key to display the Calculations menu In the Calculations menu the current preset appears at the top and a list of calcu lations appears below 3 Highlight the measurement you want to perform with the trackball and press the Enter key or the Select key A list of the measurements and calculations that you need to perform for the selected calculation appears 4 Select and perform each of the measurements or calculations on the list You can perform them in any order Crea
147. e to refill 40483A 40483B TEE Supplies TEE tip protector box of 24 M2273A Bite guards case of 24 1828 TEE disinfection basin 2 110 TEE sheath kit 12 sheaths 40487 Biopsy Kits Biopsy Sheaths To order biopsy kits and sheaths contact CIVCO Medical Instruments Co 102 First Street Kalona IA 52247 9589 USA E mail info civcomedical com http www civco com EnVisor Series User s Guide 286 M2540 30000 ug 02 Call 1 800 445 6741 within the United States or 1 319 656 4447 outside of the United States To fax orders call 1 319 656 4451 VCR Supplies and Accessories VCR Supplies You can order the following supplies to use with your VCRs Description Part Number S VHS tapes case of 10 tapes SO TI20 13921B VCR Accessories You can order the following accessories to use with your VCRs Description Part Number Video in out cable M2540 09070 Audio in out cable M2540 69200 Serial cable M2540 69090 VCR tray allows you to place a blackand M2540 00810 white or a color printer on top of the VCR Strap bracket kit M2540 86020 Strap bracket M2540 00815 Note Philips requires that you use Super VHS SVHS tapes for VCR recordings EnVisor Series User s Guide M2540 30000 ug 02 287 288 EnVisor Series User s Guide M2540 30000 ug 02 Glossary 2D Reference Image The 2D reference image is the grayscale ultrasound image 3D Dat
148. e traced contour closely approximates the real circumference CO Cardiac Output 2D Mode and MMode The cardiac output CO normal range 4 8 1 min using the x volume method given the heart rate HR and the stroke volume SV is SV 1000 CO HR lt where SV EDV ESV and CO SV ESV Cope Cobe Ve Vede Veu CO MOD sp2 _ SV MOD sp2 EDV MOD sp2 ESV MOD sp2 EnVisor Series User s Guide M2540 30000 ug 02 307 CO MOD sp4 _ SV MOD sp4 JEDV MOD sp4 ESV MOD sp4 CO MOD bp SV MOD bp EDW MOD bp _ CO mod Simp SV mod Simp EDV mod Simp ESV mod Simp CO Cubed SV Cubed EDV Cubed ESV Cubed CO Teich SV Teich EDV Teich ESV Teich Belenkie Israel et al Assessment of Left Ventricular Dimensions and Function by Echocardiography American Journal of Cardiology June 1973 Vol 31 CO Cardiac Output Doppler The cardiac output CO 1 min using the Doppler velocity time integral VTI cm flow area A and heart rate HR BPM is VIL xHR xA F000 where VTIx Ax HRx CO LVOT LV VI VTI LVOT area Aortic HR Calafiore Stewart W J Doppler Echocardiographic Quantitation of Volumetric Flow Rate Cardiology Clinics May 1990 Vol 8 No 2 pp 191 202 D to S Ratio The formula for the diastolic
149. e Color key again to bring color data back to the frozen image 4 Press the Freeze key to return to live imaging Color Compare About Color Compare Color Compare shows color flow on the right hand image and a flow suppressed ver sion of the same image on the left Both images are live Color Compare is a type of Dual Imaging Using Color Compare To use Color Compare 1 While you are viewing a live image in Color Mode press the Left or the Right key Two images appear an image that shows color flow on the right and a flow sup pressed version of the same image on the left 2 Optional To transition to Dual Imaging without Color Compare press the Left or the Right key again 3 To exit press the 2D key 88 EnVisor Series User s Guide M2540 30000 ug 02 Color Power Angio About Color Power Angio In Color Power Angio an angio box appears on the image The amplitude intensity of flow in the angio box is represented with different hues The colors being used appear in the color bar on the upper right corner of the imaging screen Turning on Color Power Angio turns off Color Mode but does not turn off MMode PW Doppler or CW Doppler Using Color Power Angio To use Color Power Angio 1 In 2D Mode optimize the image 2 Resize and reposition the 2D image if necessary Press the Angio key to enter Color Power Angio An angio box appears on the image Resize and reposition the angio box with the trackball
150. e Left key or the Right key while a body marker is displayed on the imag ing screen or press the Body Mark key while you are in Dual Imaging The body marker appears on both images 2 Optional Manipulate the body marker on the active image with the soft keys 3 Optional To manipulate the body marker on the inactive image press the soft key that corresponds to the inactive image the Left soft key or the Right soft key 4 Optional To freeze one of the two images press the Freeze key You can manipulate the body marker on the frozen image EnVisor Series User s Guide 141 M2540 30000 ug 02 Activating Body Markers During Dual Imaging and Freeze You can choose to have a body marker automatically appear on the imaging screen during Dual Imaging and Freeze when you press the Left key the Right key or the Freeze key To activate body markers during Dual Imaging and Freeze 1 Press the Setup key The Setup window appears 2 Click the System tab The System window opens 3 Select the Activate body marker during freeze and dual check box 4 Click Apply Note When you activate body markers during Dual Imaging and Freeze the follow ing occur e When you press the Freeze key you must press the Body Mark key before using the trackball to scroll through the frames e When you press the Left key or the Right key a body marker appears on both images 142 EnVisor Series User s Guide M2540 30000 ug 02 Ana
151. e Measure key Place the fifth caliper below the baseline Press the Measure key Place the sixth caliper above the baseline to create the beta angle Note The two lines must intersect Press the Enter key to complete the measurement The Hip Angle Alpha and Hip Angle Beta measurements appear in the results box Labeled Measurements by Exam Type About Labeled Measurements by Exam Type All labeled measurements are listed by exam type in the topics in this book Informa tion about each measurement such as units measurement type and meaning is included in the tables Instructions for performing the measurements are not included in the tables Abdominal Measurements All abdominal measurements are listed in the following tables which appear in alpha betical order EnVisor Series User s Guide 163 M2540 30000 ug 02 Stenosis Measurements Label Aortic Area Aortic Area 2 Aortic Diam Aortic Diam 2 Area Area 2 Diam Diam 2 Renal Artery Area Renal Artery Area 2 Renal Artery Diam Renal Artery Diam 2 Meaning Ara True or residual area True or residual area Distance True or residual diameter Distance True or residual diameter True or residual area True or residual area True or residual diameter Distance True or residual diameter Area True or residual area True residual area Distance True or residual
152. e Select key MOD is highlighted on the bottom right corner of the imaging screen Position the long axis with the trackball To approve the measurement and perform another measurement press the Mea sure key To approve the measurement and exit Measurements press the Enter key The measurement turns white to indicate that it is complete Choosing Quick Calcs You can specify which Quick Calcs appear in the results box on the upper right corner of the imaging screen for the current preset To choose which Quick Calcs appear in the results box 1 Press the Setup key The Setup window opens Click the Measurements tab The Measurements window opens Click 2D MMode or Doppler to specify the Quick Calcs that appear when you are in that mode Select the check boxes for the Quick Calcs that you want to see in the results box for the current preset when you are in the specified mode Click Apply Click OK Click Apply Click Close EnVisor Series User s Guide M2540 30000 ug 02 Obtaining an RI Calculation and an S D Ratio To obtain an RI calculation and an SD ratio you need to perform a 2 point measure ment on a waveform 1 Acquire a waveform 2 Press the Measure key 3 Use the trackball to place the first caliper on systole 4 Press the Select key to highlight Endpt 2 on the bottom right corner of the imag ing screen 5 Use the trackball to place the second caliper on diastol
153. e appears above the large Dop pler trace Large over small The large 2D reference image appears above the small Dop pler trace Side by side The Doppler trace and the reference image appear next to each other e Full screen A full screen Doppler trace appears A very small reference image appears in the corner Changing the Spectral Trace Format To change the spectral trace format l Press the Setup key The Setup window opens 2 Click the Mode tab The Mode window opens 3 Select a spectral trace format Small over large e Large over small e Side by side e Full screen 4 Click Apply EnVisor Series User s Guide 79 M2540 30000 ug 02 80 5 Click Close CW Doppler About CW Doppler Continuous Wave CW Doppler is a Doppler mode that measures velocity along a Doppler line and displays that information in a spectral trace with audio output Note CW Doppler is only available with transducers that support CW Doppler Using CW Doppler To use CW Doppler 1 7 Do one of the following If you are in a noncardiac preset press the CW key A CW reference line appears on the 2D image This is CW Doppler Preview If you are in a cardiac preset you do not need to press the CW key A 2D refer ence line appears on the 2D image Move the focus diamond on the reference line to the anatomy of interest with the trackball Press the CW key From CW Doppler Preview you can al
154. e frame rate Filter Use the Filter soft key to remove extraneous color information due to tissue motion rather than blood flow Increasing Filter decreases low velocity information and noise EnVisor Series User s Guide M2540 30000 ug 02 Decreasing Filter increases sensitivity to low velocity information Frequency Use the Frequency soft key to specify the transducer frequency used for color angio or Doppler data The Frequency soft key is available only for transducers with multiple flow or Doppler frequencies The Adaptive Flow setting is available for some transducers if you have an EnVisor HD or an EnVisor C HD Adaptive Flow changes the flow frequency to an optimal frequency for that transducer for the selected focal zone Adaptive Flow is only avail able in Color Mode and Color Power Angio In PW Doppler the Frequency soft key is only available when the spectral trace is live Map Use the Map soft key to change the set of color hues that are mapped to the range of flow amplitudes Map F represents Directional Angio which uses two differ ent hues to indicate blood flow amplitude toward and away from the transducer Map Invert Use the Map Invert soft key to reverse the colors that represent flow direction switching from the BART Blue Away Red Toward format when Map Invert is off to the RABT Red Away Blue Toward format when Map Invert is on Map Invert is only available in Color Power Angio when Directional Angi
155. e frozen image appears on the right In Quick Review press the Left key to enter Dual Imaging Quick Review The frozen image is on the left and the live image on the right In Dual Imaging press the Left key to make the left image live In Dual Imaging Quick Review press the Left key to make the left image the active frozen image In Angio or Color Mode press the Left key to turn Angio Compare or Color Com pare on or off Angio Compare or Color Compare displays the angio or color flow image on the right and a flow suppressed version of the same image on the left LGCs Move the LGC Lateral Gain Control slide controls up or down to adjust the ampli fication of a returning 2D signal Use the left LGC slide control to control the left half EnVisor Series User s Guide M2540 30000 ug 02 of the image area Use the right LGC slide control to control the right half of the image area In general align the LGC slide controls in the middle and adjust them as necessary Measure Press the Measure key to display the measurement soft keys and to start an unlabeled measurement A caliper appears on the image In Panoramic Imaging press the Measure key to perform a two point measurement Menu Label Press the Menu key above the Label key to display the Label soft keys and choose a label to place on the imaging screen Menu Measure Press the Menu key above the Measure key to display the Measurement soft keys and to choose wh
156. e labeled measurements from the Measurements menu You can perform several labeled calculations in each preset You can change the measurements available in the Measurements menu The measurements available at any one time depend on the preset the mode and your system s options Results of measurements that you perform appear in the results box on the upper right corner of the imaging screen Results of labeled measurements appear in the report There are eight types of crosshairs Each measurement and its corresponding value in the results box are labeled with the same type of crosshair so that you know which value is associated with each measurement Performing Labeled Measurements As you perform labeled measurements the results of the measurements appear in the results box on the upper right corner of the imaging screen and the results are saved in the report To perform a labeled measurement EnVisor Series User s Guide 159 M2540 30000 ug 02 1 Press the Menu key above the Measure key The Measurements menu or the Calculations menu appears 2 Ifthe Calculations menu is displayed press the Menu soft key to display the Mea surements menu In the Measurements menu the current preset appears at the top and a list of measurements appears below 3 Highlight the measurement you want to perform with the trackball and press the Enter key or the Select key A crosshair appears on the image 4 Perform the measurement
157. e labels for the current preset 4 Click Apply 5 Click Close Body Markers About Body Markers You can place a body marker graphic on the imaging screen to indicate the part of the anatomy that you are scanning When you place the body marker a transducer icon also appears You can manipulate it to show the position and orientation of the trans ducer EnVisor Series User s Guide M2540 30000 ug 02 Exiting Body Markers To exit Body Markers and remove the body marker and the transducer icon from the imaging screen press the Erase Marker soft key To exit Body Markers and leave the body marker and the transducer icon on the imag ing screen press the Body Mark key or the key for another mode or application Placing a Body Marker on the Imaging Screen To place a body marker and a transducer icon on the imaging screen press the Body Mark key A body marker and a transducer icon appear on the imaging screen Choosing a Body Marker You can choose from many body markers to represent the body part that you are scan ning To specify which body marker appears on the imaging screen do one of the following 1 Press the lt Body Marker Set gt soft key repeatedly until the set of body markers that you want appears Note Body marker sets are organized by exam type 2 Press the lt Body Marker gt soft key repeatedly until the body marker that you want appears Or 1 Press the View All soft key The Body Markers windo
158. e more likely to produce ECG artifacts due to increased muscle movement and respiration rates The type of Stress Echocardiography exam you perform influences the probability of ECG artifact occurrences as described below EnVisor Series User s Guide M2540 30000 ug 02 259 Muscle Motion Artifacts Examination Type Respiration Artifacts Recommended Type of ECG Traditional Echocardiography Stress Echo Pharmacological Stress Echo Exercise The presence of ECG artifacts can cause the following problems The heart rate display may be inaccurate if an artifact is detected as a heart beat e premature trigger for image acquisition may occur due to an ECG artifact Philips highly recommends that you videotape Stress Echo studies to avoid losing image data due to ECG artifacts Minimizing ECG Artifacts The following options may reduce the incidence of ECG artifacts and triggering prob lems during Stress Echo studies The best way to monitor ECG artifacts is to activate the audible R wave beep This audio signal helps you distinguish between true arrhythmias and premature triggering caused by ECG artifacts To minimize motion and respiration artifacts use a 12 lead cardiograph Adjust the ECG Gain so that the QRS pulses are detected and an accurate heart rate appears on the ultrasound system Some 12 lead cardiographs provide a square wave pulse output signal that can be input into
159. e presence of voltages greater than 1000 VAC 600 VAC in the United States ESD electrostatic discharge symbol The product is marked with the 4 following symbol to warn the user not to touch exposed pins Touching exposed pins can cause electrostatic discharge which can damage the product Monitor Radiation The monitor used in this system complies with the FDA regulations that were appli cable at the date of manufacture 21 CFR Subcategory J Prescription Device The United States Food and Drug Administration requires the following labeling statement CAUTION iv United States federal law restricts this device to use by or on the order of a physician EnVisor Series User s Guide M2540 30000 ug 02 CE Marking marking is for Council Directive 93 42 This system complies with the Medical Device Directive Authorized EU Representative Philips Medical Systems Nederland B V Corporate Quality and Regulatory Group Veenpluis 4 5684 PC Best The Netherlands Email PMS Incident philips com This Guide This guide provides information to help you use the EnVisor series ultrasound system The following imaging systems are included in the EnVisor series EnVisor General Imaging EnVisor C Cardiac Imaging EnVisor HD High Definition Imaging EnVisor C HD Cardiac High Definition Imaging Intended Audience The EnVisor Series Users Guide is intended for sonographers physician
160. e system covers To avoid electrical shock use only supplied power cords and connect only to properly grounded wall wall mains outlets Explosion Hazard Do not operate the system in the presence of flammable anesthetics Electromagnetic Compatibility Hazard Medical equipment needs to be installed and put into service according to the special electromagnetic compatibility guidelines provided in the Philips EnVisor Series Safety and Standards Guide EnVisor Series User s Guide M2540 30000 ug 02 Radio Frequency Communications Equipment Hazard The use of portable and mobile RF communications equipment can affect the opera tion of medical equipment Safety Information Before you use the Philips EnVisor series ultrasound system be sure to read the Philips EnVisor Series Safety and Standards Guide Before you use any transducer for the first time be sure to read all applicable usage patient safety operator safety and electrical safety guidelines in the Safety and Standards and Transducer documentation for your system Warning Symbols Used on the EnVisor Series Documentation The product is marked with the following symbol when it is necessary to refer to the EnVisor Series Online Help or other documentation such as the Philips EnVisor Series Safety and Standards Guide or the Philips EnVisor Series Transducer Guide 5 Dangerous voltages symbol This symbol appears adjacent to high voltage termi nals It indicates th
161. e to flow arrow with the Angle rotary control if necessary Adjust the spectrum with the Doppler Gain Scale and Baseline rotary controls if necessary Use the soft keys to optimize the spectral trace EnVisor Series User s Guide M2540 30000 ug 02 9 To control whether the 2D reference image or the PW spectral trace is live press the Spectral key or the Enter key The soft keys affect the element that is live 10 To scroll the spectral trace press the Freeze key and use the trackball to scroll for ward or backward 11 To exit PW Doppler press the 2D key the MMode key or the PW key Note If you press the Spectral key when you are in 2D Mode you enter PW Spectral Doppler Using PW Doppler Soft Keys These are the soft keys that may be available to you in PW Doppler Preview or PW Spectral Doppler To change any of the settings listed below press the oval key below the soft key label Audio Use the Audio soft key to turn Doppler audio on or off Audio is only available in PW Doppler Preview Colorize Use the Colorize soft key to assign a colorization map that replaces the gray scale map to improve contrast resolution The choices are Sepia Rainbow Thallium and Wheat In MMode and Doppler Mode the Colorize soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted Compress In CW or PW Doppler Preview
162. ean velocity of the uterine artery 186 EnVisor Series User s Guide M2540 30000 ug 02 Uterine SV cm s Velocity Measure the systolic velocity of the uterine artery UTH i Un m Lem Uterine length Uterine wich VdodyA e Mey Generi veloci Velocity B cm s Velocity Generic velocity Vascular Measurements All vascular measurements are listed in the following tables which appear in alphabet ical order Stenosis Measurements Label Units Meaning Area Jom Area True or residual area Area 2 True or residual area Diam jem True or residual diameter Diam 2 jem Length True or residual diameter EnVisor Series User s Guide 187 M2540 30000 ug 02 AIB Velocity Ratio Measurements Label Units Meaning CCADV j j CCA SV cm s Maximum Common carotid artery systolic velocity velocity ECA DV ems Maximum External carotid artery diastolic velocity velocity ECA SV cm s Maximum External carotid artery systolic velocity velocity ICA DV emis Maximum Internal carotid artery diastolic velocity velocity ICA SV cm s Maximum _ Internal carotid artery systolic velocity velocity SCA DV ems Maximum _ Subclavian artery diastolic velocity velocity SCA SV cm s Maximum __ Subclavian artery sy
163. ean of the peaks EnVisor Series User s Guide M2540 30000 ug 02 205 Velocity Ratios Calculations Label Formula Meaning A B Generic A B velocity ratio Aortic A B A to B Ratio Ratio Generic A B velocity ratio Aortic RAR Systolic Ratio Rato Renal aortic systolic velocity ratio RAR Renal aortic systolic velocity ratio Generic A B velocity ratio Renal Artery A B Renal Artery RAR Systolic Ratio Renal aortic systolic velocity ratio Volume Calculations Label Ellipsoid three axis volume Aortic Volume Ellipsoid three axis volume Renal Volume Volume Ellipsoid three axis volume Volume Volume Ellipsoid Three Axis Angle Calculations All angle calculations are listed in the following table See Appendix A for the formula inherent approximations and assumptions and clinical references for each calculation EnVisor Series User s Guide 204 M2540 30000 ug 02 Label Hip angle Angle in degrees Bony acetabular root line angle bony root angle Hip angle p Angle Angle in degrees Cartilage root line angle cartilage root angle Cardiac Calculations All cardiac calculations are listed in the following tables which appear in alphabetical order See Appendix A for the formula inherent approximations and assumptions and clinical references for each calculation EnVi
164. early focused If you have an EnVisor HD or EnVisor C HD you can choose up to eight focal zones depending on the current imaging depth EnVisor Series User s Guide 67 M2540 30000 ug 02 68 and the transducer you are using Otherwise you can choose up to four focal zones If you are using Trapezoidal Imaging you can choose no more than four focal zones Using multiple focal zones decreases the frame rate Each time you press the Focal Zones soft key you increase the number of focal zones or the space between them When you reach the maximum number of focal zones pressing the Focal Zones soft key gives you one focal zone The Focal Zones soft key is not available with sector transducers In Zoom pressing the up arrow on the Focal Zones soft key adds focal zones it does not increase the space between focal zones Map Use the Map soft key to specify the postprocessing grayscale map In MMode and Doppler modes the Map soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted Map is not available when a spectral trace is live Patient Temp Use the Patient Temp soft key to enter the patient s temperature Patient Temp is only available when a TEE transducer is selected Persist Use the Persist soft key to average consecutive frames to provide a smoother appearance with less noise Use lower persistence values for fast mo
165. ears in blue to indicate that it is active 2 Press the Select key Manual is highlighted on the bottom right corner of the imaging screen 3 Move the trackball to trace the region that you want to measure 4 Optional To erase the trace one dot at a time press the Del key above the Mea sure key 5 To approve the measurement and perform another measurement press the Mea sure key To approve the measurement and exit Measurements press the Enter key If you do not create an enclosed region the traced area will automatically be closed The measurement turns white to indicate that it is complete Performing a Method of Disks Measurement You can perform a Method of Disks measurement to measure the volume of an irreg ularly shaped area As you perform unlabeled measurements the results of the mea surements and of the associated Quick Calcs appear in the results box on the upper right corner of the imaging screen To perform a Method of Disks measurement 1 Press the Measure key three times 2 Press the Select key Manual is highlighted on the bottom right corner of the imaging screen A caliper appears on the imaging screen The measurement appears in blue to indicate that it is active EnVisor Series User s Guide 193 M2540 30000 ug 02 194 Move the trackball to trace the region that you want to measure Optional To erase the trace one dot at a time press the Del key above the Mea sure key Press th
166. ears on the right of an inverted image In cardiac presets the location of the transducer orientation dot is reversed L R Invert is only available in live imaging and is not available when a spectral trace is live Map Use the Map soft key to specify the postprocessing grayscale map In MMode and Doppler modes the Map soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted Map is not available when a spectral trace is live Patient Temp Use the Patient Temp soft key to enter the patient s temperature Patient Temp is only available when a TEE transducer is selected Persist Use the Persist soft key to average consecutive frames to provide a smoother appearance with less noise Use lower persistence values for fast moving organs or tis sues and higher persistence values for slower moving organs or tissues Smooth Use the Smooth soft key to soften or sharpen the 2D image Higher settings make the image softer Lower settings make the image sharper EnVisor Series User s Guide M2540 30000 ug 02 Trap Use the Trap soft key to turn Trapezoidal Imaging on or off Trapezoidal Imag ing is available with most linear transducers This soft key appears only in 2D Mode when a trapezoidal capable linear transducer is selected If you turn Trapezoidal Imag ing on when you are in 2D Mode it remains on if you switch to another mode
167. ease the compression with the Compress soft key and decrease the Reject set ting with the Reject soft key to increase the range of echoes displayed e Decrease the Filter setting with the Filter soft key e Ifyou are in PW Doppler turn the Angle rotary control to adjust the estimated angle of flow EnVisor Series User s Guide 1 15 M2540 30000 ug 02 116 Note After adjusting any control or soft key always check the position of the trans ducer Goal I want to remove artifacts from the spectrum Solution e Decrease the gain by turning the Doppler Gain rotary control counterclockwise e Increase the Filter setting with the Filter soft key e Decrease the power by turning the Power rotary control counterclockwise Note After adjusting any control or soft key always check the position of the trans ducer Goal I want to reduce noise in the spectrum Possible Actions e Decrease the gain by turning the Doppler Gain rotary control counterclockwise e Ifyou have an EnVisor HD or an EnVisor C HD press the Setup key click the Mode tab and select Adaptive Doppler e Increase the Filter setting with the Filter soft key e Increase the Reject setting with the Reject soft key e Decrease the compression with the Compress soft key Note After adjusting any control or soft key always check the position of the trans ducer Goal I want the Doppler to be more sensitive Possible Actions e Increase the ga
168. ed to delete studies according to the Disk Full Strategy Immediate Auto Delete A study is automatically deleted when all of its images are exported over a network Note If you assigned a server to the Storage Commit SCP studies are not deleted EnVisor Series User s Guide 45 M2540 30000 ug 02 46 until the Storage Commit SCP notifies the Storage SCP that a copy of the studies has been made 9 Click OK 10 Click OK 11 Click Close Notes e Ifyou have any questions about servers as your network administrator e DICOM export is a component of the DICOM Basic option Automatic DICOM Printing About Automatic DICOM Printing You can set up automatic DICOM printing so that images are automatically sent to a DICOM printer when you press the Acquire key or when you save or close a study Notes By default a page is not printed until six images are sent to the DICOM printer The ability to print to a networked DICOM printer is a component of the DICOM Basic option Setting Up Automatic DICOM Printing To set up automatic DICOM printing 1 Press the Setup key The Setup window opens 2 Click the System tab The System window opens 3 Click DICOM The DICOM Setup window opens EnVisor Series User s Guide M2540 30000 ug 02 10 11 12 Click the Servers amp Roles tab The Servers amp Roles window opens In the Roles area click Modify To specify a black and white pr
169. eject setting with the Reject soft key Decrease the compression with the Compress soft key Note After adjusting any control or soft key always check the position of the trans ducer Imaging Tips for CW Doppler Goal I want the 2D reference image to be updated EnVisor Series User s Guide M2540 30000 ug 02 Possible Actions e Make sure that the Delay or the Update soft key does not read 2D Hold On Change the Update interval at which your 2D image is updated with the Update soft key e Increase the ECG Gain setting with the ECG Gain soft key Press the Setup key to display the ECG Gain soft key e Press the Enter key the Spectral key to manually update the 2D image Press the Enter key or the Spectral key again to make the spectral trace live again e Check the ECG leads for proper placement Note After adjusting any control or soft key always check the position of the trans ducer Goal I want to display low velocity signals Possible Action e Decrease the scale by turning the Scale rotary control counterclockwise e Decrease the Filter setting with the Filter soft key Note After adjusting any soft key always check the position of the transducer Goal I need to be able to see a Doppler signal that is audible but not visible Possible Actions e Adjust the scale by turning the Scale rotary control e Increase the gain by turning the Doppler Gain rotary control clockwise e Incr
170. el on the Imaging Screen To type your own label on the imaging screen using the Label key 1 Press the Label key Cursor is highlighted on the bottom right corner of the imaging screen 2 Position the cursor with the trackball 3 Type the label Modifying a Label To modify a label on the imaging screen 1 Press the Label key 2 Use the trackball to move the cursor over the label 3 Use the keyboard and the soft keys to add or remove text from the label Note You can also press the Tab key on the keyboard to move word by word through the labels on the imaging screen Placing an Arrow on the Imaging Screen To place an arrow on the imaging screen 1 Press the Label key 2 Press the Arrow soft key EnVisor Series User s Guide M2540 30000 ug 02 3 4 Use the trackball to move the arrow To anchor the arrow press the Enter key Rotating an Arrow To rotate an arrow 1 2 3 4 Press the Label key Use the trackball to position the cursor over the label or the arrow Press the Enter key Turn the Angle rotary control Moving or Deleting a Label or an Arrow To move a label or an arrow 1 ND WN Press the Label key Use the trackball to position the cursor over the label or the arrow Press the Enter key Use the trackball to move the label or the arrow to the new position To anchor the label or the arrow press the Enter key To delete a label or an arrow
171. ements are removed before the loop is exported When you import the study you cannot reactive measurements or perform new measurements To export the current study in DICOM format When you export a study some patient demographic information may not be exported 1 1 In Image Review click gg 2 If necessary close the study and save your changes when you are prompted 3 Choose the destination for the study Note In the Destination drop down menu disk drives are identified with a drive letter and drive name Networked DICOM servers and printers are identified as DICOM PACS or DICOM printer 4 Click Start export Exporting Patient Studies You can export any patient study using the Search for Study window If you have the DICOM Media option studies exported to an optical disk or a CD R can be viewed on any DICOM viewer If you do not have the DICOM Media option exported studies can only be viewed on EnVisor A 1 systems EnVisor Series User s Guide M2540 30000 ug 02 If you have the DICOM Basic option you can export a study across a network to DICOM PACS system The following icons that appear next to the studies in the Search for Study window indicate the export status of the study e gt The study has been exported at least once to an optical disk to a CD R or over a network The study is queued to be exported over a network When the system receives confirmation that the study was exported
172. ements using the leading edge to leading edge technique When measuring slopes use measurement points as far apart as the waveform per mits EnVisor Series User s Guide M2540 30000 ug 02 Display Size Adjust the display so that the area of interest fills a large portion of the imaging screen You can adjust the image display size with the Depth key or with the Zoom key and the trackball Sweep Speed Time measurements in MMode and spectral Doppler are improved at high sweep set tings Transducer Selection Select a transducer appropriate for the application Higher frequency transducers pro vide better resolution but sacrifice penetration Lateral resolution is best where the ultrasound beam width is narrowest the focal region of the transducer For best results use a high frequency transducer for measuring small distances if depth of pen etration allows and use a transducer that focuses near the area of interest In Doppler modes lower frequency transducers can measure higher maximum veloci ties but resolution is lower for lower frequency transducers than for higher frequency transducers Use of ECG Trace The ECG trace represents the heart s electrical activity and the screen image repre sents the heart s mechanical activity Use the ECG trace as a guide for locating the mechanical end of the diastolic and the systolic phases About Measurement Primitives The EnVisor Series uses the following primary
173. emp soft key to enter the patient s temperature Patient Temp is only available when a TEE transducer is selected Persist Use the Persist soft key to average consecutive frames to provide a smoother appearance with less noise Use lower persistence values for fast moving organs or tis sues and higher persistence values for slower moving organs or tissues Persist is not available when a spectral trace is live Reject Use the Reject soft key to darken background noise in the spectrum Increase Reject for strong Doppler signals decrease Reject for weak signals Smooth Use the Smooth soft key to change the appearance of the Doppler spectrum Smooth has eight settings Generally lower settings provide a softer smoother verti cally brushed texture and higher settings provide a sharper dot like texture Spectral Invert Use the Spectral Invert soft key to invert the spectral display so that positive values representing blood movement toward the transducer are shown beneath the Doppler baseline and negative values representing blood movement away from the transducer are shown above Spectral Invert also swaps the stereo audio channels Spectral Invert is only available when the spectral trace is live EnVisor Series User s Guide M2540 30000 ug 02 Sweep Use the Sweep soft key to control the travel speed of the ECG or the auxiliary trace U D Invert Use the U D Invert soft key to reverse the up down orientation of the image
174. en placing an arrow label turn the Angle rotary control to rotate the arrow When using body markers turn the Angle rotary control to rotate the transducer icon Baseline In PW and CW Doppler turn the Baseline rotary control to adjust the zero baseline position in the Doppler spectral trace In Color Mode turn the Baseline rotary control to shift the color map to unwrap aliased flow and display more hemodynamics In Color Power Angio turn the Baseline rotary control to adjust the amplitudes dis played Body Mark Press the Body Mark key to display the body marker soft keys and choose a body marker to place on the imaging screen Color Press the Color key to enter Color Mode or to add color information to the reference image in PW Doppler CW Doppler or MMode In Color Mode press the Color key when an image is frozen to temporarily suppress color information from the frozen image without exiting Color Mode This is called Color Suppress CW In a cardiac preset press the CW key to display the CW spectral trace In a noncardiac preset press the CW key to enter CW Preview so that you can posi tion the CW reference line Press the CW key again to display the CW spectral trace EnVisor Series User s Guide 11 M2540 30000 ug 02 12 Del Label Press the Del key above the Label key to delete a selected label If no label is selected all of the labels are deleted When thumbnails are displayed in Image Review
175. en using gestational sac diameter GSD1 range 0 2 7 3 cm The following table lists the standard deviation SD in days GS GA SD GS GA SD GS GA SD GS GA SD D D D EOS pens ens EnVisor Series User s Guide 326 M2540 30000 ug 02 10 8 01 p perpe Tee so 1 3 3110 p je esp Ter s aer e eee Tes pepe a Term spo 1 se zem peer Ter mop Tr ER ER m 23 e German Society for Gynecology and Obstetrics March 1991 Issue 15 Vol 1 23 28 GA GSD via Tokyo Gestational age wk day via Tokyo University using gestational sac diameter GSD1 range 1 0 6 7 cm GSD GA 1 0 4 1 6 5 22 2 7 7 34 IE 4 1 9 48 5 7 67 12 Masahiko Mizuno et al Assessment of Fetal Growth using Ultrasound Measurements Nichidoku Iho Japanisch Deutsche Medizinische Berichte in Japanese 1989 34 3 537 544 EnVisor Series User s Guide M2540 30000 ug 02 327 GA HC via Hadlock Given the head circumference HC range 5 6 35 7 cm the gestational age via Hadlock HC GA Hadl in weeks is 8 96 0 540 HC 0 0003 HC 3 Hadlock et al Estimating Fetal Age Computer Assisted Analysis of Multiple Growth Parameters Radiology 1984 152 497 501 GA HL via Jeanty The formula for ge
176. ence image appear next to each other e Full screen A full screen MMode trace appears A very small reference image appears in the corner Changing the MMode Format To change the MMode format 1 Press the Setup key The Setup window opens 2 Click the Mode tab The Mode window opens EnVisor Series User s Guide 69 M2540 30000 ug 02 70 J Select an MMode format option Small over large Side by side Full screen Click Apply Click Close Color MMode About Color MMode You are in Color MMode when you are in Color Mode and MMode at the same time In Color MMode a color box appears on the 2D reference image and information about color flow along the entire MMode reference line appears in the MMode trace The position of the color box in the 2D reference image does not affect the color information displayed in the MMode trace Using Color MMode To use Color MMode 1 2 Press the Color key Do one of the following If you are in a noncardiac preset press the MMode key to enter Color MMode Preview An MMode reference line appears on the 2D image Move the MMode reference line to the anatomy of interest with the trackball Press the MMode key again or press the Enter key If you are in a cardiac preset move the 2D reference line to the anatomy of inter est with the trackball Press the MMode key The MMode trace appears with the 2D reference image This is Color MMode Trace Information
177. er Depth gt soft key is only available when the Biopsy soft key setting is Gun or Needle and the selected transducer supports multiple crossover depths If the selected transducer supports a biopsy guide with more than one needle position a soft key that lists the transducer name and the current crossover depth the lt Cross over Depth gt soft key appears next to the Biopsy soft key Press the lt Crossover Depth gt soft key to choose the correct crossover depth Warning The crossover depth is only an estimate Never use the crossover depth exclusively to identify the needle position on the biopsy guide Never use the crossover depth as a replacement for using the depth marker or performing measurements Moving the Biopsy Depth Marker A depth marker a crosshair appears on the anticipated needle path The minimum needle length needed to reach the depth marker appears at the top of the imaging screen Note The depth marker may not appear on the image until you move the trackball down To move the biopsy depth marker 1 Press the Select key until Needle is highlighted on the bottom right corner of the imaging screen 2 Move the biopsy depth marker with the trackball EnVisor Series User s Guide 127 M2540 30000 ug 02 128 Dual Imaging About Dual Imaging Dual Imaging allows you display two images side by side so that you can compare them You can choose which image is frozen and which is live or you can freeze bo
178. er frequency Note After adjusting any control or soft key always check the position of the trans ducer EnVisor Series User s Guide 123 M2540 30000 ug 02 124 EnVisor Series User s Guide M2540 30000 ug 02 Imaging Tools About Imaging Tools The EnVisor Series offers four imaging tools that give you more flexibility and options while you are imaging a patient e Biopsy Dual Imaging e Quick Review Zoom Biopsy Feature About the Biopsy Feature The Biopsy feature helps a physician position a transducer and an attached biopsy needle during an ultrasound biopsy procedure by displaying one or two guidelines on the image that show the anticipated path of the biopsy needle Note The biopsy guide for the L12 5 50 has infinite angle capability and can be installed on either side of the transducer it does not constrain the biopsy needle to a particular path Because the needle path is not predictable neither biopsy soft keys nor biopsy graphics appear on the imaging screen when you are using the L12 5 50 transducer For information about the 112 5 50 biopsy guide see the En Visor Series Transducer Guide in the EnVisor Series Reference Guide Warnings See the EnVisor Series Transducer Guide in the EnVisor Series Reference Guide for important information about biopsy capable transducers Biopsy guidelines are intended as guides only Never use biopsy guidelines as an absolute reference e Biopsy guidelines d
179. er to the appropriate DICOM role click Modify in the Roles area 11 For each DICOM role choose the appropriate server from the drop down list 12 To specify the parameters for each role click the Advanced button to the right of the drop down menu 13 In the Roles area click Done 14 Click OK 15 Click Close Automatic DICOM Export About Automatic DICOM Export You can set up automatic DICOM export so that images are automatically exported over a network when you press the Acquire key or when you save or close a study You can set up automatic study deletion so that a study is automatically deleted as soon as all of its images are exported over a network Note The ability to export to a DICOM PACS system or a DICOM printer is a component of the DICOM Basic option Setting Up Automatic DICOM Export Before you use automatic DICOM export you must assign and select a valid Storage SCP server That is where the images are saved You may also select a Storage Commit SCP server Images exported to the Storage SCP server are backed up on the Storage Commit SCP server If you have any questions about servers ask your network administrator To set up automatic DICOM export 1 Press the Setup key The Setup window opens 2 Click the System tab The System window opens EnVisor Series User s Guide M2540 30000 ug 02 3 Click DICOM The DICOM Setup window opens 4 Click the Servers amp Roles tab The Servers
180. erage Ultrasound Age Biophysical Profile Total Derived Gestational Age EDC AUA EDC LMD EnVisor Series User s Guide M2540 30000 ug 02 Weight Percentiles Doppler Trace About Doppler Trace Automatic Doppler trace automatically traces a frozen Doppler spectrum over one heart cycle and uses the trace to calculate and display the results of key Doppler mea surements and calculations Automatic Doppler trace allows you to save time during a patient exam In a manual Doppler trace you manually trace the Doppler spectrum On the trace the system displays the measurement bars that represent three points on the spectrum e Systolic S e Diastolic D e Next systolic S1 The systemic diastolic and mean velocity for this trace are automatically calculated and the results appear in the results box on the upper right corner of the imaging screen Note Automatic Doppler trace is available only in noncardiac application presets About Pulsatility Index and Resistivity Index Doppler Trace uses the end diastolic velocity D 70 the minimum velocity as rec ommended in some medical sources to calculate Pulsatility Index and Resistivity Index S1 end diastolic velocity minimum veloci EnVisor Series User s Guide 151 M2540 30000 ug 02 152 You can manually position the D and 1 bars If you manually move the D bar to select the minimum velocity in the situation shown in the figure above PI and RI a
181. eset Soft este ad esu yt wees 32 Removing the Name of a Preset from the Imaging Screen 32 Saving Setup Changes to a Preset aUa ty edu reet ex ux m Ead pd PR V 32 Options a vara eur edv GRUT ire 33 About Optols seue ood uersus err Ra o dean iur quet Let ui D Dd 33 Installing Options ve o nt ko aceto ste eiui ate a e a retis atu rave De A 34 About Option Keys uiae ossia auda o A pcs el e i 35 Assigning Option 35 System Settings cin eier dak E RT ELEC ESPERE 36 About oysters qud doc eu 36 Changing System Settings 5 37 Specifying the Disk Stidtesy cs ores view See VT E SE NEAR 38 DICOM Features sa ice co arate ws NO RU ORE aU ORB WORD ORI CR 39 EnVisor Series User s Guide w2540 30000 ug 02 About DICOM Features so ng oue Sor RU Ede 39 Entering DICOM Settings itr re da each inet nd de IRL eade Wh e 40 DICOM S ryers o bk td 41 Automatic DICONDEXDORGO a Sox CS a ut ade dtr AA T alee 42 Automatic DICOM Printing 26044544 eR ru ad RR Va eee d 46 Modality Worklist 24 054 5 a8 VE EXE RC ee 49 Imagine Modesa 2s 4 es DOR 8 te EU AP c RUP A
182. ess the Measure key To approve the measurement and exit Measure ments press the Enter key Performing a 2 Point Measurement You can perform a 2 point linear measurement to measure the length of a structure or a length of time As you perform unlabeled measurements the results of the mea surements and of the Quick Calcs appear in the results box on the upper right corner of the imaging screen To perform a 2 point measurement 1 Press the Measure key A caliper appears on the imaging screen The measurement appears in blue to indicate that it is active Use the trackball to position the caliper Press the Select key A second caliper appears on the imaging screen Use the trackball to position the second caliper Optional To reposition a caliper press the Select key repeatedly until the caliper that you want to move is highlighted on the bottom right corner of the imaging screen Move the trackball to move the caliper EnVisor Series User s Guide 191 M2540 30000 ug 02 192 6 To approve the measurement and initiate another measurement press the Mea sure key To approve the measurement and exit Measurements press the Enter key The measurement turns white to indicate that it is complete Performing an Ellipse Measurement You can perform an ellipse measurement on a 2D image to measure a volume As you perform unlabeled measurements the results of the measurements and of the associ ated Qu
183. ether the Calculations menu or the Measurements menu is displayed From these menus you choose a calculation or labeled measurement to perform Mic Press the Mic key to turn the microphone on and off A microphone icon appears in the right border of the imaging screen when the microphone is on Use the micro phone to record a voice annotation during a VCR recording MMode In a cardiac preset press the MMode key to display the MMode trace In a noncardiac preset press the MMode key to enter MMode Preview Press the MMode key again to display the MMode trace Use the Next soft key to display the second level of soft keys Option Keys 1 2 3 4 The option keys are labeled 1 2 3 and 4 Before using 3D Mode Panoramic Imag ing Stress Echocardiography or Tissue Doppler you need to assign one of the option keys to the mode or application in the Options setup window Press the associated option key to enter the mode or application EnVisor Series User s Guide 15 M2540 30000 ug 02 16 Notes 3D Mode is a component of the OB GYN application package e Panoramic Imaging and Tissue Doppler are only available on the EnVisor HD series e Stress Echocardiography is an option Patient Press the Patient key to open the Patient Identification window in which you can cre ate a new patient study edit information about the current patient or restart a patient study that was started earlier the same day If you have Mod
184. ets designed specifically for the exams you perform you can change system settings to reflect your needs and you can add options to enhance your imaging abili ties No matter how you customize your system be sure to back up your presets settings and patient information regularly Presets About Presets A preset is a group of settings that optimizes the system for a specific type of exam Presets establish many initial settings such as gain value color map filter and items on the Label and Measurement menus When you turn on your system the most recently used preset is active Before you begin an exam be sure that the appropriate preset is active You can choose from several default presets You cannot delete these default presets However they provide a starting point from which you can create your own presets You can create up to 20 presets for each of the 8 exam types If you need to create more than 160 presets you can save presets to a disk and restore them when you need to use them Note Presets are only available if you purchased the corresponding application pack age option About Exam Types Related presets are organized in categories called exam types Presets are only available if you purchased the corresponding application package option EnVisor Series User s Guide 29 M2540 30000 ug 02 Abdominal Abdominal Vascular Cardiac Cardiac Vascular Musculoskeletal OB GYN Pediatric
185. ew playback press the Acquire key to start and stop the acquisition of a loop When an image is frozen or when a spectral or an MMode trace is displayed press the Acquire key to acquire a frame The loop or frame is saved in the patient s study Angio Press the Angio key to enter Color Power Angio or to add angio information to the reference image in PW Doppler or CW Doppler In Color Power Angio press the Angio key when an image is frozen to temporarily suppress angio information from the frozen image without exiting Color Power Angio This is called Angio Suppress Angle In PW Doppler an arrow called the angle to flow arrow appears on the imaging screen along with the Doppler cursor line Use the Angle rotary control to position the angle to flow arrow parallel to and in the same direction as the blood flow Intelligent Doppler is on when you are in PW Doppler you are using a linear trans ducer and the Steer soft key is set to Auto Turning the Angle rotary rotates the angle to flow arrow and automatically moves the Doppler cursor line to maintain maintain an optimum cursor angle between the angle to flow arrow and the direction of blood flow EnVisor Series User s Guide M2540 30000 ug 02 In 2D Angio or Color Mode if you are using a linear transducer turn the Angle rotary control to steer the 2D image or the color or angio box In 3D Mode or Panoramic Imaging turn the Angle rotary control to rotate the image Wh
186. ey to enter the patient s temperature Patient Temp is only available when a TEE transducer is selected Persist Use the Persist soft key to average consecutive frames for a smoother appear ance with less noise Increasing Persist smooths the color or angio appearance EnVisor Series User s Guide M2540 30000 ug 02 Increasing Persist increases color or angio filling and decreases noise Decreasing Persist decreases color or angio filling and increases noise Smooth Use the Smooth soft key to change the appearance of the flow data by using spatial filtering There are eight Smooth settings Use lower settings for smaller vessels and higher Smooth settings for larger vessels Using Color Power Angio Suppress Color Power Angio Suppress temporarily removes angio data from a frozen angio image without exiting Color Power Angio To use Color Power Angio Suppress 1 While in Color Power Angio press the Freeze key to freeze the image 2 Press the Angio key Angio data is removed from the image Press the Angio key again to bring angio data back to the frozen image 4 Press the Freeze key to return to live imaging Color Power Angio Compare About Color Power Angio Compare Color Power Angio Compare shows angio flow on the right hand image and a flow suppressed version of the same image on the left Both images are live Color Power Angio Compare is a type of Dual Imaging Using Color Power Angio Compare To use Color Po
187. ey to the device in the Peripherals setup window Press the assigned key to begin printing recording or exporting data over the serial output cable Report Press the Report key to open the report for the current study Review Press the Review key to open Image Review for the current study Right In live imaging press the Right key to enter Dual Imaging The live image is on the right and the frozen image appears on the left In Quick Review press the Right key to enter Dual Imaging Quick Review The fro zen image is on the right and the live image on the left In Dual Imaging press the Right key to make the right image live In Dual Imaging Quick Review press the Right key to make the right image the active frozen image In Angio or Color Mode press the Right key to turn Angio Compare or Color Com pare on or off Angio Compare or Color Compare displays the angio or color flow image on the left and a flow suppressed version of the same image on the right Scale In Color Power Angio Color Mode or CW or PW Spectral Doppler turn the Scale rotary control clockwise to display higher velocities and frequencies Turn the Scale rotary control counterclockwise to display lower velocities and frequencies The Scale setting changes the pulse repetition frequency PRF In Color Mode the scale value appears on the right side of the imaging screen In Color Power Angio the PRF value appears on the right side of the imaging sc
188. g to reacquire resting images The study can only be resumed on the same day you started the study You must also be using the same system and preset Stopping a Stress Echo Study To stop a partially completed Stress Echo study 1 Complete the current stage E 2 Click Resuming a Stress Echo Study To resume a Stress Echo study that you started earlier the same day on the same sys tem EnVisor Series User s Guide M2540 30000 ug 02 1 Make sure you are in the same preset you used before you stopped the study 2 Press the Review key 4 Use the trackball to highlight the study you want to resume 5 Click Open Study The report opens 6 view the images you acquired before you stopped the study press the Review key 7 Press the 2D key to resume acquiring images 8 Click OK to confirm that you want to resume the study The view icon and stage view label appear on the imaging screen 9 Press the Stress Echo option key to display the Stress Echo soft keys 10 If the stage you want to acquire does not appear in the stage view label use the Stage soft key to change the stage 11 Continue acquiring images Stress Echo Review About Stress Echo Review After you acquire all of the loops for a view you view the loops in Image Review The loops are labeled with the name of the stage the name of the view the time if the timer was on and the heart rate Specifying the Type of Stress Echo Review
189. g to validate that measurement values and calculations are implemented as specified A phantom is used for the area and circumference vali dation Velocity is validated using a frequency generator and a cosine multiplication table Slope calculations are validated using a calculator Acceleration The Doppler spectral acceleration measurement is derived from the change in velocity divided by the change in time using a simple slope formula Area The area measurement is derived through use of the length measurement primitive Green s Theorem is used to calculate the area The number of points that are used in the calculation is related to how slowly the operator traces the area of interest The clinical accuracy of area measurements is highly dependent on the ability of the operator to accurately trace the area of interest You have the option to use an ellipse to calculate area This area is calculated as fol lows j is i isL h PERRA MajorAxisLen gih ength Circumference The circumference of manually traced areas is derived by adding several discrete length measurements The clinical accuracy of circumference measurements is highly dependent on the abil ity of the operator to accurately trace the area of interest The circumference measure ment accuracy should be within 5 when a phantom is used to validate the circumference Ellipse circumference is calculated as follows Ellipse Circumference when B gt 4 4 xx
190. ge A transducer orien tation dot appears on the right of an inverted image In cardiac presets the location of the transducer orientation dot is reversed L R Invert is only available in live imaging and is not available when a spectral trace is live Map Use the Map soft key to specify the postprocessing grayscale map In MMode and Doppler modes the Map soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted EnVisor Series User s Guide M2540 30000 ug 02 Map is not available when a spectral trace is live Patient Temp Use the Patient Temp soft key to enter the patient s temperature Patient Temp is only available when a TEE transducer is selected Persist Use the Persist soft key to average consecutive frames to provide a smoother appearance with less noise Use lower persistence values for fast moving organs or tis sues and higher persistence values for slower moving organs or tissues Persist is not available when a spectral trace is live Reject Use the Reject soft key to darken background noise in the spectrum Increase Reject for strong Doppler signals decrease Reject for weak signals Smooth Use the Smooth soft key to change the appearance of the Doppler spectrum Smooth has eight settings Generally lower settings provide a softer smoother verti cally brushed texture and higher settings provide a sharper
191. ge when Image is highlighted Map is not available when a spectral trace is live Persist Use the Persist soft key to average consecutive frames to provide a smoother appearance with less noise Use lower persistence values for fast moving organs or tis sues and higher persistence values for slower moving organs or tissues ROI Use the ROI soft key to define a region of interest a subregion of the image to be used when creating the 3D image When ROI is on you can change the size and the position of the region of interest box with the trackball When ROI is off the 3D dataset is created from the entire image Scan Angle When the Scan Geometry soft key setting is Fan use the Scan Angle soft key to specify the approximate angle you will tilt the transducer during the acquisition of the 3D dataset Scan Length When the Scan Geometry soft key setting is Linear use the Scan Length soft key to specify the approximate distance that you will move the transducer during the acquisition of the 3D dataset EnVisor Series User s Guide M2540 30000 ug 02 Scan Direction Use the Scan Direction soft key to specify the direction the trans ducer will move during the acquisition of the dataset L to R left to right or R to L right to left Scan Geometry Use the Scan Geometry soft key to specify how you will move the transducer during the acquisition of the dataset Linear indicates that you will move the transducer in a straight line Fan
192. ging Tools iva eae ENERO PR WERDE ERES RE eee eee 125 About Imaging d 125 Biopsy Feature ws cose uo be tem uiros iae Rt WR e cenis 125 About the Biopsy Feature foes MET s ar ortis 125 Turning the Biopsy Feature 126 Using Biopsy Soft Keys En Rd Ru PAN a d ERE 126 Moving the Biopsy Depth Marker ves og Soy ee uz eee s 127 D al doces Sc S Ea eae Sad a id ede Se aes n 128 About Dual masing 25 ed Mea Aie cee Pee Exacta ies 128 Using Dual Loco E LEA aol e LT 3 128 Using Quick Review in Dual Imaging 2 222 4 9 heeded ER ER 129 Quiclc Reviewers uus nana ee QUE Ie d OR Dd Osee Savio 129 About Quick Review ou cu don vost quta cate den o A ean qo tta cs Ba 129 Using Q ick Review aa Seg ve Ex E NEPI Vr V IN e e ux eda 129 Using Quick Review Soft ipd RU 130 Playing Back a Quick Review Loop c erem be uma mia 130 Setting the Length of a Quick Review 131 LOO sho 131 About Zoom x Ao lee cid whey eda A 131 Using Zoomi ouk hbase ian 131 Color Zool Pe EE EE RE pad
193. h aa t na v Additional Documentation Oc e dics eds v Vins Online Help io ares quus ui stg eate ias dude 1 Using Online Help ci tobe ik hei ud A ERA ERE ERA ea bei dui 1 Online Ree 2 Printing Online ses postu eii ed doa 2 EnVisor Series Overview vs eu ue S ONT lay Rede QUOS d Ie RI Sp UR Rag 3 About the s hence E Luce Lia sou roca ed cA 3 About the EnVisor HD ARA TRES 3 System COMPONENTS died nde Bore Brod igi do Soror 4 About System Components 4 Aboutthe Imaging pace eda p a eua eo E ud 5 Adjusting the Monitor Display eiua qe p ROVS END eS ey NE NU Y UE SH tea 5 Changing the Tint of the Monitor 2d Peta EA EGER ee 6 Locating the System Serial Number stes eel Gs baked ee Me eRe ee Gat RS 7 Turning Your use oed stet ates ento de m ac a 7 Restarting Your System Ls t 7 System Control Panels sere rentats IC LEE PT 8 About the System Control Panel X EX Rx uud 8 Using the System Control Panel c seras do some Led do aie eae ue he 9 site SOL di RR Rr 20 Using the Trackball the Enter Key and the Select 21 A
194. h the Reject soft key to increase the range of echoes displayed e Decrease the Filter setting with the Filter soft key e Ifyou are in PW Doppler turn the Angle rotary control to adjust the estimated angle of flow Note After adjusting any control or soft key always check the position of the trans ducer Goal I need to unwrap an aliased spectrum Possible Actions e Adjust the Baseline rotary control to unwrap the signal EnVisor Series User s Guide 113 M2540 30000 ug 02 114 e Increase the scale by turning the Scale rotary control clockwise to increase the range of displayed velocities and to decrease the size of the waveform Note After adjusting any control always check the position of the transducer Goal I want to remove artifacts from the spectrum Solution e Decrease the gain by turning the Doppler Gain rotary control counterclockwise e Increase the Filter setting with the Filter soft key e Decrease the power by turning the Power rotary control counterclockwise Note After adjusting any control or soft key always check the position of the trans ducer Goal I want to reduce noise in the spectrum Possible Actions e Decrease the gain by turning the Doppler Gain rotary control counterclockwise e Ifyou have an EnVisor HD or an EnVisor C HD press the Setup key click the Mode tab and select Adaptive Doppler e Increase the Filter setting with the Filter soft key e Increase the R
195. h x Width x Thickness Goldstein S R et al Estimation of Nongravid Uterine Volume Based on a Nomogram of Gravid Uterine Volume Its Value in Gynecologic Uterine Abnormalities Obstetrics amp Gynecology 72 No 1 86 90 July 1988 Levine Sandra Filly Roy Creasy Robert K Identification of Fetal Growth Retardation by Ultrasonographic Estimation of Total Intrauterine Volume Journal of Clinical Ultrasound 1979 7 21 26 Volume Ellipsoid Three Axis The formula for ellipse volume vol cm from its three perpendicular axes length l width w and height h is vol ix w x hx 0 523 Jeanty Philippe Measurement of Fetal Kidney Growth on Ultrasound Radiology July 1982 144 159 102 Emamian S A et al Kidney Dimensions at Sonography Correlation with Age Sex and Habitus in 665 Adult Volunteers American Journal of Radiology 1993 160 83 86 Weight Percentiles To aid the clinician in diagnosing fetal weight discrepancies and discordant growth weight percentiles are available for each estimated fetal weight on the obstetrics report These indicate where the fetus lies in relation to the normal range of values based on both clinical expected GA or LMP and ultrasound data The fetal weight value is displayed within a shaded box inverse video if the percentile is less than 10 percent or greater than 90 percent In Analysis Setup you can turn off weight percentiles so they are not included in t
196. he measurement and initiate another Press the Enter key to approve and save the mea surement and exit Measurements If you press the Acquire key the Body Mark key the Label key or a Record key the measurement is also approved and saved Notes When you export a study to an optical disk or over a network no measurements are saved with your study You can only view measurements when the study is saved on your system When you press the Acquire key the Body Mark key the Label key or a Record key measurements are saved in the patient report and disappear from the image To reactive view or print a measurement after you press one of those keys press the Review key to enter Image Review When you unfreeze an image measurements disappear from the image About the Accuracy of Measurements and Calculations You can use the EnVisor Series to provide measurements and calculations derived from ultrasound images The quantified image data is then used in conjunction with other clinical data to make a diagnosis Making a diagnosis based solely on measurement data is not recommended There are numerous factors to consider when using quantified data from any ultrasound imag ing system A careful analysis of those factors indicates that the accuracy of each mea surement and subsequent calculation is highly dependent on image quality Image quality in turn is highly dependent on system design operator scanning technique familiar
197. he HIS click the up or the down arrow in the MWL Polling Frequency area 11 Click OK 12 Click Done 13 Click OK 14 Click Close Notes e Ifyou have any questions about servers ask your network administrator e Modality Worklist is a component of the DICOM Advanced option EnVisor Series User s Guide 53 M2540 30000 ug 02 54 EnVisor Series User s Guide M2540 30000 ug 02 Imaging Modes About Imaging Modes The EnVisor Series offers several imaging modes to accommodate a variety of imaging applications Some modes display a live grayscale image Others are Doppler modes that evaluate color or angio blood flow or present information in a spectral form Spe cial modes are also available for 3D imaging and panoramic imaging Note Some modes might not be available on your system General Imaging Information About Imaging Modes The EnVisor Series offers several imaging modes to accommodate a variety of imaging applications Some modes display a live grayscale image Others are Doppler modes that evaluate color or angio blood flow or present information in a spectral form Spe cial modes are also available for 3D imaging and panoramic imaging Note Some modes might not be available on your system Beginning an Exam Before you begin acquiring images you must press the Patient key and click New to create a patient study If you do not you cannot acquire images Acquiring an Image You can acquire a single fra
198. he average appears in the report All instances appear in the work area You can measure up to 15 different follicles in each ovary For example R Follicle 3 Dist is the diameter of the third follicle in the right ovary Performing a Hip Angle Measurement When performing a hip angle measurement perform all segments of the measure ment from either left to right or right to left The first point of each line depicted by a caliper represents the source of the line The second point depicted by the arrow represents the end of the line When the hip angle measurement is complete the arrows on each line should point the same direc tion The first line you create is the baseline reference line e second line is the alpha reference line The third line is the beta reference line To readjust an endpoint press the Select key to choose the endpoint and use the trackball To perform a hip angle measurement 1 Press the Menu key 2 Select the hip angle measurement 3 Place the first caliper on the hip EnVisor Series User s Guide M2540 30000 ug 02 S9 po We cum 10 11 12 13 14 Press the Measure key Place the second caliper on the distal end of the femur toward the knee Press the Measure key Place the third caliper above the baseline Press the Measure key Place the fourth caliper below the baseline to create the alpha angle Note The two lines must intersect Press th
199. he image freezes on the current frame 2 play back the loop press the Select key until Replay is highlighted on the bot tom right corner of the imaging screen 3 Optional Move the trackball to the right or the left to increase or decrease the playback speed 4 Optional Use the Edit Start and Edit End soft keys to adjust the endpoints of the loop EnVisor Series User s Guide M2540 30000 ug 02 5 Optional To save the loop to the patient study press the Acquire key Note Only the portion of the loop between the Start and the End markers is saved to the study 6 return to live imaging press the Freeze key again Setting the Length of a Quick Review Loop You can specify the length in seconds or number of heartbeats of the Quick Review loop To specify the length of the loop 1 Press the Setup key The Setup window opens 2 Click the Acquisition tab The Acquisition window opens 3 Do one of the following To define the length of the loop in seconds choose Time To define the length of the loop in number of heartbeats choose Beats 4 To change the number of Seconds or Heartbeats click the up or the down arrow 5 Click Apply 6 Click Close Zoom About Zoom You can use Zoom to magnify a portion of an image The magnified area has high res olution because the pixels are reanalyzed not simply enlarged Using Zoom use Zoom EnVisor Series User s Guide 131 M2540 3
200. he name of the image from the Report Images field with the trackball and the Enter key and press the Del key Generating Obstetric Trending Graphs When you are in an obstetrics preset you can generate trending graphs for the current study and studies saved on a floppy disk Those trending graphs appear in the report To generate a trending graph 1 2 3 4 Press the Report key Click the Trending tab Optional Choose a new value from the Fetal Weight drop down menu Optional Change the x coordinate for the graph by clicking AUA or LMP EnVisor Series User s Guide M2540 30000 ug 02 243 244 5 Select the biometrics you want to use for the trending graphs by selecting the appropriate tabs Basic Cranium or Long Bones and check boxes 6 If necessary insert a floppy disk that contains the trending data from the previous study or studies 7 Click Import Data Trending files from studies with the same MRN are imported from the floppy disk 8 Select the check boxes for the studies you want to use in the trending graphs 9 Click Update report The trending graphs appear in the report 10 To modify the trending graphs in the report change the trending settings and click Update report Note To export obstetric trending data from the current study to a floppy disk click Export data Measurements in Image Review and Reports About Measurements in Image Review and Reports In Image Review you
201. he preset 1 Press the Preset key 2 Press the Display Name soft key Saving Setup Changes to a Preset In the Setup window the Do not save changes to a preset check box is selected by default When it is selected the changes you make in the Setup window are applied to the current state of the system but the current preset is not changed If the Do not save changes to a preset check box is not selected you can save your changes to a new or an existing preset EnVisor Series User s Guide M2540 30000 ug 02 Note You must clear the check box before you make changes in order for the changes to be saved to the preset If you clear the check box after you make changes the changes will be applied to the current state of the system but will not be saved to the preset To save changes made in the Setup window to a new or an existing preset 1 Press the Setup key The Setup window opens 2 Clear the Do not save changes to a preset check box Select a preset from the User presets list or the Philips presets list 4 Click the appropriate tabs and modify any settings that you want to change for your preset 5 Click Save 6 Ifa default preset is selected type the name of a new preset If a preset that you created is selected the changes are automatically made to that preset 7 Click Close Options About Options The following are options that you must purchase separately e DICOM Basic e DICOM Media e DICOM Adva
202. he report The following table of fetal weight smoothed percentiles Brenner is used by the system to determine weight percentiles The weights in the table are represented in grams EnVisor Series User s Guide 346 M2540 30000 ug 02 Gestational 10 25 50 75 90 Age wks 8 0 qs 2 1 pes pe n 250 EnVisor Series User s Guide M2540 30000 ug 02 347 p m pmo p x ies 5 m nx 2 300 s m 85 y zo po m x o NX X39 329 f s mm pm N50 38 ao a hmo m 4X a 9 fw 44 2790 3050 3390 3770 4 10 Brenner William et al A Standard of Fetal Growth for the United States of America American Journal of Obstetrics and Gynecology November 1976 126 555 564 348 EnVisor Series User s Guide M2540 30000 ug 02
203. ick Calcs appear in the results box on the upper right corner of the imaging screen To perform an ellipse measurement on a 2D image 1 Press the Measure key twice An ellipse appears on the imaging screen The measurement appears in blue to indicate that it is active Use the trackball to position the second endpoint Press the Select key until AXIS is highlighted on the bottom right corner of the imaging screen Adjust the width of the ellipse with the trackball Optional To reposition an endpoint or to change the width of the ellipse press the Select key repeatedly until the part of the measurement you want to change is highlighted on the bottom right corner of the imaging screen Move the trackball to make the change To approve the measurement and initiate another measurement press the Mea sure key To approve the measurement and exit Measurements press the Enter key The measurement turns white to indicate that it is complete Performing a Trace Measurement You can perform a trace measurement to measure the volume of an irregularly shaped area As you perform unlabeled measurements the results of the measurements and of the associated Quick Calcs appear in the results box on the upper right corner of the imaging screen EnVisor Series User s Guide M2540 30000 ug 02 To perform a trace measurement 1 Press the Measure key three times A caliper appears on the imaging screen The measurement app
204. ick Start Click Close Restoring Presets and Settings from a Disk To restore presets system settings VCR and printer settings or options from a disk EnVisor Series User s Guide M2540 30000 ug 02 8 Insert into the floppy disk drive the 3 5 disk that contains the presets or settings you want to restore Press the Setup key The Setup window opens Click the Floppy Disk tab The Floppy Disk window opens Click Restore Select the check boxes for the presets you want to restore or select the Select all check box Click the check boxes for the settings you want to restore System settings Printer and VCR settings Options Note When you restore options the system must have the same serial number as the system from which the backup was made Click Start Note The imaging screen is blank for a moment while the system restores the pre sets or settings Click Close Physios About Physios You can choose to display either the ECG or the auxiliary physio inputs or the ECG and the auxiliary physio inputs on the imaging screen When you use a 12 lead ECG display the auxiliary physio input In order to perform a Stress Echocardiography study you must display an ECG or an auxiliary physio input on the imaging screen EnVisor Series User s Guide 25 M2540 30000 ug 02 Connecting the ECG Cable and Attaching the ECG Leads In order to display ECG physio inputs on the imaging screen yo
205. ied by the Body Marker Set soft key To change any of the settings listed below press the oval key below the soft key label Body Marker Set Use the Body Marker Set soft key to specify the set of body markers organized by exam type that you can choose from using the Body Marker soft key The Body Marker Set soft key displays the names of body marker sets Alternatively you can change the body marker set by changing the preset Erase Marker Use the Erase Marker soft key to remove the body marker from the imaging screen and exit Body Markers EnVisor Series User s Guide M2540 30000 ug 02 Left Use the Left soft key when you in Dual Imaging to manipulate the body marker on the left hand image Probe Size Use the Probe Size soft key to change the size and shape of the transducer icon Your choices are e Large T Small T e Arrow e Small crosshair Right Use the Right soft key when you are in Dual Imaging to manipulate the body marker on the right hand image Rotate Probe Use the Rotate Probe soft key to rotate the transducer icon You can also rotate the transducer icon with the Angle rotary control View All Use the View All soft key to open the Body Markers window You choose the body marker that appears on the imaging screen from the body markers in the Body Markers window Using Body Markers and Dual Imaging at the Same Time To use body markers and Dual Imaging at the same time 1 Press th
206. iger Philadelphia 1985 p 295 Folland E D et al Assessment of Left Ventricular Ejection Fraction and Volumes Real Time Two Dimensional Echocardiography Circulation October 1979 Vol 60 No 4 pp 760 766 Single plane Ellipse Formula S 3z LVA s 1 2 LVLs apical Folland E D et al Assessment of Left Ventricular Ejection Fraction and Volumes by Real Time Two Dimensional Echocardiography Circulation October 1979 Vol 60 No 4 pp 760 766 Teichholz Formula 7 24 LVIDs LVIDs 2 EnVisor Series User s Guide 31 5 M2540 30000 ug 02 Teichholz L E et al Problems in Echocardiographic Volume Determinations Echocardiographic Angiographic Correlations in the Presence or Absence of Asynergy American Journal of Cardiology January 1976 Vol 37 pp 7 11 Fetal Heart Rate The formula for heart rate r BPM given the peak to peak interval over two beats t sec is r 120 t FL to AC Ratio The ratio unitless of femur length cm to abdominal circumference cm is FL AC Hadlock et al A Date Independent Predictor of Intrauterine Growth Retardation Femur Length Abdominal Circumference Ratio American Journal of Roentgenology 1983 141 979 984 Hadlock et al Use of Femur Length Abdominal Circumference Ratio in Detecting the Macrosomic Fetus Radiology 1985 154 503 505 FL to BPD Ratio The ratio unitless of femur length cm to biparie
207. image Image Invert reverses the left right orientation of the image Render Mode Use the Render Mode soft key to change the way the 3D image is dis played The values are e Gradient An image that can be adjusted to display surface shape or textures using the Texture and Brightness settings e X ray An X ray like translucent image adjust the translucency with the Trans parency setting e MaxIP A projection showing only the maximum gray values along the current viewing direction Save Frame to Disk When a movie is stopped use the Save Frame to Disk soft key to save the current frame to a floppy disk or to an optical disk as a bmp file Save Movie to Disk When a movie is playing use the Save Movie to Disk soft key to save the movie to an optical disk as an avi file Span Use the Span soft key to adjust the range of image movement of the 3D movie in increments of 5 degrees from 30 to 180 degrees EnVisor Series User s Guide M2540 30000 ug 02 Speed Use the Speed soft key to specify the speed of the 3D movie playback The choices are Slow and Normal Stop Use the Stop soft key to discontinue the playback of a 3D movie Play Use the Play soft key to continue the playback of a 3D movie Note After you save a 3D movie to disk you may need to press the Enter key or the Select key to display the 3D movie soft keys Panoramic Imaging About Panoramic Imaging In Panoramic Imaging you acquire a series of
208. images in 2D Mode These images are called the panoramic dataset This dataset is compiled to show a larger area of anat omy As you scan the image frames are held in memory and then electronically stitched together for display The panoramic image is static and appears in grayscale To use Panoramic Imaging you must first acquire the panoramic dataset You can then review and edit the panoramic image Notes e Panoramic Imaging is only available on the EnVisor HD series Panoramic Imaging does not support up down inverted images Up down inverted images appear uninverted in Panoramic Imaging Before You Use Panoramic Imaging Before you use Panoramic Imaging you need to assign one of the option keys to Pan oramic Imaging Exiting Panoramic Imaging To exit Panoramic Imaging press the Panoramic Imaging option key or the 2D key Acquiring a Panoramic Imaging Dataset Before you use Panoramic Imaging you must assign an option key to Panoramic Imaging When you use Panoramic Imaging you must first acquire a series of 2D images called the panoramic dataset EnVisor Series User s Guide 103 M2540 30000 ug 02 To acquire a panoramic dataset 1 To start Panoramic Imaging press the Panoramic Imaging option key 2 change the appearance of your image use the soft keys 3 specify the scanning direction press the Scan Direction soft key 4 Begin moving the transducer at a constant speed across the area of in
209. in by turning the Doppler Gain rotary control clockwise increase the compression with the Compress soft key and decrease the Reject setting with the Reject soft key to increase the amount of Doppler information displayed EnVisor Series User s Guide M2540 30000 ug 02 e Ifyou have an EnVisor HD or EnVisor C HD press the Setup key click the Mode tab and select the Adaptive Doppler check box e Ifyou are using a linear transducer adjust the Steer soft key to achieve the optimal angle to flow e Ifyou are in PW Doppler and you are using a multifrequency transducer use the Frequency soft key to select the lowest frequency Otherwise use a lower fre quency probe Ifyou are in PW Doppler increase the size of the PW sample volume gate with the Gate soft key Ifyou are in CW Doppler use the trackball to move the focus diamond on the CW reference line over the area where the greatest sensitivity is needed Note After adjusting any control or soft key always check the position of the trans ducer Imaging Tips for Color Mode Goal I want to unwrap aliased signals Possible Actions e Increase the scale by turning the Scale rotary control clockwise e Unwrap aliased signals by adjusting the Baseline rotary control e Ifyou are using a multifrequency transducer use the Frequency soft key to select the lowest frequency Otherwise use a lower frequency transducer Note After adjusting any control or soft key alw
210. in the results box Note You must perform a measurement within a single calibration region A dashed line called a calibration line in an MMode trace or a spectral Doppler trace separates distinct calibration regions Measurements cannot cross a calibration line Performing a Point Depth or Velocity Measurement If you are not in MMode or in a physio trace when you initiate a measurement a 1 point depth measurement or a 1 point velocity measurement automatically appears in the results box As you perform unlabeled measurements the results of the measurements and of the associated Quick Calcs appear in the results box on the upper right corner of the imaging screen Note If Default to Doppler Auto Trace is selected on the Measurements Setup tab press the Select key to obtain a 1 point measurement To perform a 1 point depth or velocity measurement EnVisor Series User s Guide M2540 30000 ug 02 1 Press the Measure key A caliper appears on the image If the caliper is in a 2D image a 1 point depth measurement appears in the results box If the caliper is in a spectral trace a 1 point velocity measurement appears in the results box Note If the caliper is in a frozen spectral trace and you are in a noncardiac preset you must press the Measure key again for the 1 point velocity measurement to appear in the results box To approve the 1 point depth or velocity measurement and initiate another mea surement pr
211. indow opens 2 Click the System tab The System window opens 3 Click Top Border Date Time Locale DICOM or Monitor Adjust to change these system wide settings Note You cannot save system wide settings to a preset 4 Click the appropriate option to change any of the following settings e LGC profile display e TGC profile display Depth markings temperature units e Power index 5 Click Apply 6 Click Close Specifying the Disk Full Strategy You can specify the strategy the system uses when the disk is almost full You have two choices e oldest studies are automatically deleted when the disk is almost full e You are automatically prompted to specify which studies are deleted when you press the Patient key if the disk is almost full To specify the disk full strategy 38 EnVisor Series User s Guide M2540 30000 ug 02 9 7 Press the Setup key The Setup window opens Click the Acquisition tab The Acquisition window opens Click Disk Full Strategy The Disk Full Strategy window opens Select the disk full strategy Automatically delete the oldest studies or Prompt the user to manually delete studies Click OK Click Apply Click Close DICOM Features About DICOM Features DICOM format is used for patient studies that are transferred among computers that make up a hospital s information management system and for studies that are accessed by physicians at remo
212. indow opens 2 Click the System tab The System window opens 3 Click DICOM The DICOM Setup window opens 4 Click the Servers amp Roles tab The Servers amp Roles window opens 5 In the Roles area click Modify 6 Click the Advanced button to the right of B amp W Printer SCP or Color Printer SCP The B amp W Printer Configuration or Color Printer Configuration window opens 7 Click the Basic Layout Density or Advanced tab 8 Click OK 9 Click Done 10 Click OK 11 Click Close Note The ability to print to DICOM printer is a component of the DICOM Basic option Canceling DICOM Print Jobs To cancel print jobs that you sent to a DICOM printer EnVisor Series User s Guide M2540 30000 ug 02 1 Press the Setup key The Setup window opens 2 Click the System tab The System window opens 3 Click DICOM The DICOM Setup window opens 4 Click the Diagnostics tab The Diagnostics window opens 5 Click Jobs The Job Manager window opens 6 Use the trackball to highlight the print job you want to delete 7 Press the Enter key 8 Click Delete Job 9 Click Close to close the Job Manager window 10 Click OK 11 Click Close Note The ability to print to a networked DICOM printer is a component of the DICOM Basic option Modality Worklist About Modality Worklist If your system is connected to the hospital information system HIS Modality Worklist allows you to display and choose from a lis
213. ing table lists the measurements that appear in the results box when an Automatic Doppler Trace is performed cm sec2 Acceleration Acceleration slope EnVisor Series User s Guide 155 M2540 30000 ug 02 Diastolic velocity em Time averaged peak velocity Systolic velocity cm sec Centroid velocity TAVM Time averaged mean velocity Automatic Doppler Trace Calculations The following table lists the calculations that automatically appear in the results box when an Automatic Doppler Trace is performed See Appendix A for the formula inherent approximations and assumptions and clinical references for each calculation Label Formula Meaning D S D to SRatio Diastolic to Systolic Ratio n Pussy Index RI Resistivi Index S D S to D Ratio Systolic to Diastolic Ratio Measurements About Measurements You can perform unlabeled measurements at any time You can also perform several labeled measurements in each preset You can specify the measurements available in the Measurements menu for each mode and preset The measurements available at any one time depend on the preset the mode and your systems options Results of measurements that you perform appear in the results box on the upper right corner of the imaging screen 156 EnVisor Series User s Guide M2540 30000 ug 02 After you perform a measurement press the Measure key to approve and save t
214. integral is the integral of the Doppler spectral instantaneous velocity V over the total time interval T The integral is approxi mated by the following formula N VID Y Viti i l where T is the total time interval the sum of all t time increments About PISA Measurements and Calculations You can perform the following PISA proximal isovelocity surface area calculations when you are in PW or CW Doppler and in a cardiac preset MRPISA MR flow rate MRERO MR volume MRRF In order to perform the calculations above you need to perform the following mea surements e MR PISA radius measured on a full screen 2D image or a 2D reference image e MR max vel e MRVTI EnVisor Series User s Guide 149 M2540 30000 ug 02 150 MR alias vel MV E point MV diam 1 MV diam 2 Note To perform an MR alias vel shift the baseline down until aliasing occurs Then match the color of the isovelocity hemisphere to the color bar and the PRF to the scale The PRF is the alias velocity Formulas Used for Quick Calcs The following formulas are used to calculate Quick Calcs See Appendix A for the complete formula and associated references Acceleration Slope Area Circumference D to S Ratio Deceleration Slope Length Pulsatility Index Resistivity Index S to D Ratio Formulas Used in Reports The following formulas are used in reports See Appendix A for the complete formula and associated references Av
215. inter select the appropriate server from the B amp W Printer SCP drop down list To specify a color printer select the appropriate server from the Color Printer SCP drop down list To change the automatic DICOM printing setting click the Advanced button to the right of B amp W Printer SCP or Color Printer SCP The Printer Configuration window opens Click the Auto Print tab Click the appropriate option and press the Enter key Manual print only You must print manually Batch mode All frames are automatically printed when you save or close the study Send as you go Each frames is automatically printed when you press the Acquire key Click OK Click Close Note The ability to print to a networked DICOM printer is a component of the DICOM Basic option Changing DICOM Printer Settings You can change many DICOM printer settings in the B amp W Printer Configuration window and the Color Printer Configuration window Information about each setting appears in the Description area The DICOM infor mation about each setting appears below the Description area EnVisor Series User s Guide 47 M2540 30000 ug 02 48 Some drop down menus include Printer specific so that you can enter a value used specifically for your printer If you choose Printer specific you can type a value in the field to the right of the drop down menu To change the DICOM printer settings 1 Press the Setup key The Setup w
216. ity with system controls and most importantly patient echogenicity Three of these variables are independent of the system and therefore prevent Philips from spec ifying a clinical accuracy for the measurements and calculations produced by the sys tem About the Sources of Measurement Error Measurement errors can be caused by several factors including the following EnVisor Series User s Guide 157 M2540 30000 ug 02 158 Doppler Alignment Doppler velocity measurements are most accurate when the direction of blood flow is aligned with the acoustic beam axis Errors due to misalignment are typically about 45 For best accuracy aim the transducer so that the acoustic beam axis is aligned as closely as possible with blood flow With linear transducers when alignment is not possible use the Angle rotary control to compensate Formulas Some formulas used in clinical calculations are based on assumptions or approxima tions For example volume formulas may assume a particular three dimensional shape Circumference measurements approximate the actual shape by using a polygon made up of many short line segments Height Weight and Age Demographics Height and weight values are manually entered to estimate body surface area for car diac calculations Height and weight values can be estimated incorrectly Moreover adult weight values can vary over the course of the day Entering an incorrect age can also result in errors
217. l MR PISA radius cm Length Alias radius of the proximal convergence zone of the mitral valve regurgitation MV diam cm Length Mitral valve diameter MV diam 2 fem Length Mitral valve diameter 2 Right diam Flow diameter on right side of heart RVAWd cm Height Right ventricular wall dimension at end diastole RVDd Height Right ventricular internal diameter at end diastole 170 EnVisor Series User s Guide M2540 30000 ug 02 LVAd sax epi LVAd sax PM LVLd apical Al ICKNESS apica EnVisor Series User s Guide 171 M2540 30000 ug 02 Doppler Demographics Label Meaning Estimated Right Atrial Pressure Doppler Measurements Label Meaning Al max PG Aortic insufficiency maximum pressure gradient Al max vel Maximum velocity of aortic insufficiency Ao dec slope Aortic insufficiency deceleration slope Ao max PG Pressure gradient Aortic flow maximum pressure gradient Ao mean PG mmHg Pressure gradient Aortic flow mean pressure gradient Ao V2 max cm s Maximum velocity Maximum velocity for continuity formula Ao V2 VTI fcm j Velocity time j Velocity time integral integral 2 for continuity formula Aortic R R sec Time R R interval measured when making measurements on the aortic valve 172 EnVisor Series User s Guide M2540 30000 ug 02 Left max vel LV me
218. l corresponds to a key on the system con trol panel The foot switch pedals have different functions in different situations The following table summarizes the foot switch functions Situation Left Pedal Middle Pedal Right Pedal 2D Mode Record __ Fee Rec 3D Mode Stress Review Echocardiography Acquire You can change the configuration of the foot switch for 2D Mode Notes EnVisor Series User s Guide 280 M2540 30000 ug 02 foot switch is an option that you can purchase separately It is also included in the Stress echo option The Stress Echo soft keys must be visible in order for the foot switch to function as described in the table above To display the Stress Echo soft keys press the Stress Echo option key Warning The foot switch supplied with the ultrasound system meets only drip proof construction requirements and may not be used in the operating room Configuring the Foot Switch You can change the functionality of the foot switch in 2D Mode To configure the foot switch 1 Press the Setup key The Setup window opens 2 Click the Peripherals tab The Peripherals window opens 3 assign a control panel key to each foot switch pedal choose the control panel key from the Left the Middle or the Right drop down menu Your options are Record Rec2 Rec3 and Freeze 4 Click Apply 5 Click Close Warning The foot switch supplied with
219. l soft key to resume a paused protocol Stage Use the Stage soft key to advance to the next stage while you are acquiring loops The Stage soft key is available only after you have acquired at least one loop per EnVisor Series User s Guide 264 M2540 30000 ug 02 view in the current stage The Stage soft key is not available if you have acquired any loops in the next stage Timer Use the Timer soft key to start the timer if it is off If the timer is running pressing the Timer soft key hides the timer Elapsed time is maintained while the timer is hidden View Use the View soft key to specify which view you want to acquire next About the View Icon and the Stage View Label When you are acquiring loops in a Stress Echo study a view icon and a stage view indicator appear on the imaging screen to help you monitor loop acquisition View Icon A rectangle appears on the upper right corner of the imaging screen that indicates how many views have been acquired for the current stage The rectangle contains four or eight squares one for each possible view e Blank square The view has not yet been acquired or the loop has been deleted e Check mark The view has been acquired e X No view needs to be acquired For instance if a stage has five views three of the eight squares will contain an X Stage View Label The stage view label lists the name of the current stage and view Acquiring Loops for a Single Cycle or a Quad Cy
220. land E D et al Assessment of Left Ventricular Ejection Fraction and Volumes by Real Time Two Dimensional Echocardiography Circulation October 1979 Vol 60 No 4 pp 760 766 EnVisor Series User s Guide M2540 30000 ug 02 309 Bullet Formula 5 6 LVAd sax MV LVL apical Folland E D et al Assessment of Left Ventricular Ejection Fraction and Volumes by Real Time Two Dimensional Echocardiography Circulation October 1979 Vol 60 No 4 pp 760 766 Cubed Formula LVID 3 Dodge H T Sandler D W et al The Use of Biplane Angiography for the Measurement of Left Ventricular Volume in Man American Heart Journal 1960 Vol 60 pp 762 776 Belenkie Israel et al Assessment of Left Ventricular Dimensions and Function by Echocardiography American Journal of Cardiology June 1973 pg 31 Method of Discs Biplane 20 L 22 2 i l where ay is the th disc diameter of LVAd ap2 MOD by is the i th disc diameter of LVAd ap4 MOD and L is the maximum length from LVAd ap2 MOD or LVAd ap4 MOD Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 p 364 Method of Discs Single Plane Four Chamber 20 A2 22 1 L 20 bel D 1 where is the i th disc diameter of LVAd ap4 MOD and L is the length from LVAd ap4 MOD 310 E
221. lect an image flag from the list Click OK Viewing 3D or Panoramic Images in Image Review Viewing a 3D or Panoramic Dataset To view a 3D dataset or a panoramic dataset In Image Review click Use the trackball to move the cursor over one of these icons on the bottom left corner of the image 3D dataset Peed Panoramic dataset Press the Enter key 3D Mode or Panoramic Imaging opens and displays the image To close 3D Mode or Panoramic Imaging press the 2D key the 3D Mode option key or the Panoramic Imaging option key Note The thumbnail of a 3D and panoramic image is not an accurate representation of the dataset Viewing a 3D Frame a 3D Movie or a Panoramic Frame To view a 3D frame 3D movie or a panoramic frame EnVisor Series User s Guide 232 M2540 30000 ug 02 1 In Image Review click 2 Use the trackball to move the cursor over one of these icons on the bottom left corner of the image 3D 3D frame or 3D movie __ Panoramic frame 3 Quickly press the Enter key twice or press the Enter key and click Play Printing Images in Image Review To print an image 1 Press the Review key to enter Image Review 2 If you are viewing a loop click freeze the loop 3 If necessary use the Frame Select slide control to choose the frame you want to print 4 Press the Record key assigned to the printer you want to use Note To print the Thumbnails view click H
222. ler press the Plex key again To exit spectral Doppler press the key for any imaging mode Note If you are in Triplex and you press the Color or Angio key you enter Duplex EnVisor Series User s Guide M2540 30000 ug 02 Using Duplex and Triplex Soft Keys The soft keys available to you depend on the term that is highlighted on the bottom right corner of the imaging screen In Duplex PW Doppler soft keys always appear In Triplex PW Doppler soft keys appear when Gate is highlighted n Triplex Color Mode soft keys or Color Power Angio soft keys appear when Size or Position is highlighted Tissue Doppler About Tissue Doppler Tissue Doppler optimizes settings to measure the movement of tissue using color Doppler Before you use Tissue Doppler you need to assign one of the option keys to Tissue Doppler Note Tissue Doppler is only available on the EnVisor HD series and with cardiac presets Tissue Doppler is not available with all transducers Using Tissue Doppler To use Tissue Doppler press the Tissue Doppler option key To exit press the key for any other mode Tissue Doppler Soft Keys The Tissue Doppler soft keys are the same as the Color Mode soft keys Color Mode About Color Mode In Color Mode a color box appears on the image The velocity and direction of flow in the color box are represented with different colors for direction and different shades for velocity The colors being used ap
223. lysis About Analysis You can perform many unlabeled measurements labeled measurements and calcula tions based on the images you acquire You can also perform automatic Doppler trace and manual Doppler trace measurements and you can create your own OB GYN cal culations Note When you export a study to an optical disk or over a network no measure ments or calculations are saved with your study You can only view measurements and calculations when the study is saved on your system General Analysis Information About Analysis You can perform many unlabeled measurements labeled measurements and calcula tions based on the images you acquire You can also perform automatic Doppler trace and manual Doppler trace measurements and you can create your own OB GYN cal culations Note When you export a study to an optical disk or over a network no measure ments or calculations are saved with your study You can only view measurements and calculations when the study is saved on your system Changing Analysis Settings You can select which labeled measurements and calculations appear in the Measure ments menu and the Calculations menu respectively for the current preset You can also configure protocol measurements and specify height and weight units To change analysis settings 1 Press the Setup key The Setup window opens 2 Click the Analysis tab The Analysis window opens EnVisor Series User s Guide 143 M2540 3
224. me or an image loop The loop or frame is saved in the patient study If Automatic DICOM Export is on images are automatically exported across a network when you press the Acquire key To acquire a loop press the Acquire key in live imaging or in Quick Review To acquire an image press the Freeze key and then the Acquire key Notes When it is possible to acquire an image a small open box the acquisition icon appears on the bottom right corner of the imaging screen to the right of the trans ducer frequency and depth EnVisor Series User s Guide 55 M2540 30000 ug 02 56 When an image is acquired you hear a beep to confirm that the loop or frame was saved in the patient s study If you press the Acquire key while a live MMode or Doppler trace is displayed you acquire an image not a loop Automatic DICOM Export is a component of the DICOM Basic option Setting the Length of a Loop You can specify the length in seconds or number of heartbeats of an acquired loop To specify the length of a loop 1 Press the Setup key The Setup window opens Click the Acquisition tab The Acquisition window opens Do one of the following To define the length of the loop in number of heartbeats choose Beats To define the length of the loop in seconds choose Time To change the number of Seconds or Heartbeats click the up or the down arrow 4 S 6 Click Apply Click Close Specifying Acquisition P
225. me you turn it on Some infor mation on the system may also be corrupted Restarting Your System If your system is frozen or is not working properly follow this procedure to restart the system 1 Press and release the On Off button If the system responds wait for the system to shut down completely Then press the On Off button again to turn the system on 2 Wait at least 60 seconds If the system does not respond press and release the small Reset button below the On Off button EnVisor Series User s Guide 7 M2540 30000 ug 02 If the system responds it may require several minutes to restart 3 If the system does not respond press the On Off button and hold it for ten sec onds If the system responds wait for the system to shut down completely Then press the On Off button again to turn the system on The system may require several minutes to restart If the system does not respond to the steps above follow this procedure Unplug the power cord from the outlet Wait at least 30 seconds Plug the power cord back into the outlet Press the On Off button peor GN e Lam The system may require several minutes to restart System Control Panel About the System Control Panel The system control panel is the horizontal surface that contains keys that you press rotary controls that you turn and slide controls that you move left and right or up and down The keys the rotary controls and the slide controls are
226. menu appears on the imaging screen Menu Hide Use the Menu Hide soft key to hide or display the Measurements menu or the Calculations menu Results Mode Use the Results Mode soft key to display in the result box all measure ments currently on the image the last measurement you performed or no measure ments Reactivating a Measurement You can reactivate a measurement if you want to move the endpoints To reactivate a measurement 1 Press the Measure key A crosshair appears 2 Use the trackball to move the crosshair over an endpoint until the measurement turns orange to indicate that it is active 3 Press the Enter key or the Select key The measurement turns blue to indicate that it is active again 4 Use the trackball to move the endpoint 5 To approve the measurement and initiate another measurement press the Mea sure key To approve the measurement and exit Measurements press the Enter key Deleting a Measurement To delete a measurement EnVisor Series User s Guide 161 M2540 30000 ug 02 162 1 Press the Measure key A crosshair appears 2 Move the crosshair over the measurement with the trackball until the measure ment turns orange to indicate that it is active 3 Press the Del key above the Measure key Note If no crosshair is active pressing the Del key erases all measurements About Follicle Measurements You can perform up to five diameter measurements on each follicle Only t
227. ming a Manual Doppler Trace Measurement To perform a manual Doppler trace measurement 1 2 3 In PW or CW Spectral Doppler press the Freeze key and the Measure key three times Press the Select key Move the trackball to trace the waveform EnVisor Series User s Guide M2540 30000 ug 02 4 Optional To erase the trace dot at time press the Del key above the Mea sure key 5 To approve the measurement and perform another manual Doppler trace mea surement press the Measure key To approve the measurement and exit press the Enter key The measurement turns white to indicate that it is complete Using Automatic Doppler Trace Soft Keys To change any of the settings listed below press the oval key below the soft key label D Time Use the D Time soft key to move the D point to the left or to the right D Velocity Use the D Velocity soft key to move the D point up or down Results Mode Use the Results Mode soft key to display in the result box all measure ments currently on the image the last measurement you performed or no measure ments S Time Use the S Time soft key to move the S point to the left or to the right S Velocity Use the S Velocity soft key to move the S point up or down S1 Time Use the S1 Time soft key to move the S1 point to the left or to the right S1 Velocity Use the S1 Velocity soft key to move the 1 point up or down Automatic Doppler Trace Measurements The follow
228. n RVAWd RVDd cm Height Left ventricular posterior wall dimension at end systole sec Time MMode or 2D R R interval Mitral valve E F slope cm Height Mitral valve excursion cm Height Right ventricular wall dimension at end diastole cm Height Right ventricular internal diameter at end diastole MMode also supports the following protocol measurements These are measurements that are made one after the other usually occurring in a single slice of the anatomy MMode Protocol Measurements RVAW Free cross hair EnVisor Series User s Guide 177 M2540 30000 ug 02 Cardiac Meta Measurements A number of meta measurements are supported in the Cardiac exam type When these measurements are performed a number of child measurement values are gener ated and displayed in the results box Only the child measurements however are dis played in the report All cardiac meta measurements are listed in the following table with their correspond ing child measurements Al max Al max PG Al max vel Ao max Ao max PG Ao V2 max 178 EnVisor Series User s Guide M2540 30000 ug 02 Ao V2 Trace LV VI Trace Ao max PG Ao mean PG Ao V2 max Ao V2 LV mean PG LV VI max LV VI VTI EnVisor Series User s Guide M2540 30000 ug 02 179 LVAd 2 MOD EDV MOD sp2 LVAd ap2 LVAd apical LVLd apical LVAd ap4 MOD EDV MOD
229. n export data and patient demographic information to a third party software application if you are in an obstetric GYN or Fetal Heart preset Before you export data to a third party application you must EnVisor Series User s Guide 254 M2540 30000 ug 02 e Plug a serial cable into your system to connect your system to the computer that houses the third party software application e Assign a Record key to serial output To export the data from the current study to a third party application press the Record key you assigned to serial output while you are viewing the report Note For information about the format of the exported data see the EnVisor Series Safety and Standards Guide in the EnVisor Series Reference Guide EnVisor Series User s Guide 255 M2540 30000 ug 02 EnVisor Series User s Guide 256 M2540 30000 ug 02 Stress Echocardiography About Stress Echocardiography Stress Echocardiography Stress Echo is a protocol driven exam that allows a cardiol ogist to assess cardiac wall motion at various heart rates by acquiring views of the heart at different stages of the exam A Stress Echo study consists of two to eight stages during which loops are acquired for up to eight anatomical views Each loop is a sequence of frames captured at systole starting at the R wave Before You Perform Your First Stress Echo Study Before you perform the first Stress Echo study Stress Echo must be installed on your system Al
230. n the study e Ifyou have the DICOM Media option you can export studies in DICOM for mat Those studies can be viewed on any DICOM viewer If you do not have the DICOM Media option exported studies can only be viewed on EnVisor A 1 sys tems Importing a study from an optical disk or a CD R is a component of the DICOM Media option To import one or more patient studies 29 1 In Image Review click Jl 2 Use the trackball and the Enter key to highlight the study you want to import 3 Optional Press and hold the Control key or the shift key to select more than one study 4 Click Import all or Import selected 5 Use the trackball to specify the patient folder for the imported data 6 Click OK EnVisor Series User s Guide M2540 30000 ug 02 249 250 Exporting the Current Patient Study in DICOM Format If you have the DICOM Media option you can export a study to an optical disk or a CD R If you have the DICOM Basic option you can export a study across a network toa DICOM PACS system When you export a study in DICOM format the images and information are saved as DICOM files Notes e Ifyou have the DICOM Media option studies exported to an optical disk or a CD R can be viewed on any DICOM viewer If you do not have the DICOM Media option exported studies can only be viewed on EnVisor A 1 systems When you export a still image any measurements remain on the image When you export a loop all measur
231. nVisor Series User s Guide M2540 30000 ug 02 Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 p 364 Method of Discs Single Plane Two Chamber 20 L gt 420 2 i i l where 15 the i th disc diameter of LVAd ap2 MOD and L is the length from LVAd ap2 MOD Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiology Sept Oct 1989 Vol 2 No 5 p 364 Modified Simpson s Formula ical 41 VAd sax MV 2 LVAd PM sax sax PM Weyman Arthur E Cross Sectional Echocardiography Lea amp Febiger 1985 p 295 Folland E D et al Assessment of Left Ventricular Ejection Fraction and Volumes Real Time Two Dimensional Echocardiography Circulation October 1979 Vol 60 No 4 pp 760 766 Single plane Ellipse Formula 8 3 LVAd apical LVL apical Folland E D et al Assessment of Left Ventricular Ejection Fraction and Volumes by Real Time Two Dimensional Echocardiography Circulation October 1979 Vol 60 No 4 pp 760 766 Teichholz Formula 7 24 LVID LVID 3 Teichholz L E et al Problems in Echocardiographic Volume Determinations Echocardiographic Angiographic Correlations in the Presen
232. nced e On Board Diagnostics Resident Self Test Printers VCRs and biopsy kits e Stress Echocardiography You must install software options before you use them EnVisor Series User s Guide 33 M2540 30000 ug 02 34 Application Package Options You must purchase application package options for the exam types that you want to perform There are four application package options The Cardiac application package includes cardiac presets and the physio panel The General Imaging application package includes abdominal musculoskeletal pediatric and small parts presets The OB GYN application package includes obstetrical presets gynecological pre sets and 3D Mode The Vascular application package includes vascular presets abdominal vascular presets and the physio panel Installing Options When you receive your system the options you purchased are installed and enabled At some point however you may need to install a new option remove an option or disable an option To install an option remove an option or disable an option 1 Press the Setup key The Setup window opens Click the Options tab Click the Options button The Options window opens Do one of the following To install an option with an access code select an option click Install and type the access number To install an option from a floppy disk insert the disk into the floppy drive and click Install From File To permane
233. nder mode press the Render Mode soft key 3D Movies Viewing a 3D Movie While you are reviewing a 3D image you can view an animation or movie of the rendered 3D image 1 2 To view a movie of the 3D image press the Movie soft key While a movie is playing you can do the following Manipulate the movie with the 3D movie soft keys Change 3D image display settings Orbit rotate zoom or pan the 3D image This option is not available if the movie is stopped or paused EnVisor Series User s Guide 101 M2540 30000 ug 02 102 e Press the Record key assigned to a or a printer to start a VCR recording of the movie or to print the current frame 3 When you are finished viewing the movie press the Exit Movie soft key Using 3D Movie Soft Keys To change any of the settings listed below press the oval key below the soft key label Archive Frame When a movie is stopped use the Archive Frame soft key to save the current frame to the patient study Archive Movie When a movie is playing use the Archive Movie soft key to save the movie as a loop to the patient study Colorize Use the Colorize soft key to replace the grayscale map with a color map The choices are Gray Amber Beige Sepia and Skin Exit Movie Use the Exit Movie soft key to end the display of the 3D movie and to display the 3D image Image Invert Use the Image Invert soft key to reverse the order of the 2D frames and construct a new 3D
234. nimaging CW Doppletiic ce sup 2250s Too Sere rid de Se Reo 83 D plexand eo ritate Le EE 83 About Duplex and Lu pletcoo esr eI VT OSEE MIA Ede d EE SEEN 83 Using Duplex udo uec Ete LAGE PN MEL RAI S A ea 84 DSng F plesis ss we os do coo S vetu ue tlU tuU OE cL kde 84 Using Duplex and Triplex Soft Keys E exu we v eae UNS ee SS 85 Tisste Doppler us eh d Dg vo pee e END RA he SN d Sed 85 About Eissue Dopplers cate oes 85 Color Modes ea RPM E DEN Ede NN 85 EnVisor Series User s Guide M2540 30000 ug 02 About 4 3 2 2o defeat ueque RU ai et udi 85 Using Color t stu Mo Cos aided Geen 86 Using Color Mode Soft Keys uites soa Voluts loea ie est des 86 Using Color S ppresS ee Sus en VT AED DEVE S pe Ee ES aet Qe 88 Color Compare teo ete e VE SR EM EIAS EN uL Ete EE EV 88 Color Power Angio s occus S ved Vote fee ea hh eS cus pU P b 89 About Col t Power Angio cuve pd etx te PREGA E hd 89 Usine Color Power Anglo 42 4004 dete be Mee Ras 89 Using Color Power Angio Soft Keys o oes hee tei ok Bay us 89 Using Color Power Angio Suppress 255222 be ut x TER RR 91 Color Power Angio Compare t 91 SIRE PO ewe amet ae ten aha a alan ow eps gina dre rare nen gel hme 92 LD Modes
235. nt of the Monitor You can change the tint of the monitor You have two options e Color 1 Bluish hue e Color 2 Grayish hue To view the current monitor tint setting simultaneously press the key and the key below the brightness symbol on the front of the monitor The monitor tint setting Color 1 or Color 2 is displayed on the screen To change the tint of the monitor press the key and the key again while the cur rent monitor tint setting is still displayed EnVisor Series User s Guide M2540 30000 ug 02 Locating the System Serial Number The system serial number model number and software revision for your system appear on a label above the input output panel on the back of the system They also appear in the Options window To locate the system serial number model number and software revision 1 Press the Setup key The Setup window opens 2 Click the Options tab 3 Click the Options button The Options window opens The system serial number model number and soft ware revision appear at the top of the Options window in the blue border 4 Click Close Turning Your System On or Off To turn your system on or off press the On Off button under the floppy disk drive Caution Do not unplug the system from the wall until the system turns off com pletely If you unplug the system before the system turns off completely you will have to wait longer than usual to use your system the next ti
236. ntly remove an option click Remove A password is required to pre vent accidental deletion of an option Make a note of the confirmation number EnVisor Series User s Guide M2540 30000 ug 02 To temporarily disable an option clear the appropriate check box To re enable an option select the appropriate check box 5 Click OK Information in the Status column in the Options window indicates the status of each application Not installed An application that is not yet installed e Permanent An installed application e Expires on date A trial application that expires on the specified date e Expired An expired trial application Removed A permanently deleted application About Option Keys Before you use any of the following you must assign an option key to the application 3D Mode a component of the OB GYN application package option e Panoramic Imaging only available on the EnVisor HD series e Stress Echocardiography an option that you must purchase separately e Tissue Doppler only available on the EnVisor HD series The option keys are labeled 1 2 3 and 4 To use the application press the option key assigned to the application Assigning Option Keys To assign an option key to 3D Mode Panoramic Imaging Stress Echocardiography or Tissue Doppler 1 Press the Setup key The Setup window opens 2 Click the Options tab 3 Click Keyboard 4 To assign an option key to an applic
237. o is on To turn on Directional Angio select map F with the Map soft key Map Invert is always available in Color Mode Packet Use the Packet soft key to specify the flow packet size which determines the number of times each color or angio scan line is interrogated Increasing Packet increases color or angio sensitivity and decreases the frame rate Decreasing Packet decreases color or angio sensitivity and increases the frame rate Patient Temp Use the Patient Temp soft key to enter the patient s temperature Patient Temp is only available when a TEE transducer is selected Increasing Persist increases color or angio filling and decreases noise Persist Use the Persist soft key to average consecutive frames for a smoother appearance with less noise Increasing Persist smooths the color or angio appearance Decreasing Persist decreases color or angio filling and increases noise Smooth Use the Smooth soft key to change the appearance of the flow data by using spatial filtering There are eight Smooth settings Use lower settings for smaller vessels and higher Smooth settings for larger vessels EnVisor Series User s Guide 87 M2540 30000 ug 02 Using Color Suppress Color Suppress temporarily removes color data from a frozen color image without exiting Color Mode To use Color Suppress 1 While in Color Mode press the Freeze key to freeze the image 2 Press the Color key Color data is removed from the image Press th
238. o not take into account the possible bending of the needle e The crossover depth is only an estimate Never use the crossover depth exclusively to identify the needle position on the biopsy guide Never use the crossover depth as a replacement for using the depth marker or performing measurements EnVisor Series User s Guide 125 M2540 30000 ug 02 126 e Some biopsy guides can inadvertently be installed backward When you turn the Biopsy feature on for the first time during an exam a warning appears on the imaging screen if the selected transducer supports one of these biopsy guides Turning the Biopsy Feature On If you are in 2D Mode and a noncardiac preset and are using a transducer that sup ports biopsy press the Next soft key The Biopsy soft key appears To turn the Biopsy feature on press the Biopsy soft key and choose either the Gun or Needle setting If the selected transducer supports a biopsy guide with more than one needle position a soft key that lists the transducer name and the current crossover depth the lt Cross over Depth gt soft key appears next to the Biopsy soft key Press the lt Crossover Depth gt soft key to choose the correct crossover depth Notes e If the selected transducer supports a biopsy guide that can inadvertently be installed backward a warning appears on the imaging screen The biopsy guide for the 112 5 50 has infinite angle capability When you are using the L12 5 50 transduce
239. o one of the follow ing 1 Press the Report key 2 Click the Interpret tab 3 Use the trackball to move the cursor over the Visualizations or Observations field 4 Press the Select key 5 Use the trackball to highlight the visualization or observation or highlight Man ual Text Entry to type a value 6 Press the Enter key The visualization or observation appears in the report Or 1 Press the Report key 2 Click the Interpret tab EnVisor Series User s Guide 242 M2540 30000 ug 02 the finding code in the Finding Code field and skip to step 6 or type the first letter of the finding code Press the Return key Scroll to the appropriate finding code Press the Enter key The interpretation appears in the report Adding Comments to a Report You can use the Comments tab in the report work area to add comments and sum mary statements to a report On the Comments tab you can also view the list of images in the report and delete images from the report To add comments to a report 1 2 3 Press the Report key Click the Comments tab To make a comment use the trackball to move the cursor into the Comments area press the Enter key and type the comment To add a summary statement use the trackball to move the cursor into the Sum mary area Press the Select key highlight the summary statement with the track ball and press the Enter key To delete an image from the report select t
240. of inter est from the background Gray values above the specified threshold are taken into account when constructing the 3D image gray values below the threshold are not When the value is 0 all 3D data is used to create the rendered 3D image When the value is 100 no 3D data is used to create the rendered 3D image Transparency adjusts the transparency of the 3D image A value of 0 results in a com pletely opaque projection A value of 100 produces a translucent appearance To change 3D image display settings EnVisor Series User s Guide M2540 30000 ug 02 4 Press the Enter key until a cursor appears on the imaging screen To change the Transparency Threshold Texture Intensity Image Length or Image Angle setting click the up or the down arrow next to the name of the set ting To change the Image Filter setting choose a value from the Image Filter drop down menu When you finish changing settings press the Enter key again Changing the 3D Render Mode You can change the way the 3D image is displayed by changing the render mode You can choose from three render mode values Gradient An image that can be adjusted to display surface shape or textures using the Texture and Brightness settings X ray An X ray like translucent image adjust the translucency with the Trans parency setting MaxIP A projection showing only the maximum gray values along the current viewing direction To change the re
241. of the contents of the disk click Close 5 To close the Setup window click Close Clearing a Floppy Disk or an Optical Disk To erase all of the files on a floppy disk or an optical disk 1 Press the Setup key The Setup window opens 2 Click the Floppy Disk or Optical Disk tab 3 Click Clear Disk The Clear Disk window opens 4 To erase all of the files on the disk click OK 5 close the Setup window click Close Formatting a Floppy Disk or an Optical Disk To format a floppy disk or an optical disk 1 Press the Setup key The Setup window opens 2 Click the Floppy Disk or Optical Disk tab 3 Click Format Disk The Format Disk window opens EnVisor Series User s Guide 275 M2540 30000 ug 02 276 4 Change other settings if necessary 5 format the disk click Start 6 To close the Setup window click Close Note You must format a disk before you export to it If you try to export to an unfor matted disk an error message appears Ejecting a Disk To eject a floppy disk press the small button right below the floppy disk drive To eject a CD R press the small button right below the CD drive To eject an optical disk press the small button right above the optical disk drive Peripherals About Peripherals You can purchase the following optional peripherals to use with your system Sony Digital Graphic Printer UP D895MD black and white printer Sony Digital Color Printer UP D21MD
242. olume Volume single plane 2 chamber MOD ESV Volume Volume single plane 4 chamber MOD Volume single plane ellipse Fractional shortening Difference of LV lengths Difference of LV lengths Left ventricular mass at end diastole Left ventricular mass at end diastole indexed by body surface area Wee ventricular tract area Mitral valve regurgitation proximal isovolumic surface area Mitral valve flow area Stroke Volume Stroke volume Stroke volume 2D 208 EnVisor Series User s Guide M2540 30000 ug 02 SV Cubed Stroke Volume Stroke volume Stroke volume 2D SV MOD bp Stroke Volume Stroke volume Stroke volume 2D SV mod Simp Stroke Volume Stroke volume Stroke volume 2D SV MOD sp2 Stroke Volume Stroke volume Stroke volume 2D SV MOD sp4 Stroke Volume Stroke volume Stroke volume 2D SV sp el Stroke Volume Stroke volume Stroke volume 2D SV Teich Stroke Volume Stroke volume Stroke volume 2D EnVisor Series User s Guide M2540 30000 ug 02 209 Doppler Calculations Label Al max PG Ao max PG Ao max PG 2 Ao mean PG Ao mean PG 2 Ao PI 2t Aortic HR AVA 1 0 AVA CO LVOT Formula Maximum Pressure Gradient Aortic Insufficiency Maximum Pressure Gradient Aortic Flow Maximum Pressure Gradient Aortic Flow Mean Pressure Mean Pressure
243. ominal Circumferences Ellipse Calculations Versus Planimetry Journal of Clinical Ultrasound May 1987 15 237 239 HC to AC Ratio The ratio unitless of head circumference cm to abdominal circumference cm is AC The typical range for HC AC is 0 96 13 weeks gestational age to 1 23 41 weeks gestational age Campbell S Thoms A Ultrasound Measurement of Fetal Head to Abdomen Circumference Ratio in the Assessment of Growth Retardation British Journal of Obstetrics and Gynecology 1977 84 165 174 ICA to CCA Ratio The formula for the ICA CCA ratio unitless given the internal carotid artery systolic velocity vycA cm s and the common carotid artery systolic velocity cm s is VICA VCCA r Garth K Carroll B et al Duplex Ultrasound Scanning of the Carotid Arteries with Velocity Spectrum Analysis Radiology June 1983 147 826 EnVisor Series User s Guide 333 M2540 30000 ug 02 LA to AO Ratio LA dimension Ao root diam Roelandt Joseph Practical Echocardiology vol 1 of Ultrasound in Medicine Series ed Denis White Research Studies Press 1977 p 270 Schiller N B et al Recommendations for Quantification of the LV by Two Dimensional Echocardiography Journal of the American Society of Echocardiography Sept Oct 1989 Vol 2 No 5 p 364 Length t where X7 Y7 and are the endpoint coordinates of the line segment Note
244. ork area appears to the right of Report Work Area the patient report It includes several tabs that allow you to edit information that appears in the report Resolution is a fusion setting that is used to achieve image information at shallower depths The Resolution setting optimizes the image for superficial structures Resolution A region of interest ROI box is a box that appears on an image The area in the ROI ROFBOX box is the portion of the image that is acquired SCP An SCP service class provider is a server on a network The Setup window allows you to change Setup Window system settings and settings for modes applications options peripherals and so on In a Stress Echocardiography single cycle Single Cycle Acquisition acquisition stage one loop is acquired and saved to the study EnVisor Series User s Guide M2540 30000 ug 02 297 Soft Keys Soft keys are the oval keys above the system control panel and below the monitor The functions of the soft keys change depending on the mode the application the preset and the transducer The function of each soft key is described above the soft key on the bottom of the imaging screen To use a soft key press the up or the down arrow on the key to choose or change the selection that appears above the key on the imaging screen Stage View Label In Stress Echocardiography the stage view label lists the name of the current
245. osition only appears on the bottom right corner of the imaging screen if the image is not full size You cannot reposition a full size image Moving a Reference Line A 2D reference line appears in cardiac presets an MMode reference line appears in MMode and a CW reference line appears in CW Doppler To move the reference line 1 Press the Select key until Line is highlighted on the bottom right corner of the imaging screen 2 Use the trackball to move the reference line Note The CW Doppler transmit and receive focus is indicated by a small focus dia mond on the CW reference line Use the trackball to move the CW Doppler transmit and receive focus and the reference line as one unit Tissue Harmonic Imaging About Tissue Harmonic Imaging Tissue Harmonic Imaging is a 2D Mode in which the transducer receives at twice the transmit frequency Tissue Harmonic Imaging clears clutter from the image and can be helpful when imaging areas that are filled with fluid such as the gallbladder or heart chambers EnVisor Series User s Guide 63 M2540 30000 ug 02 64 Note In Tissue Harmonic Imaging the frame rate is generally limited to 30 Hz for the black and white image Using Tissue Harmonic Imaging To use Tissue Harmonic Imaging Press the THI key A Tissue Harmonic Imaging icon like the one below appears on the lower left corner of the imaging screen 1 9 3 8 Adjust the 2D GAIN rotary control and the TG
246. ow opens 5 In the Roles area click Modify 6 Click the Advanced button to the right of Storage SCP The Network export preferences window opens 7 Click the Image Format tab 8 Click Palette Color or RGB Note Choose RGB only if your PACS and DICOM viewer do not support Pal ette Color Palette Color format uses less space on the server and provides better viewing 9 Click OK 10 Click OK 11 Click Close 44 EnVisor Series User s Guide M2540 30000 ug 02 Setting Up Automatic DICOM Study Deletion You can set up automatic study deletion so that a study is automatically deleted as soon as all of its images are exported over a network Automatic study deletion is asso ciated with automatic DICOM export To turn automatic study deletion on or off 1 Press the Setup key The Setup window opens 2 Click the System tab The System window opens 3 Click DICOM The DICOM Setup window opens 4 Click the Servers amp Roles tab The Servers amp Roles window opens 5 In the Roles area click Modify 6 Click the Advanced button to the right of Storage SCP The Network Export Preferences window opens 7 Click the Auto Delete tab 8 Click the appropriate option and press the Enter key No Auto Deletion Studies not deleted from your system when they exported over the network When space is limited on your system the oldest stud ies are automatically deleted or you are prompt
247. pear in the color bar in the upper right corner of the imaging screen EnVisor Series User s Guide 85 M2540 30000 ug 02 86 Turning on Color Mode turns off Color Power Angio but does not turn off MMode PW Doppler or CW Doppler Using Color Mode To use Color Mode 1 In 2D Mode optimize the image 2 Resize and reposition the 2D image if necessary 3 To start Color Mode press the Color key A color box appears on the image Resize and reposition the color box with the trackball if necessary Adjust the Baseline Doppler Gain and Scale rotary controls if necessary To change the appearance of your image use the soft keys Amb GNE E Optional If you re using a linear transducer use the Angle rotary control to steer the color box 8 To exit press the Color key again or press the 2D key Using Color Mode Soft Keys To change any of the settings listed below press the oval key below the soft key label B W Suppress Use the B W Suppress soft key to force the width and position of the 2D image to match the width and position of the color or angio window Reducing the size of the window increases the frame rate B W Suppress is available only with sector and curved linear transducers Density Use the Density soft key to specify the number of color or angio interroga tion lines Use Density in conjunction with the Packet soft key Increasing Density decreases the frame rate Decreasing Density increases th
248. physical profile values that are used to calculate the biophysical profile total Note Biophysical profiles do not appear in the report if they have no value To add a visualization an observation or biophysical profile information to an obstet ric report 1 Press the Report key 2 Click the Interpret tab 3 Use the trackball to move the cursor over the Visualizations or Observations field 4 Press the Select key EnVisor Series User s Guide 241 M2540 30000 ug 02 5 Use the trackball to highlight the visualization or observation or highlight Man ual Text Entry to type a value 6 Press the Enter key The visualization or observation appears in the report 7 enter biophysical profile values clear the appropriate N A check box click the Movement Tone Breathing or AF Volume field and type the value The biophysical profile value appear on the Interpret tab and in the report Adding Visualizations and Observations to a Gynecologic Report When you are in a gynecologic preset you can choose or manually type gynecologic visualizations and observations which appear in the report To make observations about follicles click the Left Follicle or the Right Follicle tab Select the appropriate check boxes Crenation or Cumulus for each follicle To hide follicle observation information from the report clear the Show on report check box To add a visualization or an observation to a gynecologic report d
249. plane volume calculation uses two orthogonal plane area traces the two chamber apical view and the four chamber apical view and a long axis length the longer of the two long axes The area traces are divided into 20 elliptical disk seg ments Area Length Method The non MOD single plane ellipse biplane ellipse and Bullet volume calculations use the Area Length Method which uses apical measurements When a two chamber or a four chamber measurement is made the area values are copied into the equivalent generic apical measurement using the meta measurement feature However generic apical measurements are not copied back into either the two chamber view or the four chamber view measurements EnVisor Series User s Guide M2540 30000 ug 02 Three Distance Volumes For radiology and other applications volumes of solids are calculated using the fol lowing formula Length x Width x Height x 0 523 One Distance Volumes Follicular volumes are one distance volumes They are calculated using the following formula 0 523 X DXD XD where D follicular distance Calculations by Exam Type About Calculations by Exam Type All calculations are listed by exam type in the topics in this book The tables include the type and the meaning of the calculation Instructions for performing the calcula tions are not included in the tables See Appendix A for the formula inherent approximations and assumptions and clin ical references fo
250. port Exporting an Image in PC Format You can export an individual frame or loop to a floppy disk an optical disk or a CD Frames are saved in format Loops are saved in avi format Note When you export a still image any measurements remain on the image How ever when you export a loop all measurements are removed before the loop is exported To export a frame or a loop In Image Review click 4 Use the trackball to move the cursor over the image Quickly press the Enter key twice A full screen image appears If you are viewing a loop click a to freeze the playback of the loop If necessary use the Frame Select slide control to choose the frame you want to export Do one of the following EnVisor Series User s Guide M2540 30000 ug 02 e Press the Select key highlight Export Image with the trackball and press the Enter key Click 7 For a loop specify whether you want to export the current frame or the whole loop 8 Change any necessary settings 9 Click Export 10 Choose the destination 11 Type the file name for the image 12 Click Save Exporting Images in PC Format You can export all of the images displayed in Thumbnails or just selected images to an optical disk or a CD R The frames are saved in bmp format The loops are saved in avi format When you export images you can specify whether you want to export the latest ver sion of the report with the im
251. press the Del key to mark or unmark selected images for deletion Del Measure Press the Del key above the Measure key to delete a selected measurement If no mea surement is selected all of the measurements are deleted When thumbnails are displayed in Image Review press the Del key to mark or unmark selected images for deletion Depth Press the up or the down arrow on the Depth key to increase or decrease the distance from the face of the transducer to the deepest point in the displayed image The cur rent imaging depth is displayed on the right side of the imaging screen In Zoom press the up or the down arrow on the Depth key to increase or decrease the degree of magnification of the zoomed image In 3D Mode or Panoramic Imaging press the up or the down arrow on the Depth key to enlarge or reduce the size of the image Doppler Gain In PW and CW Doppler turn the Doppler Gain rotary control to adjust the bright ness of the spectral display Adjusting the Doppler Gain also affects the volume of the audio output In Color and Color Power Angio turn the Doppler Gain rotary control to adjust the intensity of the color or the angio In Triplex the Doppler Gain rotary control affects spectral trace when Gate is high lighted on the bottom right corner of the imaging screen It affects the color or angio gain when Size or Position is highlighted The Doppler Gain rotary control is located under the Scale rotary control and i
252. ption Part Number Trunk Cables 3 Lead trunk cable AAMI MI500A 3 Lead trunk cable IEC MI510A AAMI Lead Sets for North America and Australia 3 Lead set grabber 603 3 Lead set snap MI605A 3 Lead set mini clip 1 5 0 45m 1 5 45m 3 Lead set mini clip lii 2 3 0 7m 2 3 0 7m IEC Lead Sets for all other countries 3 Lead set grabber MI6IIA 3 3 1 0m OR use 3 Lead set grabber MI613A 3 3 1 0m ICU use 3 Lead set snap 1615 3 Lead set mini clip 1619 EnVisor Series User s Guide 283 M2540 30000 ug 02 Electrodes Foam electrodes rectangular pre gelled 40420A 1O card 100 cards case Cloth electrodes pre gelled 5 card 300 13944B pack 300 case Foam electrodes round pre gelled 30 pack 300 case Pediatric electrodes cloth pre gelled 30 13951 oes Printer Supplies and Accessories Printer Supplies You can order the following supplies to use with your printers Description Part Number Black and White Thermal Printer Paper Hi Glossy paper box of 5 rolls Sony UPP SNYIIOHG 110 Hi Density paper box of 5 rolls Sony SNYTIOHD UPP I10HD Standard paper box of 5 rolls Sony UPP m 10S 1105 Color Printer Paper Sony 211 SNY21L EnVisor Series User s Guide 284 M2540 30000 ug 02 Note Philips recommends the use of Hi Glossy paper SNY110HG to maximize print image quality Using Hi Density
253. r s Guide M2540 30000 ug 02 235 To select the frame use the Frame Select slide control Specifying the Synchronization Mode When you are playing back more than one loop simultaneously you can use the track ball to select from the Synchronization Mode drop down menu e Free run The loops play back continuously at the same speed e Synch to both ends If the loops are different lengths the speed is adjusted so that the loops all begin and end at the same time e Synch to beginning All loops begin at the same time and play back at the same speed Comparing Images from Two Studies To compare an image from the current study with an image from a previous study in the same patient folder 1 In Image Review click i 2 Move the cursor over the first image with the trackball 3 Press the Enter key 4 Click the tab for the previous study 5 Use the trackball to move the cursor over the second image 6 Press the Enter key 7 Click Play Editing the Endpoints of a Loop To edit the beginning or the end of a loop 1 In Image Review click Use the trackball to move the cursor over the image Quickly press the Enter key twice ps T9 Use the trackball to move the cursor over the image EnVisor Series User s Guide 236 M2540 30000 ug 02 5 Press the Select key 6 Highlight Loop Edit with the trackball 7 Press the Enter key To adjust the endpoints use the trackball to move the cursor
254. r neither biopsy soft keys nor biopsy graphics appear on the imaging screen For information about the L12 5 50 biopsy guide see the EnVisor Series Transducer Guide in the EnVisor Series Reference Guide Using Biopsy Soft Keys To change any of the settings listed below press the oval key below the soft key label Biopsy Use the Biopsy soft key to initiate the biopsy feature Biopsy has three set tings e Off Turns the Biopsy feature off e Needle Two guide lines appear that outline the area in which the biopsy needle path is most likely to be e Gun One guide line appears that shows the anticipated path of the biopsy nee dle The Biopsy soft key is only available when you are in 2D Mode and a noncardiac pre set and are using a transducer that supports biopsy EnVisor Series User s Guide M2540 30000 ug 02 See the EnVisor Series Transducer Guide for important information about using biopsy capable transducers Warnings e Biopsy guide lines are intended as guides only Never use biopsy guide lines as an absolute reference e Biopsy guide lines do not take into account the possible bending of the needle lt Crossover Depth gt The lt Crossover Depth gt soft key shows the name of the selected transducer and its crossover depth The crossover depth is the distance along the cen terline of the image from the transducer lens surface to the intersection with the antic ipated needle path The lt Crossov
255. r each calculation Abdominal Vascular Calculations All abdominal vascular calculations are listed in the following tables which appear in alphabetical order See Appendix A for the formula inherent approximations and assumptions and clinical references for each calculation EnVisor Series User s Guide 201 M2540 30000 ug 02 Stenosis Calculations Label Formula Meaning Area sten li Area Stenosis Diam sten Diameter Stenosis Percent area stenosis Percent diameter stenosis Percent area stenosis Aortic Area sten Diameter Stenosis Renal Artery Area Stenosis Area sten Percent diameter stenosis Aortic Diam sten area stenosis Renal Artery Diameter Percent diameter Diam sten Stenosis stenosis Flow Volume Calculations Label Formula Meaning Flow volume via diameter Aortic flow vol Flow volume via diameter Flow vol Flow volume via diameter Flow Volume Diameter Renal Artery flow vol Label Type Aortic RI Resistivity index Aortic PI Pulsatility index using time averaged mean of the peaks EnVisor Series User s Guide 202 M2540 30000 ug 02 Renal Artery RI JRE Resistivity index Renal Artery Pulsatility index using time averaged mean of the peaks Pulsatility index using time averaged m
256. r in the color bar in the upper right corner of the imaging screen In Color Power Angio an angio box appears on the image The amplitude intensity of flow in the angio box is represented with different hues The colors being used appear in the color bar on the upper right corner of the imaging screen Color Power Angio Colur Power Aligio Zoom Color Power Angio Zoom shows angio flow in a magnified image Color Zoom shows color flow in a magni Color Zoom fied image The CW focus diamond lies on the CW ref CW Focus Diamond erence line Use the trackball to place the CW focus diamond over the area of interest The CW reference line appears on the refer ence image Use the trackball to place the CW focus diamond on the CW reference line over the area of interest CW Reference Line Digital Imaging and Communications in Medicine DICOM is a standard devel oped by ACR NEMA to allow medical images to be exchanged between instru ments computers and hospitals It includes a number of image file format options with respect to pixel form and format palette compression and so on DICOM EnVisor Series User s Guide 291 M2540 30000 ug 02 Doppler Modes Doppler modes measure blood flow or tis sue motion from detected frequency shifts in returning sound waves The frequency shifts can be used to produce audio signals or they can be displayed graphically in a Doppler spectral
257. r key When the cursor is hidden the trackball function is highlighted on the bottom right corner of the imaging screen The default trackball functions are Pan and Rotate You can press the Zoom key to change the trackball function to Zoom EnVisor Series User s Guide 105 M2540 30000 ug 02 106 Performing Measurements a Panoramic Image You can perform two point measurements on a panoramic image You cannot per form other measurements on a panoramic image You can delete measurements on a panoramic image but you cannot reactivate mea surements Placing a Title Above a Panoramic Image You can place a title above a panoramic image before you save the panoramic dataset It appears on the upper left corner of the imaging screen To place a title above a panoramic image 1 Press the Label key The Title soft key appears 2 Press the Title soft key 3 Doone of the following e fno title currently exists a cursor appears on the upper left corner of the imaging screen Type a title for the panoramic image e Ifa title already exists the title is selected so that you can edit it Note To delete the title press the Del key 4 When you are finished press the Label key again Placing a Label on a Panoramic Image You can type a label anywhere on a panoramic image To place a label on a panoramic image 1 Press the Label key 2 Use the trackball to move the I cursor to the location where you want to type
258. r patient folder 1 SO Oo DM 9 Press the Review key to enter Image Review The Search for Study window opens It lists all of the patient studies saved on your system Use the trackball to move the icon over the patient study you want to move Press the Select key Use the trackball to highlight Move Press the Enter key Choose the patient folder you want to the study into Click OK Click Yes to confirm that you want to move the study EnVisor Series User s Guide M2540 30000 ug 02 227 228 Deleting a Patient Study To delete a patient study 1 Press the Review key to enter Image Review 2 Click R The Search for Study window opens Click Search 4 Use the trackball to move the icon over the patient study that you want to delete Optional Press and hold the Control key or the shift key to select more than one study Press the Select key Use the trackball to highlight Delete 5 6 7 Press the Enter key 8 Click Yes to confirm 9 Click Close Viewing a Previous Study for the Current Patient In Image Review a tab appears for each patient study in the patient folder The tab lists the time and date of the study To view a previous patient study click the tab Note Previous studies are read only You cannot modify or add images or data to them Closing a Patient Study To close a study and save all of the changes you made press the Review key to enter Image Review
259. r when you save or close a study Automatic DICOM Printing Automatic DICOM printing automatically sends images to a DICOM printer when you press the Acquire key or when you save or close a study Automatic Doppler Trace Automatic Doppler trace automatically traces a frozen Doppler spectrum over one heart cycle and uses the trace to calculate and display the results of key Doppler mea surements and calculations Automatic Study Deletion Automatic study deletion automatically deletes a study as soon as all of its images are exported over a network Automatic study deletion is associated with automatic DICOM export Body Marker A body marker is a graphic that you can place on the imaging screen to indicate the part of the anatomy that you are scanning When you place the body marker a trans ducer icon also appears Color Box A color box appears on the image in Color Mode The velocity and direction of flow in the color box are represented with different colors for direction and different shades for velocity EnVisor Series User s Guide 290 M2540 30000 ug 02 You are in Color MMode when you in Color MMode Color Mode and MMode at the same time In Color Mode a color box appears on the image The velocity and direction of flow in the color box are represented with different Color Mode colors for direction and different shades for velocity The colors being used appea
260. re calculated according to PI and RI formulas which use the minimum velocity How ever Acceleration Time AT Acceleration Slope AS Diastolic Systolic ratio D S and Systolic Diastolic ratio S D are now inaccurately reported since these formulas require use of the end diastolic rather than the minimum diastolic velocity If you want to use the minimum velocity method you should use your best diagnostic judgment in making and using PI and RI calculations that come from automatic Doppler trace You can also use manual Doppler trace to produce PI and RI calculations Clinical Sonography A Practical Guide 2nd ed Roger C Sanders ed Little Brown and Company 1991 Nanda Navin D Doppler Echocardiography 2nd ed Philadelphia Lea and Febiger 1993 29 Sahn D DeMaria A Kisslo Weyman A The Committee on MMode Stan dardization of the American Society of Echocardiography Recommendations Regarding Quantitation in MMode Echocardiography Results of a Survey of Echocardiographic Measurements Circulation 1978 Vol 58 No 6 pp 1072 1083 Feigenbaum Harvey Echocardiography 4th ed Philadelphia Lea and Febiger 1986 pp 115 122 Emamian S A et al Kidney Dimensions at Sonography Correlation With Age Sex and Habitus in 665 Adult Volunteers American Journal of Radiology January 1993 160 83 86 About Automatic Doppler Trace Doppler Trace is intended for use on spectral waveforms that
261. rea that you want to remove Use the trackball to trace the area that you want to remove Press the Enter key again to remove the tissue within the enclosed area EnVisor Series User s Guide M2540 30000 ug 02 Placing a Title Above a 3D Image You can place a title above a 3D image before you save the 3D dataset It appears on the upper left corner of the imaging screen To place a title above a 3D image 1 Press the Label key The Tide soft key appears 2 Press the Title soft key 3 Do one of the following e Ifno title currently exists a cursor appears on the upper left corner of the imaging screen Type a title for the 3D image e Ifa title already exists the title is selected so that you can edit it Note To delete the title press the Del key 4 When you are finished press the Label key Placing a Label on a 3D Image You can type a label anywhere on a 3D image To place a label on a 3D image 1 Press the Label key 2 Use the trackball to move the I cursor to the location where you want to type a label 3 Type the label 4 If necessary you can move edit or delete the label To move the label use the trackball to move the cursor over the label press the Enter key and move the label with the trackball Press the Enter key again to reposition the label e To edit the label use the trackball to move the cursor over the label until the cur sor starts to blink Use the backspace key to remove
262. reen EnVisor Series User s Guide 17 M2540 30000 ug 02 18 In CW or PW Spectral Doppler the scale is displayed in the trace area Select Press the Select key to change the active function of the trackball The possible func tions of the trackball for the current mode transducer and preset are listed on the bottom right corner of the imaging screen The active trackball function is high lighted and its associated imaging screen elements appear in blue Use the Select key in conjunction with the trackball to choose an option from the Pre set Label Measurements or Calculations menu Highlight the item with the track ball and press the Select key Setup Press the Setup key to open the Setup window The Setup window allows you to modify system and feature settings and if you want save those changes to new or existing presets Press the Setup key to display the physio soft keys Soft Keys Soft keys are the oval keys above the system control panel and below the monitor The functions of the soft keys change depending on the mode the application the preset and the transducer The function of each soft key is described above the soft key on the bottom of the imaging screen To use a soft key press the up or the down arrow on the key to choose or change the selection that appears above the key on the imaging screen Press the Previous or the Next soft key to display more soft keys Spectral In CW Preview or PW
263. references You can control some aspects of image acquisition To specify acquisition preferences 1 Press the Setup key The Setup window opens Click the Acquisition tab The Acquisition window opens EnVisor Series User s Guide M2540 30000 ug 02 7 If you want the blue border around the image to be saved when you press the Acquire key select the Acquire Border check box If you want to switch to Image Review after you press the Acquire key select the Switch to Review after acquire completes check box If you want to hear a beep after an image is acquired select the Beep after acquire completes check box Click Apply Click Close Printing in Live Imaging You must assign a Record key to a printer or a VCR before you can use it To print an image press the Record key assigned to the printer you want to use During printing a printer icon appears and the soft keys disappear You cannot start printing again until the printer icon is removed from the screen Notes The ability to print to a networked DICOM printer is a component of the DICOM Basic option You cannot assign a Record key to a DICOM printer Pressing the Record key assigned to a VCR begins a VCR recording Changing the Image Size You can specify the size of the image Your choices are Medium and Large To change the image size 1 Press the Setup key The Setup window opens Click the System tab The System
264. s K L et al Calculation of Aortic Valve Area by Doppler Echocardiography A Direct Application of the Continuity Equation Circulation Vol 73 No 5 May 1986 pp 964 969 AUA Average Ultrasound Age The Average Ultrasound Age formula is AUA GA GA GA n where n varies from 1 to 12 The Average Ultrasound Age AUA is the average of all with one exception the gestational ages that were generated during an exam from acquired values Gestational ages generated from corrected BPD are not included in the calculation Also only gestational ages that are generated from measurable values contribute to the AUA Gestational ages based on fetal biometric parameters only are inputs to the AUA GA LMP for instance is not an input to AUA You can mark gestational ages for inclusion in or exclusion from the AUA An editable marker field allows you to select which gestational ages should be included in the calculation of the AUA to be included in the report The gestational age is proceeded by a plus sign to indicate that the age will be included in the AUA or a minus sign to indicate that the age will be excluded from the AUA This feature allows you to decide during an obstetric exam that a particular gestational age is out of line with the others and would inappropriately skew the calculation In this case you may enter the edit mode and deselect the calculation by replacing with for that particul
265. s and biomed ical engineers who operate and maintain the ultrasound system Additional Documentation In addition to this guide the ultrasound system includes the following documentation for your reference e Philips EnVisor Series Getting Started Guide This guide includes information to help you get started using the ultrasound sys tem EnVisor Series User s Guide M2540 30000 ug 02 T 1 e Philips EnVisor Series Safety and Standards Guide This guide includes critical information about the intended uses of the ultrasound system patient and operator safety device standards and maintenance e Philips EnVisor Series Transducer Guide This guide identifies all of the transducers that you can use with the ultrasound system and provides information about transesophageal echocardiography TEE intraoperative and endocavity transducers that you can use with the EnVisor series This guide provides detailed information on the use and care of the Philips transducers that you can use with the ultrasound system EnVisor Series Online Help The EnVisor Series Online Help provides information and step by step instruc tions for performing tasks with the ultrasound system e Philips EnVisor Series Quick Cards The Quick Cards provide answers to commonly asked questions EnVisor Series User s Guide M2540 30000 ug 02 Contents Tus Guide usce eee le LUN alle BON UE gu Up Lut v Intended II P ash ns miai iaaa
266. s labeled Gain EnVisor Series User s Guide M2540 30000 ug 02 Enter Use the Enter key in conjunction with the trackball to click an item or choose a menu option Highlight the item or option with the trackball and press the Enter key In Zoom Preview press the Enter key to magnify the area enclosed in the zoom box In PW Preview CW Preview or MMode Preview press the Enter key to display the spectral or the MMode trace In CW or PW spectral Doppler press the Enter key to specify whether the 2D refer ence image or the PW spectral trace is live In 3D Mode or Panoramic Imaging press the Enter key while reviewing the 3D or panoramic image to specify whether the trackball moves the cursor or moves the image When using the trim tool in 3D Mode press the Enter key to remove an area that you have traced with the trackball After you select a label with the trackball press the Enter key to move the label Press the Enter key again to place the label in the new position Focus Press the up or the down arrow on the Focus key to move the location of the focal zone or focal zones the area or areas where the image is most clearly focused Freeze Press the Freeze key to freeze a live image and initiate Quick Review which allows you to scroll through the frames using the trackball Press the Freeze key again to unfreeze an image Unfreezing an image removes all measurements and calculations from the image In Dual Imaging
267. s Online Help window to display the topic in the right pane The Related Topics button appears at the bottom of each topic to direct you to other topics that you might find useful Click this button to display a list of topics and then click the topic you want to view Related Topics Click the Back icon at the top of the window return to Back the most recently viewed topic c Click the Forward icon at the top of the window to Fond advance to the next topic in a previously viewed sequence Printing Online Help To print the current online Help screen press the Record key assigned to the printer you want to use EnVisor Series User s Guide M2540 30000 ug 02 EnVisor Series Overview About the EnVisor Series The EnVisor series includes the following systems EnVisor General imaging EnVisor C Cardiac imaging EnVisor HD High definition general imaging EnVisor C HD High definition cardiac imaging The EnVisor series is a powerful ultrasound imaging and image review tool The EnVisor series allows you to do the following Image in a variety of modes including 3D Mode and Panoramic Imaging Store manage and review images Perform measurements and calculations using the comprehensive analysis package Create edit and add images to reports Send images and patient information over a network Note Some features are not available on all systems About the EnVisor HD Series The EnVisor
268. s you acquire The way you create a patient study depends on whether or not you are using Modality Worklist To create a patient study if you are not using Modality Worklist 1 Press the Patient key The Patient Identification window appears 2 Click New EnVisor Series User s Guide M2540 30000 ug 02 223 224 3 Enter the demographic information about the patient pressing the Tab key to move from field to field 4 Click OK Notes e Ifyou enter a last name but do not enter an MRN is automatically gen erated based on the current time and date e Each time you change the preset a new study is created for the patient and the current study is closed Editing Patient Demographic Information To edit demographic information about the current patient 1 Press the Patient key If you are using Modality Worklist select a patient from the Patient Selection window The Patient Identification window opens 2 Click Edit 3 Add or edit demographic information 4 Click OK Note The information shown in the Patient Identification window is determined by the current preset To display information about the patient related to a different pre set select the preset from the Additional Data Types drop down menu Saving a Patient Study To save all of the changes you made to the current study including changes in the report work area press the Review key to enter Image Review and click the following
269. scale by turning the Scale rotary control clockwise e Ifyou are using a sector or curved linear transducer turn on B W Suppress with the B W Suppress soft key EnVisor Series User s Guide M2540 30000 ug 02 If you are using a linear transducer resize the 2D image before pressing the Color key to turn on Color Mode Decrease the packet size with the Packet soft key Decrease the Density setting with the Density soft key Decrease the imaging depth with the Depth key Note After adjusting any control or soft key always check the position of the trans ducer Goal I want the color to be more sensitive Possible Actions Reposition the transducer Increase the gain by turning the Doppler Gain rotary control clockwise Use the Focus key to place the focal zone at the area of interest Decrease the scale by turning the Scale rotary control counterclockwise Decrease the Filter setting with the Filter soft key Increase the Smooth setting with the Smooth soft key Change the Doppler frequency with the Frequency soft key Decrease the density with the Density soft key Note After adjusting any control or soft key always check the position of the trans ducer Goal I need to improve the color filling Possible Actions Increase the gain by turning the Doppler Gain rotary control clockwise Use the Focus key to place the focal zone at or just below the area of interest Decrease the scale by turning the S
270. screen image click H EnVisor Series User s Guide M2540 30000 ug 02 229 230 Specifying the Image Display You can choose how many images are automatically selected to be played back each time you select an image Choose from the Image Display drop down menu e Choose Random to display only the images you choose e Choose 2 up to display two images simultaneously e Choose 4 up to display four images simultaneously e Choose to display six images simultaneously e Choose 9 up to display nine images simultaneously If you choose 2 up when you select one image that image and the following image are selected If you click Play those two images are played back simultaneously Specifying the Flag Display You can choose to display only those images that have an image flag or a caption Choose from the Flag Display drop down menu e All Images displays all images Flagged Images displays flagged images e Captioned Images displays images with a caption Flag Combination displays only images with the image flags you specify Deleting an Image in Image Review Throughout a study you can mark images to be deleted When you save the study the images are deleted To mark or unmark one or more images for deletion 1 In Image Review click i 2 Use the trackball to move the cursor over the image 3 Press the Enter key 4 Press either Del key EnVisor Series User s Guide M2540 30000 ug 02 5 Repeat s
271. sing the trackball to highlight the measurement and pressing the Del key above the Measure key You can display an image associated with a measurement only if you acquired the image or if the measurement is still on the image in live imaging Importing and Exporting About Importing and Exporting Importing and Exporting in DICOM Format DICOM format is used for patient studies that are transferred among computers that make up an information management system and for studies that are accessed by phy sicians at remote viewing stations You can export a patient study in DICOM format to an optical disk to a CD R or over a network EnVisor Series User s Guide M2540 30000 ug 02 247 248 You can import one more studies that were created an EnVisor system and saved in DICOM format from an optical disk or a CD R Notes e Ifyou have the DICOM Media option you can export studies in DICOM for mat Those studies can be viewed on any DICOM viewer If you do not have the DICOM Media option exported studies can only be viewed on EnVisor A 1 sys tems e Exporting a study over a network is a component of the DICOM Basic option The DICOM Media option includes an optical disk drive Any data that can be exported to a CD R can also be exported to an optical disk A CD R can only be used once whereas the files on an optical disk can be deleted so the optical disk can be used again Exporting in PC Format You can e
272. so you need to assign one of the option keys to Stress Echo Gain Save During the first stage of a Stress Echo protocol you can adjust the system settings the ROI setting and imaging controls such as the Depth key the 2D Gain rotary con trol the TGC slide controls Because of a feature called gain save the settings for each view are saved and then are restored when you acquire the same view in the other stages Note If you stop and resume a stress echo study gain save no longer applies ECG in Stress Echo In Stress Echo the acquisition of loops is triggered by the R wave Therefore in order to perform a Stress Echo study an ECG trace with R waves must appear on the imag ing screen If no R wave is detected the icon below is displayed on the imaging screen and a one second Stress Echo loop is acquired The ECG is captured and displayed with loops that you acquire in Stress Echo Notes Stress Echo is an option EnVisor Series User s Guide M2540 30000 ug 02 257 e The foot switch option is included in the Stress Echo option When you export a Stress Echo study only the preferred loops are exported Stress Echo Setup About Stress Echo Setup Before you begin a Stress Echo study you may create Stress Echo presets based on default Stress Echo protocols During a Stress Echo study you may modify the Stress Echo preset you are using by adding views or stages Creating a Stress Echo Preset To create a Stre
273. soot EPIO esequi eq a 92 Acquimnga 9D Datasets ess cody eS 93 Defining a 3D Region of Inter st ss gags been ta eg iGo eee eae E 94 Using 3D Dat ser Acquisition Soft Keys sees weeny ees 94 Changing the Default 3D vui corset ne de or Ue edente oa 95 319 Imaee IREVIGW oe ege ene ads soe ce Lt pL eub sts 95 oL MOVIES Sd taret ux utu exte ebbe I Rt MESE Du EE 101 Panoramic E CREDERE REPRE bred 103 About Panoramic 103 Acquiring a Panoramic Imaging Dataset 103 Using Panoramic Imaging Soft Keys soa ark eae MN pde EE REPRE eS 104 About the Accuracy of Panoramic Images 105 Panoramic Image Reviews 9 ER ee Ses E CEP RS 105 Imaging TIpsassexevetseteesueeticex er eR ay eet Re x eg 109 About mace pS Suni ette teste teo die unt 109 Imaging Tips for rea re Gly er d Eae 109 Imaging Tips for MMode suede xd eu EN NEAR MEE PE 112 EnVisor Series User s Guide xi M2540 30000 ug 02 Imaging Tips for PW Doppleros ii 2 ewe Retenir hU Ee REPE terete 112 Imaging Tips for CW Doppler coeur te Goes def S ate duro eee 114 Imaging Tips for Color MOdE va trt bed ee ite div sepa 117 Imaging Tips for Color Power Anglo EEG pde dU PES Y 120 Ima
274. sor Series User s Guide M2540 30000 ug 02 205 2D Mode Calculations Label CO bp el CO Bullet CO Cubed CO MOD bp CO mod Simp CO MOD sp2 CO MOD sp4 CO sp el CO Teich EDV bp el EDV Bullet EDV Cubed EDV MOD bp EDV mod Simp EDV MOD sp2 Formula Cardiac output 2D Cardiac output 2D Cardiac output 2D Cardiac output 2D Cardiac output 2D Volume biplane MOD EDV Volume Volume single plane 2 chamber MOD 206 EnVisor Series User s Guide M2540 30000 ug 02 EDV MOD sp4 EDV Volume Volume single plane 4 chamber MOD EDV sp el EDV Teich EF bp el EF Bullet EF Cubed EF MOD bp EF mod Simp EF MOD sp2 EF MOD sp4 EF sp el EF Teich ESV bp el ESV Bullet ESV Cubed ESV MOD bp ESV mod Simp EMEN single plane emm Ejection fraction Ejection fraction Ejection fraction Ejection fraction Ejection fraction Ejection fraction Volume biplane MOD ome EnVisor Series User s Guide M2540 30000 ug 02 207 ESV MOD sp2 ESV MOD sp4 ESV sp el ESV Teich FS LVLd diff LVLs diff LVmass AL d LVmass AL dl LVOT Area MM HR MR PISA MV Flow Area SV bp el SV Bullet ESV V
275. ss Echo preset Select a cardiac preset as a starting point for your Stress Echo preset 1 Press the Setup key The Setup window opens 2 Click the Stress tab The Stress window opens 3 Make changes that you want for your preset Load Defaults Choose one of three default protocols or create your own Default Acquisition Type Specify whether the stages are single cycle or quad cycle acquisition stages Stage Name Add stages or edit stage names 258 EnVisor Series User s Guide M2540 30000 ug 02 4 5 6 7 8 9 Start View Select a new starting view for any stage Note The view order appears below the Load Defaults button Multi Specify the multi cycle stage VCR Specify which stages are VCR stages Timer Specify the timer stage Edit Views Add views or edit view names Clear All Delete all of the settings R Wave Delay Specify the time lapse between the R wave and the acquisition of the first frame A positive number results in acquisition after the R wave a nega tive number results in acquisition before the R wave Click Apply Click Close Press the Preset key Press the Save Preset soft key Click Create New Type the name of the preset you want to create 10 Click Save About ECG Artifacts Although artifacts can occur during traditional echocardiography exams while patients are lying at rest exercise induced Stress Echocardiography exams ar
276. ssigning Record ise wane seo RE uA ad XA FETA RAE KE 21 Using the World trcs ee uu po LU Edu iue 22 Typing an Apostrophe a Quotation Mark an Accent Tilde or a 23 Backups cet crite es heo teat teas tcx tta e capstan trs Ma eae 23 About 23 EnVisor Series User s Guide M2540 30000 ug 02 Backing Up Presets and Settings to a Disk 405 205 00 se desiree E xe 24 Restoring Presets and Settings from a Disk 6 0 0 eee eee eee 24 le ge ees 25 About A score a aes EE eal Vende Bee et ed e eke YS 25 Connecting the ECG Cable and Attaching the ECG 26 Using Physio Soft Keys oor a eve te eae at oleh ee ERR 26 Changing Physio Settings oues eee e od ed ewe COR 27 CUSTOMIZING WOUP SYSTEM Sri Gea E 29 Customizing Your Systems sd ak e eue tS E EP ett Ene 29 Presets a uve PAM vod tci vui ddr ws ep 29 Ced ou ML ane ub xc LU edt 29 About Exam Ma oe e Set Ged US ae en 29 Selecting a Preset v d ema Doors eibi te tuto conte Rd d 30 Creating a Preset e Dre uh OE Leu LEA 31 Modifying a ce oo RETE EE E 31 Deleting Preset LUE Ao D ERA Deut iori eode 32 Using Pr
277. stage and view Stress Echocardiography Stress Echocardiography Stress Echo is a protocol driven exam that allows a cardiolo gist to assess cardiac wall motion at various heart rates by acquiring views of the heart at different stages of the exam A Stress Echo study consists of two to eight stages during which loops are acquired for up to eight anatomical views Each loop is a sequence of frames captured at systole starting at the R wave Synchronization Mode In Image Review when you are playing back more than one loop simultaneously you can specify the synchronization mode that is whether and how the loops are synchro nized when they are played back Texture Texture is a fusion setting that is used to achieve image information at average depths The Texture setting optimizes the tissue texture at these depths Thumbnails In Image Review you can view images in a grid format called Thumbnails 298 EnVisor Series User s Guide M2540 30000 ug 02 Tissue Doppler optimizes settings to mea Tissue Doppler sure the movement of tissue using color Doppler Tissue Harmonic Imaging is a 2D Mode in which the transducer receives at twice the transmit frequency Tissue Harmonic Imag Tissue Harmonic Imaging ing clears clutter from the image and can be helpful when imaging areas that are filled with fluid such as the gallbladder or heart chambers The transducer orientation do
278. stational age wk day via Jeanty using humerus length HL range 1 0 6 9 cm is 9 6519438 2 6200391 HL 0 26105367 HL The following table lists the percentiles in weeks for each value 95th I 6 96 I I 5th 50th a 5th 50th 7 50th 3 fiss ni m 265 55 sra sei es 220 325 353 38 22 139 194 225 953290 62 9 359 387 328 EnVisor Series User s Guide M2540 30000 ug 02 TPO POST pas 99 365 14 37 1 39 9 Jeanty Philippe et al Estimation of Gestational Age from Measurements of Fetal Long Bones Journal of Ultrasound Medicine February 1984 3 75 79 GA HL via Osaka Gestational age wk day via Osaka University using humerus length HL range 1 0 6 2 cm HL 1 01 1 31 1 59 1 87 2 15 2 41 2 67 119 s m E I 140 Nobuaki Mitsuda et al Image Diagnosis of Fetal Growth Obstetrical and Gynecological Practice in Japanese 1988 37 10 1459 70 GA MSD via Hellman The formula for gestational age wk day via Hellman using mean gestational sac diameter gestational sac diameter range 1 0 cm 5 0 weeks 6 0 cm 12 2 weeks is 10 GSD1 GSD2 6803 3 25 43 7 02 EnVisor Series User s Guide M2540 30000 ug 02 329 Hellman L M et al Growth and Development of the Human Fetus Prior
279. stolic velocity for the and RI calculation z m enath Brie Endometrium FB m enh F m eng Flow diam Diameter for flow volume Foo m For enh EnVisor Series User s Guide 183 M2540 30000 ug 02 FTA traced cm2 Area Traced fetal trunk cross sectional area GSD fem Length Gestational sac diameter one GSD2 fem Length Gestational sac diameter two GSD3 Length Gestational sac diameter three HC traced Traced head circumference m Humerus length IOD Inner orbital diameter L Follicle 1 16 Dist cm Length Diameter of left ovarian follicle 1 16 L ovary DV cm s Velocity Left ovary diastolic velocity L ovary Mean PI Left ovary mean velocity L ovary SV cm s Velocity Left ovary systolic velocity Lat V Lateral ventricle width m ieem Le ovaran m ien feng LOW imm Lek varan with M Phalanx 5 cm Length Length of the middle phalanx on the fifth digit Mean P eo Memvelody 184 EnVisor Series User s Guide M2540 30000 ug 02 Mean vel Mean velocity for flow volume NUCH em Lewh OFD cm Length Occipito frontal diameter OOD fcm j Length Outer orbital diameter om ee Pros orb
280. stolic velocity velocity VA DV cm s Maximum _ Vertebral artery diastolic velocity velocity VA SV cm s Maximum Vertebral artery systolic velocity velocity 188 EnVisor Series User s Guide M2540 30000 ug 02 Flow Volume Measurements Label Flow diam Mean vel Mean velocity Meaning Flow diameter for flow volume Mean velocity for flow volume Resistivity Index and Pulsatility Index Measurements Label CCA Mean V CCA MnV CCA MxV ECA Mean V PI ECA MnV ECA MxV ICA Mean V PI ICA MnV ICA MxV SCA Mean V SCA MnV SCA MxV VA Mean V PI VA MnV VA MxV Units Units Type ems mk ew ems ew mk e mk ew mk ew mk e mk ew mk mk ew mk w mk mk mk ew cm s ems Velocity EnVisor Series User s Guide M2540 30000 ug 02 189 190 Unlabeled Measurements About Unlabeled Measurements You can perform five types of unlabeled measurements e 1 point velocity or 1 point depth e 2 point e Ellipse e Method of Disks e Trace Results of unlabeled measurements that you perform appear in the results box on the upper right corner of the imaging screen Results of unlabeled measurements are not saved in the report but do appear in the work area in Image Review Quick Calcs are common calculations that are computed automatically as unlabeled measurements are made Quick Calc results appear
281. such as lighting other equipment or telecommunications devices EnVisor Series User s Guide M2540 30000 ug 02 Goal I need to increase the frame rate Possible Actions Resize the angio box to make it smaller If the scale setting is very low increase the scale by turning the Scale rotary control clockwise If you are using a sector or curved linear transducer turn on B W Suppress with the B W Suppress soft key If you are using a linear transducer resize the 2D image before pressing the Angio key to turn on Color Power Angio Decrease the packet size with the Packet soft key Decrease the Density setting with the Density soft key Decrease the imaging depth with the Depth key Note After adjusting any control or soft key always check the position of the trans ducer Goal I want the angio to be more sensitive Possible Actions Reposition the transducer Increase the gain by turning the Doppler Gain rotary control clockwise Use the Focus key to place the focal zone at the area of interest Decrease the scale by turning the Scale rotary control counterclockwise Decrease the Filter setting with the Filter soft key Increase the Smooth setting with the Smooth soft key Change the Doppler frequency with the Frequency soft key Decrease the density with the Density soft key EnVisor Series User s Guide 121 M2540 30000 ug 02 122 Note After adjusting any control or soft key always check
282. t appears at Transducer Orientation Dot the upper left corner of a noninverted image Trapezoidal Imaging adds additional imag ing area by changing a linear transducer s rectangular image to a trapezoidal shape Trapezoidal Imaging The extended field of view is often useful in vascular and small parts presets Use the Trap soft key to turn Trapezoidal Imaging on or off Triplex enables you to simultaneously dis Triplex play a live 2D image with color or angio and a PW Doppler trace You can create your own calculations when you are in an OB GYN preset You can add those calculations to the Calculations menu for OB GYN presets User Defined Calculation In Stress Echocardiography a rectangular view icon appears on the upper right corner of the imaging screen that indicates how many views have been acquired for the cur rent stage The rectangle contains four or eight squares one for each possible view View Icon EnVisor Series User s Guide M2540 30000 ug 02 299 World Key The two World keys are labeled with a globe They appear on either side of the space bar Use a World key to type the char acters that appear on the right side of some keys on the keyboard Zoom In Zoom you can magnify a portion of an image The magnified area has high resolu tion because the pixels are reanalyzed not simply enlarged Zoom Box When you press the Zoom key a zoom box appears on
283. t appears in the upper left corner of a noninverted image A transducer orien tation dot appears on the right of an inverted image In cardiac presets the location of the transducer orientation dot is reversed L R Invert is only available in live imaging and is not available when a spectral trace is live Map Use the Map soft key to specify the postprocessing grayscale map EnVisor Series User s Guide 65 M2540 30000 ug 02 66 In MMode and Doppler modes the Map soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when Image is highlighted Map is not available when a spectral trace is live Patient Temp Use the Patient Temp soft key to enter the patient s temperature Patient Temp is only available when a TEE transducer is selected Persist Use the Persist soft key to average consecutive frames to provide a smoother appearance with less noise Use lower persistence values for fast moving organs or tis sues and higher persistence values for slower moving organs or tissues Smooth Use the Smooth soft key to soften or sharpen the 2D image Higher settings make the image softer Lower settings make the image sharper Trap Use the Trap soft key to turn Trapezoidal Imaging on or off Trapezoidal Imag ing is available with most linear transducers This soft key appears only in 2D Mode when a trapezoidal capable linear transducer is selected If you
284. t of scheduled patients When you select a patient from the list the Patient Identification window appears populated with the patient s demographic information EnVisor Series User s Guide 49 M2540 30000 ug 02 50 If you temporarily disconnect your system from the HIS you still use Modality Worklist The most recent information from the HIS is stored on your system and is updated when you reconnect to the HIS If you specify a server for Modality Performed Procedure Step MPPS your system notifies the HIS when a patient study is complete The list of scheduled patients and patient billing information can then be updated Notes e Before you use Modality Worklist you must specify the Modality Worklist server e Modality Worklist is a component of the DICOM Advanced option Using Modality Worklist To use Modality Worklist 1 Press the Patient key The Patient Selection window opens It lists the scheduled patients 2 To sort by exam time last name or another category click the appropriate col umn header 3 Optional Search for the patient e Type one or more letters or numbers in the Find field and choose a column from the In Column drop down menu As you type the list changes to show only the patients that match your criteria e To find a subset of the results type a value for a different column in the And field and choose the column from the In Column drop down menu To start a new search
285. tal diameter cm is FL BPD The typical range for FL BPD is 0 776 23 weeks gestational age to 0 81 40 weeks gestational age Hohler C Quetal T Comparison of Fetal Femur Length and Biparietal Diameter in Late Pregnancy American Journal of Obstetrics and Gynecology December 1981 Vol 141 No 7 pp 759 762 Flow Volume Diameter The flow volume V l min formula given the flow diameter D cm and the flow mean velocity MeanV cm s is Burns RN The Physical Principles of Doppler and Spectral Analysis Journal of Clinical Ultrasound November December 1987 15 9 587 31 6 EnVisor Series User s Guide M2540 30000 ug 02 Follicle Volume Follicle volume 0 523 X DXDxXD where D follicular distance Penzias A S et al Ultrasound prediction of follicle volume is the mean diameter reflective Fertility and Sterility December 1994 Vol 62 No 6 pp 1274 6 FS Fractional Shortening LVIDd LVIDs T LVIDd Belenkie Israel et al Assessment of Left Ventricular Dimensions and Function by Echocardiography American Journal of Cardiology June 1973 Vol 31 GA AC via Hadlock The formula for gestational age wk day via Hadlock using abdominal circumference AC range 5 0 cm 12 0 weeks 38 0 cm 42 0 weeks is 8 14 0 753 AC 0 0036 AC2 Hadlock E P et al Estimating Fetal Age Computer Assisted Analysis of Multiple Growth Parameters Radiology 1984 152 497 501 GA
286. tant fraction Mitral valve regurgitant volume Mitral valve E to A ratio Mitral valve maximum pressure gradient simplified Mitral valve mean pressure gradient simplified Mitral valve pressure half time Mitral valve area via PI 2t Maximum pressure gradient simplified M2540 30000 ug 02 PI 2t PI max PG Qp Qs RVSP TR SV LVOT SV MV Pressure Half Time Pressure half time Maximum Pressure Pressure gradient Gradient Pulmonary Insufficiency Stroke Volume Doppler Stroke Volume Stroke volume Doppler Pulmonary insufficiency pressure half time Pulmonary insufficiency maximum pressure gradient simplified Ratio of pulmonic flow to systemic flow via simplified Doppler echocardiographic method Right ventricular systolic pressure via TR Left ventricular outflow tract stroke volume Doppler Mitral valve stroke volume Doppler 212 EnVisor Series User s Guide M2540 30000 ug 02 MMode Calculations Label Aortic HR CO bp el CO Bullet CO Cubed CO MOD bp CO mod Simp CO MOD sp2 CO MOD sp4 CO sp el CO Teich EDV bp el EDV Cubed EDV Teich EF bp el EF Cubed Formula Cardiac output MMode Cardiac Cardiac output Cardiac output Output MMode MMode CO Cardiac Cardiac output Cardiac output Output
287. te Research Studies Press 1977 p 124 EnVisor Series User s Guide 344 M2540 30000 ug 02 Stroke Volume Doppler SV VTI A where the stroke volume SV ml using Doppler flow given a velocity time integral cm and the flow area A cm are SV Kane sv Mav SV Ao AoVaVII root area SV LVOT LVOT area SV MV j wvvavri MV flow area NES parnm SV MV Myvi MV flow area SV TV TV V2 TV flow area Hatle Liv Angelsen Bjorn Doppler Ultrasound in Cardiology Physical Principles and Clinical Applications 2nd ed Philadelphia Lea and Febiger 1985 p 306 Systolic Ratio The formula for the systolic ratio unitless given the end systolic velocity for vessel 1 v1 cm s and the end systolic velocity for velocity 2 v cm s is I TT la e Garth et al Duplex Ultrasound Scanning of the Carotid Arteries with Velocity Spectrum Analysis Radiology June 1983 147 826 TC Thoracic Circumference Thoracic circumference can be computed by two means If TC traced is present then TC TC traced If the two thoracic diameters TDtrv and TDap are present then IDin IDap y EnVisor Series User s Guide 345 M2540 30000 ug 02 Kurtz Alfred B Goldberg Barry B Obstetrical Measurements in Ultrasound A Reference Manual Year Book Medical Publishers Inc 1988 p 33 Uterine Volume Lengt
288. te viewing stations The EnVisor series offers three DICOM options With the DICOM Basic option you can export over a network to a DICOM PACS system or to a DICOM printer With the DICOM Media option you can export to an optical disk or a CD R in DICOM format With the DICOM Advanced option you can use Modality Worklist and Modal ity Performed Procedure Step Before you use DICOM features you must enter DICOM settings for your system and assign DICOM servers EnVisor Series User s Guide 39 M2540 30000 ug 02 40 Caution If you want to change DICOM settings not covered in this book see your network administrator Do not make any changes to network settings without con sulting with your network administrator Entering DICOM Settings You must enter DICOM settings for your EnVisor system before you connect your system to the network Ask your network administrator if you have questions To enter DICOM settings for your EnVisor system 1 Press the Setup key The Setup window opens 2 Click the System tab The System window opens 3 Click DICOM The DICOM Setup window opens 4 Click the This System tab The This System window opens 5 In the System Name area enter the AE title for your system specified by your net work administrator Note The AE title for each device on the network must be unique 6 In the System port number area use the up or the down arrow to enter the port number specifie
289. teps 2 3 and 4 for other images you want to mark or unmark for dele tion The images are marked for deletion and are deleted when you save the study Caution If mark an image for deletion that contains a measurement the measure ment is lost even if you unmark the image for deletion later Calibrating an Image in Image Review To manually calibrate an image 1 In Thumbnails move the cursor over the image with the trackball 2 Press the Enter key 3 Click Play 4 Ifyou are viewing a loop click to freeze the loop 5 If necessary use the Frame Select slide control to choose the frame you want to calibrate 6 Use the trackball to move the cursor over the image 7 Press the Select key 8 Highlight Calibrate Image with the trackball 9 Press the Enter key 10 The Manual Calibration window opens 11 Click the tab for the correct mode 12 Follow the procedure described in the Manual Calibration window 13 Click OK Adding a Caption or a Flag to an Image You can add a caption or an image flag to an image Image flags can be helpful when you want to indicate which images will be used for example for a teaching demon stration To add a caption or an image flag to an image EnVisor Series User s Guide 231 M2540 30000 ug 02 1 2 3 4 5 In Image Review use the trackball to move the cursor over the image Press the Select key Highlight Caption Flag with the trackball Type the caption or se
290. terest Note Avoid rocking and tilting the transducer Do not move the transducer back ward 5 To begin acquiring the panoramic dataset press the Acquire key or use the foot switch 6 Ifyou decide not to complete the acquisition press the Cancel Acquire soft key 7 To complete the acquisition of the panoramic dataset press the Acquire key again Imaging automatically stops if the maximum number of frames is acquired The panoramic image is displayed on the imaging screen where you can review or edit it Using Panoramic Imaging Soft Keys To change any of the settings listed below press the oval key below the soft key label Archive Use the Archive soft key to save the panoramic dataset or the still image to the patient s study The title is saved with the dataset The title labels and measure ments are saved with the still image Cancel Acquire Use the Cancel Acquire soft key to discontinue the acquisition of a panoramic dataset Cancel Acquire is available only while you are acquiring a pan oramic dataset Re acquire Use the Re acquire soft key to begin the acquisition of a new panoramic dataset Reset Use the Reset soft key to restore the panoramic image to its original state Save to Disk Use the Save to Disk soft key to save the panoramic image to a floppy disk or to an optical disk as a bmp file 104 EnVisor Series User s Guide M2540 30000 ug 02 Title Use the Title soft key to create a title for
291. ternatively press the Enter key or the Spectral key A CW spectral trace appears with a 2D reference image This is CW Spectral Doppler To change the appearance of your image use the soft keys To scroll the spectral trace press the Select key until Trace is highlighted on the bottom right corner of the imaging screen Press the Freeze key and use the track ball to scroll forward or backward To specify whether the 2D reference image or the CW spectral trace is live press the Spectral key or the Enter key The soft keys affect the element that is live To exit CW Doppler press the 2D key the MMode key or the PW key Note If you press the Spectral key when you are in 2D Mode you enter PW Spectral Doppler EnVisor Series User s Guide M2540 30000 ug 02 Using CW Doppler Soft Keys These are the soft keys that may be available to you in CW Doppler Preview or CW Spectral Doppler The soft keys affect either 2D reference image or the CW spectral trace whichever is live To change any of the settings listed below press the oval key below the soft key label Colorize Use the Colorize soft key to assign a colorization map that replaces the gray scale map to improve contrast resolution The choices are Sepia Rainbow Thallium and Wheat In MMode and Doppler Mode the Colorize soft key affects the spectrum when Trace is highlighted on the bottom right corner of the imaging screen It affects the reference image when
292. th images and choose which one is active so that you can review the frames using Quick Review Dual Imaging is available in 2D Mode Tissue Harmonic Imaging Color Mode and Color Power Angio Using Dual Imaging To use Dual Imaging when an image is live press the Left or the Right key e Ifyou press the Left key the live image appears on the left and the frozen image appears on the right e If you press the Right key the live image appears on the right and the frozen image appears on the left To use Dual Imaging when an image is frozen press the Left or the Right key e If you press the Left key the frozen image appears on the left and the live image appears on the right e If you press the Right key the frozen image appears on the right and the live image appears on the left Note The live image is marked with a small open circle called a transducer orienta tion dot the frozen image is marked with a small solid circle To choose which image is live press the key Left or Right for the image that you want to be live For the live image you can turn Color Mode Color Power Angio or Zoom on or off by pressing the Color Angio or Zoom key To use Color Suppress or Color Power Angio Suppress on the frozen image press the Freeze key and then the Color key To exit Dual Imaging press one of the following keys 2D CW MMode Plex PW or Spectral You may need to press the key twice EnVisor Series User s Gui
293. th the DICOM Media option e Ifyou have the DICOM Media option you can export studies in DICOM for mat Those studies can be viewed on any DICOM viewer If you do not have the DICOM Media option exported studies can only be viewed on EnVisor A 1 sys tems EnVisor Series User s Guide 23 M2540 30000 ug 02 24 Backing Up Presets and Settings to a Disk You should regularly back up your presets and settings If your system s memory fails for any reason and you did not save your presets and settings to a disk you will lose all of this information You can create up to 20 presets for each exam type If you need to create more presets you can save presets to a disk and restore them when you need to use them To back up presets system settings printer and VCR settings or options settings 1 Insert a formatted 3 5 disk into the floppy disk drive Caution System settings printer and VCR settings and options that are already on the disk will be overwritten If you try to save a preset with the same name as a preset already on the disk you have to choose whether or not to overwrite the pre set Press the Setup key The Setup window opens Click the Floppy Disk tab The Floppy Disk window opens Click Backup Select the check boxes for the presets you want to save or select the Select All check box Note System settings printer and VCR settings and options are automatically saved Cl
294. the Cardiologist Applications to the Study of Blood Flow and Jets by Imaging Techniques Journal of the American College of Cardiology 1988 Vol 12 pp 1344 1353 Mean Pressure Gradient Simplified Bernoulli Short form PG V2 trace The short form is clinically applicable in the case of stenosis where gt 4V4 Yoganathan Ajit P et al Review of Hydrodynamic Principles for the Cardiologist Applications to the Study of Blood Flow and Jets by Imaging Techniques Journal of the American College of Cardiology 1988 Vol 12 pp 1344 1353 MM HR MMode or 2D Heart Rate 60 R R int 338 EnVisor Series User s Guide M2540 30000 ug 02 Dorland Illustrated Medical Dictionary 27th ed Philadelphia W B Sanders Co 1988 p 1425 E A Mitral Valve E to A Ratio MVE max vel MV A max vel Maron Barry J et al Noninvasive Assessment of Left Ventricular Diastolic Function by Pulsed Doppler Echocardiography in Patients with Hypertrophic Cardiomyopathy Journal of the American College of Cardiology 1987 Vol 10 pp 733 742 MV Flow Area The calculated Mitral Valve Flow area MVFlowArea cm is MVFlowArea pil4 x MVDiam1 x MVDiam2 Hagen Ansert Sandra L Textbook of Diagnostic Ultrasound ed 3 The C V Mosby CO 1989 73 MV PI 2t MVimax vel l A m slope where MV max vel is the peak velocity on the spectrum and MV Decel slope is the slope of the spectrum
295. the first time you press the MMode key The first time you press the Zoom key a zoom box appears the image Change the size and position of the zoom box with the trackball so that the zoom box con tains the area that you want to magnify EnVisor Series User s Guide 71 M2540 30000 ug 02 72 The second time you press the Zoom key the magnified area appears To exit MMode but remain in Zoom press the MMode key To exit Zoom but remain in MMode press the Zoom key To exit MMode Zoom press the 2D key or the MMode and Zoom keys PW Doppler About PW Doppler Pulsed Wave PW Doppler is a Doppler mode that measures velocity in a sample vol ume gate and displays that information in a spectral trace with audio output Note PW Doppler is only available with transducers that support PW Doppler Using PW Doppler To use PW Doppler I Press the PW key A PW cursor line and an angle to flow arrow appear on the 2D image The PW sample volume gate lies on the PW cursor line This is PW Doppler Preview Place the PW sample volume gate in the center of the vessel with the trackball Adjust the width of the PW sample volume gate with the Gate soft key if neces sary Press the Spectral key the Enter key or the PW key A PW spectral trace appears with a 2D reference image This is PW Spectral Dop pler Adjust the volume of the Doppler audio with the Volume rotary control if neces sary Adjust the angl
296. the imaging screen press the Enter key to remove the cur sor from the imaging screen If Zoom appears on the bottom right corner of the imaging screen press the Zoom key Pan and Rotate appear on the bottom right corner of the imaging screen Press the Select key until Pan is highlighted in the bottom right corner of the imaging screen EnVisor Series User s Guide 107 M2540 30000 ug 02 108 4 To move the panoramic image around the imaging screen move the trackball Rotating a Panoramic Image To rotate the panoramic image clockwise or counterclockwise turn the Angle rotary control or perform this procedure 1 3 4 If the cursor appears on the imaging screen press the Enter key to remove the cur sor from the imaging screen If Zoom appears on the bottom right corner of the imaging screen press the Zoom key Pan and Rotate appear on the bottom right corner of the imaging screen Press the Select key until Rotate is highlighted Move the trackball You can change the point that the panoramic image rotates around To change the point of rotation 1 2 Press the Enter key until the cursor appears on the imaging screen Use the trackball to move the cursor to the point you want the panoramic image to rotate around Press the Enter key again to reposition the point of rotation EnVisor Series User s Guide M2540 30000 ug 02 Imaging Tips About Imaging Tips Imaging tips help you impro
297. the right of the image LGC profile display controls whether or not a horizontal line the LGC profile appears on upper right corner of the imaging screen to indicate the LGC setting On The LGC profile always appears on the imaging screen Off The LGC profile does not appear on the imaging screen Auto The LGC profile appears on the imaging screen briefly while you are adjusting the LGC setting Power index controls the way the output power is measured and displayed Normal The most appropriate index based on the preset transducer and other factors MI mechanical index raw acoustic power TIS thermal index soft tissue Temperature rise in soft tissue TIB thermal index bone Temperature rise in deep bone TIC thermal index cranial Temperature rise at the surface TEE temperature units controls whether the TEE temperature is displayed in Centi grade or Fahrenheit TGC profile display controls whether or not a vertical line the TGC profile appears on the upper right corner of the imaging screen to indicate the TGC setting On The TGC profile always appears on the imaging screen Off The TGC profile does not appear on the imaging screen Auto The TGC profile appears on the imaging screen briefly while you are adjusting the TGC setting Changing System Settings To change system settings EnVisor Series User s Guide 37 M2540 30000 ug 02 1 Press the Setup key The Setup w
298. the time that has elapsed since the timer started The timer starts under the following circumstances The timer automatically starts when you begin acquiring loops in a stage that you defined as a timer stage e You may start the timer at any point by pressing the Timer soft key If the timer is already running pressing the Timer soft key hides the timer Elapsed time is maintained while the timer is hidden The timer stops automatically at the end of the stage You cannot manually turn the timer off Note If an ImPost stage is defined to be a timer stage be sure to account for the time lapse between the moment exercise ends and acquisition begins Stress Echo Acquisition About Stress Echo Acquisition A Stress Echo protocol leads you through the acquisition and acceptance of loops for each view for each stage of the protocol The number of loops acquired for each stage depends on the acquisition method you choose for the stage To display the Stress Echo soft keys at any time press the Stress Echo option key Performing a Stress Echo Study The following overview describes how to perform a Stress Echo study Click a step for more information To perform a Stress Echo study 1 Connect the ECG cable and attach the ECG leads 2 Assign an option key to Stress Echo if you have not done so already EnVisor Series User s Guide M2540 30000 ug 02 263 3 Create a Stress Echo preset or select a Stress Echo preset that yo
299. the ultrasound system s ECG auxiliary channel on the physio panel This output signal helps minimize ECG artifacts If a square wave pulse from another machine is used you may have to increase the ECG Gain Modifying a Stress Echo Preset You can modify the current Stress Echo preset at any time EnVisor Series User s Guide 260 M2540 30000 ug 02 To modify the current Stress Echo preset 1 5 Press the Setup key The Setup window opens Click the Stress tab The Stress window opens Make changes to the preset You can define additional views or delete views for a protocol before you acquire the first loop of a study You can create additional stages anytime You can delete a stage if you have not yet acquired a loop for that stage Click Apply Click Close About Stress Echo Protocols You can use one of the three Philips Stress Echo protocols to perform a Stress Echo study or you can base your own preset on one of the protocols Protocol Name Exercise 2 Stage Exercise 3 Stage Stages Timer VCR First View Acquisition Post Off Off Quad cycle EnVisor Series User s Guide 261 M2540 30000 ug 02 meme en pe 222 ical 4 Stage Quad cycle Quad cycle Post Pos Off Off ES LAX Quad cycle About Stress Echo Acquisition Methods For each Stress Echo stage you can choose from three acquisition methods e Single cycle When you press the Acquire key one loop is a
300. ting a User Defined Calculation Using a Formula When you are in an OB GYN preset you can create a calculation using a formula You can add calculations that you create to the Calculations menu for OB GYN pre sets Notes e You must define GA calculation so that the answer is displayed in weeks You must define a GA range calculation so that the answer is displayed in days e You cannot define range calculations for fetal weight or for ratio To create a user defined calculation using a formula 1 Press the Setup key The Setup window opens 2 Click the Analysis tab The Analysis window opens 196 EnVisor Series User s Guide M2540 30000 ug 02 DW gx as 9 Click User Defined Calculations The Calculation Editor window opens Click New Calculation Type the name of the calculation in the Calculation Name field Specify the Calculation Type using the drop down menu Specify whether the formula is a Calculation or Range days using the option buttons Generate the formula by clicking the keypad to place numbers and mathematical operators in the formula Select inputs to the formula from the Inputs menu Click OK 10 Click Apply 11 Click Close Creating a User Defined Calculation Using a Table When you are in an OB GYN preset you can create a calculation using a table You can add calculations that you create to the Calculations menu for OB GYN presets To create a user defined calculation
301. tion scoring 1 In Thumbnails view the stage you want to score 2 Click A 3 Use the slide control at the top of the window to indicate which stage you are scoring 4 see the wall segments from different perspectives click the view icons 5 Do one of the following e Ifall wall segments are normal click All Normal EnVisor Series User s Guide 271 M2540 30000 ug 02 e Use the trackball to move the cursor over the wall segment press the Select key highlight the wall score for the segment and press the Enter key 6 Repeat steps 1 through 5 for each stage Click Carry Over to apply the scores from the previous stage to the current stage EnVisor Series User s Guide 272 M2540 30000 ug 02 Transducers Disks and Peripherals About Transducers Disks and Peripherals You can use several different transducers printers VCRs and removable disks with your system Transducers About Transducers You can use the transducers listed below with your EnVisor system To learn how to use care for clean and disinfect transducers see the EnVisor Series Transducer Guide in the EnVisor Series Reference Guide Note The s4 and the c3540 are only available on the EnVisor HD series Model Number Transducer Transducer Name Frequency _ Biopsy Harmonics Capable Capable PAD AMA Sector Ye s4 21330A Ultraband 2 0 40 MHz sector s8 21350A Ultraband 3 0 8 0 MHz sector 512 21
302. to make the MMode trace larger Note After adjusting any soft key always check the position of the transducer Imaging Tips for PW Doppler Goal I want the 2D reference image to be updated Possible Actions e Make sure that the Delay or the Update soft key does not read 2D Hold On e Change the Update interval at which your 2D image is updated with the Update soft key e Increase the ECG Gain setting with the ECG Gain soft key Press the Setup key to display the ECG Gain soft key e Press the Enter key or the Spectral key to manually update the 2D image Press the Enter key or the Spectral key again to make the spectral trace live again EnVisor Series User s Guide M2540 30000 ug 02 e Check the ECG leads for proper placement Note After adjusting any control or soft key always check the position of the trans ducer Goal I want to display low velocity signals Possible Action e Decrease the scale by turning the Scale rotary control counterclockwise e Decrease the Filter setting with the Filter soft key Note After adjusting any soft key always check the position of the transducer Goal I need to be able to see a Doppler signal that is audible but not visible Possible Actions e Adjust the scale by turning the Scale rotary control e Increase the gain by turning the Doppler Gain rotary control clockwise e Increase the compression with the Compress soft key and decrease the Reject set ting wit
303. ton on a mouse In Image Review pressing the Select key is like pressing the right button on a mouse Clicking an Item on the Imaging Screen or Choosing an Option To click an item on the imaging screen or to choose an option use the trackball to move the cursor over the item or the option and press the Enter key Changing the Active Function of the Trackball In many circumstances you can use the trackball for more than one function The possible functions of the trackball for the current mode transducer and preset are listed on the bottom right corner of the imaging screen The active trackball function is highlighted and its associated imaging screen elements appear in blue To change the active trackball function press the Select key Choosing an Item in a Preset Label Measurements or Calculations Menu To choose an item in a Preset Label Measurements or Calculations menu use the trackball to highlight the item and press the Enter key or the Select key Using the Select Key in Image Review and Reports In Image Review and reports press the Select key at any time to view the options that are currently available to you To choose an option highlight the option with the trackball and press the Enter key Assigning Record Keys You must assign a Record key to each VCR printer and serial output cable that is connected to your system The Record keys which appear on the system control panel are labeled Record Rec2 and Re
304. twice Type the information Optional Click Next to proceed to the next field Click OK Adding Interpretations to a Cardiac Report You can choose or manually type finding codes for various attributes of cardiac struc tures An interpretation summary determined by the fining code appears in the report To add an interpretation to the report do one of the following 1 2 3 4 3 Press the Report key Click the Interpret tab Click the button for the structure the interpretation relates to Use the trackball to move the cursor over a field Press the Select key EnVisor Series User s Guide M2540 30000 ug 02 6 Use the trackball to highlight the finding code or highlight Manual Text Entry if you want to manually type an interpretation 7 Press the Enter key The interpretation appears in the report Or 1 Press the Report key 2 Click the Interpret tab 3 Click the button for the structure the interpretation relates to 4 Type the finding code in the Finding Code field and skip to step 7 or type the first letter of the finding code 5 Press the Return key 6 Scroll to the appropriate finding code 7 Press the Enter key The interpretation appears in the report Adding Visualizations and Observations to an Obstetric Report When you are in an obstetric preset you can choose or manually type obstetric visual izations and observations which appear in the report You can also type bio
305. u created previ ously 4 Create a new patient study 5 Press the Stress Echo option key A view icon and a stage view label appear on the imaging screen 6 Acquire loops for single cycle and quad cycle acquisition stages 7 Select the preferred loop for each view in Image Review 8 Acquire loops for the multi cycle acquisition stage if the protocol includes one 9 Select the preferred loop for each view in Image Review Note In order to perform a Stress Echo study an ECG trace must appear on the imaging screen If no R wave is detected the icon below is displayed on the imaging screen and a one second Stress Echo loop is acquired Using Stress Echo Soft Keys To display the Stress Echo soft keys at any time press the Stress Echo option key To change any of the settings listed below press the oval key below the soft key label End Acquire Use the End Acquire soft key to end the acquisition of the loop for the current stage The End Acquire soft key is available only during a multi cycle acquisi tion stage when acquisition is paused Hide ROI Use the Hide ROI soft key to remove the region of interest ROI box from the image Show ROI Use the Show ROI soft key to display the ROI box on the image Pause Protocol Use the Pause Protocol soft key to temporarily leave the Stress Echo protocol so that you can acquire additional loops or frames outside of the Stress Echo protocol Unpause Protocol Use the Unpause Protoco
306. u have an EnVisor HD or an EnVisor C HD Adaptive Doppler is turned on by default Note Adaptive Doppler is only available on the EnVisor HD series To turn Adaptive Doppler on or off EnVisor Series User s Guide M2540 30000 ug 02 1 Press the Setup key The Setup window opens 2 Click the Mode tab The Mode window opens 3 To turn Adaptive Doppler on select the Adaptive Doppler check box To turn Adaptive Doppler off clear the Adaptive Doppler check box 4 Click Apply 5 Click Close Turning Intelligent Doppler On or Off When Intelligent Doppler is on turning the Angle rotary control moves the PW cur sor line whenever the angle to flow arrow is moved to maintain an optimum cursor angle between the angle to flow arrow and the direction of blood flow To specify the optimum cursor angle press the Setup key click che Mode tab and dick the optimum cursor angle Note Intelligent Doppler is only available in PW Doppler and on linear transducers To turn on Intelligent Doppler press the Steer soft key and choose the Auto setting Changing Doppler Settings You can change two Doppler settings Optimum cursor angle The angle the system tries to maintain between the PW cursor line and the direction of blood flow when Intelligent Doppler is on e Doppler scale units The units in which the Doppler spectrum is measured To change Doppler settings EnVisor Series User s Guide 97 M2540 30000 ug 02
307. u must connect the ECG cable and properly attach the ECG leads Warning Do not use ECG patient cables with detachable lead wires that have exposed male pins Electrocution can result if these pins are plugged into AC power To connect the ECG cable and attach the ECG leads 1 Plug the ECG cable into the port on the physio panel which is under the CD drive and above the floppy disk drive 2 Attach the ECG leads to the patient as shown below A Right arm B Left leg C Left arm Note Although the lead placement does not match the anatomical labels on the leads you need to attach the electrodes as shown in order to receive a good ECG signal 3 Make sure the ECG signal appears properly on the imaging screen If it does not check the cable connections and the placement of the electrodes and leads Using Physio Soft Keys To display the physio settings press the Setup key The physio soft keys appear under the Setup window 26 EnVisor Series User s Guide M2540 30000 ug 02 To change any of the settings listed below press the oval key below the soft key label Beats Use the Beats soft key to specify how often in number of R waves the 2D image is updated Display Dialog Use the Display Dialog soft key to remove the Setup window from the imaging screen or to display the Setup window on the imaging screen ECG Gain or Aux Gain Use the ECG Gain or the Aux Gain soft key to adjust the display size of the ECG or
308. ure gradient Pulmonary artery maximum pressure gradient PA V2 max cm s Maximum velocity Maximum velocity measured distal to the pulmonary artery with CW Doppler max PG mmHg Pressure gradient Pulmonic insufficiency maximum pressure gradient 174 EnVisor Series User s Guide M2540 30000 ug 02 PI max vel Maximum velocity velocity of pulmonic insufficiency Right max vel Maximum velocity flow volume on right side of heart TR max vel cm s Maximum velocity velocity of the tricuspid valve regurgitation EnVisor Series User s Guide 175 M2540 30000 ug 02 MMode Measurements Label ACS Ao root diam Aortic R R EPSS IVSd IVSs LA dimension LVIDd LVIDs LVPWd Aortic cusp separation cm Height Aortic root diameter sec Time R R interval measured when making measurements on the aortic valve E point septal separation cm Height Interventricular septal dimension at end diastole cm Height Interventricular septal dimension at end systole em hom letal dimension cm Height Left ventricular internal diameter at end diastole cm Height Left ventricular internal diameter at end systole cm Height Left ventricular posterior wall dimension at end diastole 176 EnVisor Series User s Guide M2540 30000 ug 02 LVPWs MM R R int MV E F slope MV excursio
309. using a table 1 Press the Setup key The Setup window opens Click the Analysis tab The Analysis window opens Click User Defined Tables The Gestational Age Table Editor window opens Click New Table Type the name of the calculation in the Author s Name dialog box Choose the biometry from the Biometry drop down menu EnVisor Series User s Guide 197 M2540 30000 ug 02 198 9 Indicate how the age should be displayed by selecting the Weeks and Days or the Days option button values in the Measurement GA and Range columns Click a table cell to type a value Use the Tab key or the arrow keys to move between table cells To remove all of the values in the table click Clear Table To add a row above the current row click Insert Row To delete the current row click Delete Row Click OK 10 Click Apply 11 Click Close Editing a User Defined Calculation After you create a GA calculation using a formula or a table you can modify the cal culation To edit a user defined calculation 1 5 6 7 Press the Setup key The Setup window opens Click the Analysis tab The Analysis window opens Click User Defined Calculations or User Defined Tables The Calculation Editor or Gestational Age Table Editor window opens Select the calculation you want to edit from the Calculation Name or the Table Name drop down menu Click Edit Calculation or Edit Table Make any ne
310. ust the compression of returning echos which affects the grayscale display Increasing Compress softens the image Decreasing Compress produces a high contrast image EnVisor Series User s Guide 59 M2540 30000 ug 02 60 The compression setting appears on the right side of the imaging screen Focal Zones Use the Focal Zones soft key to add focal zones Focal zones are the areas where the image is most clearly focused If you have an EnVisor HD or EnVisor C HD you can choose up to eight focal zones depending on the current imaging depth and the transducer you are using Otherwise you can choose up to four focal zones If you are using Trapezoidal Imaging you can choose no more than four focal zones Using multiple focal zones decreases the frame rate Each time you press the Focal Zones soft key you increase the number of focal zones or the space between them When you reach the maximum number of focal zones pressing the Focal Zones soft key gives you one focal zone The Focal Zones soft key is not available with sector transducers In Zoom pressing the up arrow on the Focal Zones soft key adds focal zones it does not increase the space between focal zones L R Invert Use the L R Invert soft key to reverse the left right orientation of the image If you are in a noncardiac preset a small open circle called a transducer orien tation dot appears in the upper left corner of a noninverted image A transducer orien tation dot app
311. ve the appearance of your image or solve problems you encounter while imaging Imaging tips are available for several imaging modes Imaging Tips for 2D Mode Goal I need to be able to see the soft tissue Possible Actions e Reposition the transducer e Increase the gain by turning the 2D GAIN rotary control clockwise e Move the TGC slide controls to the right e Adjust the compression with the Compress soft key Use the Fusion key to try a different fusion setting e Adjust the Smooth setting with the Smooth soft key e Use the Colorize soft key to improve the contrast resolution e Increase the persistence with the Persist soft key e Increase the power by turning the Power rotary control clockwise Note After adjusting any control or soft key always check the position of the trans ducer Goal I want the image to be less soft hazy or gray Possible Actions e Decrease the gain by turning the 2D GAIN rotary control counterclockwise e Move the TGC slide controls to the left e Change the grayscale contrast with the Map soft key EnVisor Series User s Guide 109 M2540 30000 ug 02 110 Decrease the compression with the Compress soft key Decrease the Smooth setting with the Smooth soft key Sharpen the image by decreasing the persistence with the Persist soft key If you are using a transducer that supports harmonics press the THI key to turn on Tissue Harmonic Imaging Note After adjusting any control
312. ving organs or tis sues and higher persistence values for slower moving organs or tissues Smooth Use the Smooth soft key to soften or sharpen the 2D image Higher settings make the image softer Lower settings make the image sharper Sweep Use the Sweep soft key to control the travel speed of the scrolling trace Sweep is only available when the trace is live About the Scrolling of the MMode Trace You can control whether the MMode trace is scrolling or nonscrolling Scrolling trace While the trace is live it moves from right to left with new data appearing at the right margin e Nonscrolling trace An erase bar slides from left to right across the trace with new data appearing just to the left of the erase bar EnVisor Series User s Guide M2540 30000 ug 02 Controlling the Scrolling of the MMode Trace To control the MMode trace 1 Press the Setup key The Setup window opens 2 Click the Mode tab The Mode window opens 3 Fora scrolling trace select the Scrolling Trace check box For a nonscrolling trace clear the Scrolling Trace check box 4 Click Apply 5 Click Close About the MMode Format You can specify the format of the MMode display which is how the MMode trace and the 2D reference image appear on the imaging screen You have three options Small over large The small 2D reference image appears above the large MMoce trace Side by side The MMode trace and the 2D refer
313. w opens 2 Click the tab for the exam type 3 Move the cursor over the body marker with the trackball 4 Press the Enter key Moving a Body Marker or the Transducer Icon To move a body marker EnVisor Series User s Guide 139 M2540 30000 ug 02 140 1 Press the Select key until Icon is highlighted on the bottom right corner of the imaging screen 2 Use the trackball to move the body marker 3 Press the Enter key to anchor the body marker To move the transducer icon 1 Press the Select key until Probe is highlighted on the bottom right corner of the imaging screen 2 Use the trackball to move the transducer icon 3 To anchor the transducer icon and exit Body Markers press the Body Mark key or the key for any imaging mode or application Rotating or Specifying the Shape of the Transducer Icon Rotating the Transducer Icon To rotate the transducer icon either press the Rotate Probe soft key or turn the Angle rotary control Specifying the Shape of the Transducer Icon To specify the shape of the transducer icon press the Next soft key and press the Probe Size soft key repeatedly until the shape that you want is displayed Using Body Marker Soft Keys lt Body Marker gt Use the lt Body Marker gt soft key to specify the body marker that you want The lt Body Marker gt soft key displays the names of the body markers Press it repeatedly to cycle through the body markers in the set of body markers specif
314. wer Angio Compare 1 While you are viewing a live image in Color Power Angio press the Left or the Right key EnVisor Series User s Guide 9 M2540 30000 ug 02 92 Two images appear an image that shows angio flow on the right and a flow sup pressed version of the same image on the left 2 Optional To transition to Dual Imaging without Angio Compare press the Left or the Right key again 3 To exit press the 2D key 3D Mode About 3D Mode In 3D Mode you acquire a series of 2D images called the 3D dataset Information from this dataset is used to create a lifelike 3D image The image is static and appears in grayscale To use 3D Mode you must first acquire the 3D dataset You can then review and edit the 3D image You may also view an animated display or movie of the 3D image Before You Use 3D Mode Before you use 3D Mode you need to assign one of the option keys to 3D Mode Notes 3D Mode is a component of the OB GYN application package option 3D Mode does not support up down inverted images Up down inverted images appear uninverted in 3D Mode e Pressing the 3D option key in any mode other than 3D turns off all other modes and switches to 3D Pressing the 3D option key during any 3D stage exits 3D Mode Helpful Hints for 3D Mode e Ifyou want to view the fetal face use the Map Compress and Smooth soft keys to set the image contrast such that the fetal face has a high contrast against the sur
315. window Modifying a Preset You can make changes to any preset that you created You cannot however modify default presets To modify a preset that you created 1 Select the preset Modify any settings that you want to change for your preset Press the Preset key Click Modify Current 2 3 4 Press the Save Preset soft key 5 6 Click Note You can also change a preset in the Setup window EnVisor Series User s Guide 3 M2540 30000 ug 02 32 Deleting a Preset You can delete that preset you created You cannot however delete default presets To delete a preset 1 Press the Preset key 2 Highlight the preset you want to delete with the trackball 3 Press the Delete Preset soft key 4 Click OK Using Preset Soft Keys To change any of the settings listed below press the oval key below the soft key label Delete Preset Use the Delete Preset soft key to permanently delete the current preset You can only delete presets that you created Display Name Use the Display Name soft key to hide or display the name of the cur rent preset on the imaging screen Save Preset Use the Save Preset soft key to create a new preset or to make changes to a preset that you created Removing the Name of a Preset from the Imaging Screen By default the name of the preset appears on the imaging screen You may however choose to hide the name and then display it again later To hide or display the name of t
316. witch A fusion icon appears on the lower left cor ner of the imaging screen The fusion icon Fusion Icon summarizes information about the fusion setting Fusion settings control the transmit and receive frequencies for the transducer Fusion settings apply to 2D Mode and Tis sue Harmonic Imaging Fusion Settings The hospital information system HIS is the institution s network Ultrasound sys Hospital Information System tems and other devices are connected to the HIS so that information can be shared between them and stored on servers In Image Review you can add an image cap Image Caption g P tion a short statement to an image In Image Review you can add an image flag to an image Image flags can be helpful Image Flag when you want to indicate which images will be used for example for a teaching demonstration In Image Review you view all of the image you acquired In Image Review you can Image Review view frames and loops delete frames and loops from the patient study edit loops and close the study EnVisor Series User s Guide M2540 30000 ug 02 293 Intelligent Doppler Intelligent Doppler helps you maintain an optimum cursor angle between the angle to flow arrow and the direction of blood flow by automatically moving the PW cur sor line whenever the angle to flow arrow is moved Manual Doppler Trace In manual Doppler trace you manuall
317. xport images and reports in PC format e Frames are saved as bmp files Loops are saved as avi files e Reports are saved as HTML files You can export a frame or a report to a floppy disk a CD R or an optical disk You can export images to a CD R or an optical disk Notes e You cannot import files saved in PC format bmp avi or HTML files e You can export the report and all of the images in a study in PC format but you cannot export a study in PC format Importing and Exporting Obstetric Trending Data You can import trending data from and export trending data to a floppy disk Note Files in PC format bmp avi and HTML files are typically used to make copies of images for training sessions and presentations EnVisor Series User s Guide M2540 30000 ug 02 Caution If you want to change DICOM settings not covered in this book see your network administrator Do not make any changes to network settings without con sulting with your network administrator Importing a Patient Study in DICOM Format You can import from an optical disk or a CD R one or more patient studies that were created on an EnVisor system and saved in DICOM format When you import a study a new patient study is created If a patient folder for the already exists the new study is placed the existing folder If a folder does not exist for that MRN a new folder is automatically created Notes Importing a study does not ope
318. xt label will appear at the home position Labels About Labels You can place a label anywhere on the imaging screen so that you can comment on the image You can add an arrow to indicate which part of the image the label applies to Exiting Labels To exit Labels press the Label key or the Menu key above the Label key or press a key for another mode or application Placing a Label on the Imaging Screen You can place a label on the imaging screen by pressing the Label key or the Menu key above the Label key To place a label on the imaging screen using the Label key 1 Press the Label key 2 Use the trackball to position the cursor where you want the label to appear 3 Press the Select key so that Label is highlighted on the bottom right corner of the imaging screen 4 Move the trackball up and down to view the label choices 5 To anchor the label press the Enter key To place a label on the imaging screen using the Menu key above the Label key EnVisor Series User s Guide 135 M2540 30000 ug 02 136 1 Press the Menu key above the Label key The Label menu appears 2 Use the trackball to highlight the label you want to place on the imaging screen 3 Press the Enter key or the Select key or use the trackball to move the label onto the image 4 To anchor the label press the Enter key or the Select key 5 To remove the Label menu from the imaging screen press the Menu key above the Label key Typing a Lab
319. y and Pitfalls Radiology 1985 154 385 391 Diameter Stenosis The percentage of stenosis S 96 formula given a true lumen diameter Drue cm and the true residual lumen diameter D esidual is S 100 Perue D esidual Y true Diagnostic ranges 0 20 normal 20 60 mild 60 8090 moderate 80 90 severe 90 99 critical 100 occluded Honda Nobuo et al Echo Doppler Velocimeter in the Diagnosis of Hypertensive Patients The Renal Artery Doppler Technique Ultrasound in Medicine and Biology 1986 Vol 12 12 pp 945 952 EnVisor Series User s Guide 340 M2540 30000 ug 02 PI Pulsatility Index Using Time Averaged Mean of the Peaks The formula for pulsatility index PI given a maximum velocity V nax in cm s a minimum velocity Vipin in cm s and a mean velocity V nean in cm s is PI Vmax Vmin Vmean Burns Peter N The Physical Principles of Doppler and Spectral Analysis Journal of Clinical Ultrasound November December 1987 Vol 15 No 9 p 585 Pressure Half time max vel 1 L h Decel slope where max vel is the peak velocity on the spectrum and Decel slope is the slope of the spectrum as it declines from one of the values for max vel listed in the following table Pressure Half time Max Vel Decel Slope Flow Ao PI 2t JAI max vel Al dec slope Aortic flow MV PI 2t MV PI 2t max v MV dec slope
320. y trace the Doppler spectrum over one heart cycle The results of key Doppler measure ments and calculations are displayed in the results box Modality Worklist If your system is connected to the hospital information system Modality Worklist allows you to display and choose from a list of scheduled patients When you select a patient from the list the Patient Identifica tion window opens populated with the patient s demographic information MMode Preview In MMode Preview you can position the MMode reference line before displaying the MMode trace MMode Reference Line The MMode reference line appears on the reference image in MMode Information about the movement along the MMode ref erence line appears in the MMode trace The MMode trace displays information MMode Trace about the movement along the MMode ref erence line When you are in MMode you can magnify a portion of the reference image by entering MMode Zoom MMode Zoom In MMode Zoom the MMode trace represents only the informa tion in the zoom box EnVisor Series User s Guide 294 M2540 30000 ug 02 MPPS Modality Performed Procedure Step is a feature associated with Modality Worklist If you specify an MPPS server MPPS your system notifies the hospital informa tion system when a patient study is com plete The list of scheduled patients and patient billing information can then be updated The medical recor
321. y via Robinson using crown rump length CRL range 0 67 cm 6 3 weeks to 8 2 cm 14 0 weeks is 8 052 CRI x 10 23 73 7 Robinson Fleming J E A Critical Evaluation of Sonar Crown Rump Length Measurements British Journal of Obstetrics and Gynecology September 1975 82 702 710 GA CRL via Tokyo Gestational age wk day via Tokyo University using crown rump length CRL range 1 4 8 8 cm The following table lists the associated standard deviation in days for each value EnVisor Series User s Guide 322 M2540 30000 ug 02 CRL 4 18 2 1 9 2 9 3 7 4 6 57 71 114 8 8 115 Masahiko Mizuno et al Assessment of Fetal Growth using Ultrasound Measurements Nichidoku Iho Japanisch Deutsche Medizinische Berichte in Japanese 1989 34 3 537 544 GA FL via Hadlock The formula for gestational age wk day via Hadlock using femur length FL range 0 7 8 2 cm is 10 35 2460 FL 0 170 FL Hadlock E P et al Estimating Fetal Age Computer Assisted Analysis of Multiple Growth Parameters Radiology 1984 152 497 501 GA FL via Jeanty The formula for gestational age wk day via Jeanty using femur length FL range 1 0 8 0 cm is 9 5411757 2 9774510 x FL 0 10388 x FL The following table lists the percentiles in weeks for each value EnVisor Series User s Guide M2540 30000 ug 02 325 FL 5th 50th 5th 50th 50th 95th 95th

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