Acuson Aspen User Manual

Acuson Aspen Ultrasound System
User Manual
Siemens Medical Solutions Acuson, a Siemens Company

Ultrasound Division 1220 Charleston Road
European Business Centre Mountain View, CA 94043
125-135 Staines Road
Hounslow, Middlesex TW3 3JF (650) 969-9112
United Kingdom (800) 4-ACUSON
Tel: +44 (0) 208 479 7950 www.acuson.com

Fax: +44 (0) 208 479 7971 1220 Charleston Road
Mountain View, CA 94043
Document No. 58233

Rev. 4
Language: English
0123
ii Acuson Aspen Ultrasound System 0202
COPYRIGHT Copyright © 2001 by Acuson Corporation. All rights reserved.
No part of this publication may be reproduced, transmitted, transcribed,
stored in retrieval systems, or translated into any language or computer
language, in any form or by any means, electronic, mechanical, magnetic,
optical, chemical, manual, or otherwise, without the prior written
permission of Acuson Corporation.
Acuson Corporation reserves the right to change its products and services
at any time. In addition, this manual is subject to change without notice.
Acuson Corporation welcomes customer input on corrections and
suggestions for improvements to this manual.
Although Acuson Corporation has attempted to ensure accuracy
throughout this manual, Acuson Corporation assumes no liability for any
errors or omissions, nor for any damages resulting from the application
or use of this information.
TRADEMARKS ACUSON, MultiHertz, Native, RES, Sequoia, SpaceTime, The Value of

Vision, Vector, XP, 128XP, 128XP/4, 128XP/10, and AEGIS are registered
trademarks of Acuson Corporation. 128XP/10c, AcuNav, Aspen, Aspen
Advanced, Cadence, CCD, Convergent, CWS3000, Cypress, DBPro,
DELTA, DIMAQ, DS3000, DTI, EF, eUltrasound, FreeStyle, Imagegate,
microCase, MICROSON, Multizone, NewView, Perspective,
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Equalization, WorkPro, WebPro, WS3000, ViewPro, ViewPro-Net, and
Xpress are trademarks of Acuson Corporation. Remote First is a service
mark of Acuson Corporation
Cidex, Cidex Plus, and Cidex 7 are registered trademarks of Surgikos, Inc.
K-Y Lubricating Gel is a trademark of Johnson & Johnson Products, Inc.
IBM is a registered trademark of International Business Machines
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Tosoh is a trademark of Tosoh Corporation. Multi-Imager is a trademark
of International Imaging Electronics.
All other product names are trademarks of their respective companies.
CAUTION! United States Federal Law restricts use of this device to or on the order of
a physician.
0202 Acuson Aspen Ultrasound System iii

LICENSE AGREEMENT All computer programs copyright 1990-2001 by Acuson Corporation OR
ITS SUPPLIERS. Such programs are licensed under the following
software license agreement:
Acuson or its suppliers retain(s) ownership of and title to any computer
program supplied with the equipment and to the trade secrets embodied
in such computer programs. Subject to the Buyer’s acceptance and
fulfillment of the obligations in this paragraph, Acuson grants the Buyer a
personal, non-transferable, perpetual, non-exclusive license to use any
computer program supplied with the Equipment that is necessary to
operate the Equipment solely on the medium in which such program is
delivered for the purpose of operating the equipment in accordance with
the instructions set forth in the operator’s manuals supplied with the
Equipment and for no other purpose whatsoever. Buyer may not reverse-
assemble, reverse-compile or otherwise reverse-engineer such computer
programs nor may Buyer make a copy of such program or apply any
techniques to derive the trade secrets embodied therein. In the event of a
failure by Buyer to comply with the terms of this license, the license
granted by this paragraph shall terminate. Further, because unauthorized
use of such computer programs will leave Acuson without an adequate
remedy at law, Buyer agrees that injunctive or other equitable relief will
be appropriate to restrain such use, threatened or actual. Buyer further
agrees that (i) any of Acuson's suppliers of software is a direct and
intended beneficiary of this end-user sublicense and may enforce it
directly against Buyer with respect to software supplied by such supplier,
and (ii) NO SUPPLIER OF ACUSON SHALL BE LIABLE TO BUYER FOR
ANY GENERAL, SPECIAL, DIRECT, INDIRECT, CONSEQUENTIAL,
INCIDENTAL OR OTHER DAMAGES ARISING OUT OF THE
SUBLICENSE OF THE COMPUTER PROGRAMS SUPPLIED WITH THE
EQUIPMENT.
iv Acuson Aspen Ultrasound System 0202

Table of Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Part 1 System Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2 System Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Part 2 Basic Exam Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Chapter 3 Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Chapter 4 Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter 5 Annotating Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 6 ECG and Physio Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chapter 7 Freeze and Cine Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Chapter 8 Data Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Part 3 Imaging Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Chapter 9 2-D Imaging Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Chapter 10 Color Doppler Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Chapter 11 VEL, ENE, and CONV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Chapter 12 Doppler Tissue Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Chapter 13 Spectral Doppler Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Chapter 14 M-Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Chapter 15 Color M-Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Chapter 16 Perspective™ Advanced Display Option . . . . . . . . . . . . . . . . . . . . 95
Part 4 Measurements and Calculations. . . . . . . . . . . . . . . . . . . . . . 115

Chapter 17 Measurement Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Chapter 18 Auto Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Chapter 19 Obstetrical Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Chapter 20 Vascular Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Chapter 21 Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Part 5 Cardiovascular Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Chapter 22 Stress Echo Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Chapter 23 Transesophageal Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
0202 Acuson Aspen Ultrasound System v

Part 6 Vascular Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter 24 Transcranial Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Part 7 General Imaging Features . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Chapter 25 Using Needle Guides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Chapter 26 Endocavity Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Chapter 27 Laparoscopic Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Chapter 28 Intraoperative Transducers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Part 8 System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Chapter 29 System Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Part 9 Supplement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
vi Acuson Aspen Ultrasound System 0202

Preface
PREFACE
Welcome Thank you for choosing the Acuson Aspen™ Ultrasound System. Acuson
systems are specially designed to help you perform radiology, obstetrics,
gynecology, cardiac, and vascular exams. They offer a wide range of
standard and optional operating modes and transducer formats. This
manual explains all standard and optional features. Your system may not
have all of these features installed.
Acuson systems have an exceptional record of dependability and our
customer service network is ready to respond to your individual needs.
How to Use this This User Manual explains how to use your Acuson system to perform
Manual typical exams. Acuson recommends that you read this manual before you
begin using the system. Refer to it whenever you have questions about
system operation. Each chapter covers one mode of operation or feature,
so you can quickly turn to the information you want.
Other Manuals This manual is part of a set that also includes:

• Safety Manual, which provides important safety information for all
Acuson systems. Be sure to read the Safety Manual before using the
system.
• Transducer Specifications Manual, which provides a list of available
transducers, power values, and approved disinfecting and sterilizing
solutions.
• Administrator Manual, which contains detailed instructions for system
setup and reference information useful for customizing your system.
A Service Manual is also available for purchase from Acuson.
Contacting Acuson For additional information about the Acuson system, contact your nearest
Acuson office. Addresses and phone numbers are listed in your Safety
Manual.
0202 Acuson Aspen Ultrasound System vii

Preface
Key Conventions This manual uses several special symbols to refer to the controls on the
system or to indicate a procedure. The following table shows the symbols
and their descriptions:
SYMBOL DESCRIPTION
◆ A diamond-shaped bullet indicates steps to follow

to perform a procedure.
CALC Terms in bold, uppercase font represent a key, knob,
switch, or toggle control on the system’s keyboard.
The example at left represents the CALC key.
CODE + DATA Plus signs (+) used in this way mean to hold down
the CODE key and press the indicated key (in this
case, the DATA key). See “Code Keys” on page 11.
[LEFT] Terms in brackets represent a soft key. See “Soft
Keys” on page 12.
[GROUP] Italicized terms in brackets represent soft keys that
have a label that changes as you press it, to represent
a current setting or choice.
Acuson provides special alphanumeric keys and annotation terms for

labeling images in different languages. This manual uses English labels
for all keys and annotation terms. To convert your system to another
language, contact your Acuson Customer Engineer.
viii Acuson Aspen System 0202

PART 1
SYSTEM BASICS
System Basics introduces you to the basic components of your Aspen
system. It includes the following chapters:
Chapter 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2 System Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
0202 Acuson Aspen Ultrasound System 1

2 Acuson Aspen System 0202
Aspen Ultrasound System Components
CHAPTER 1
INTRODUCTION
Aspen Ultrasound
System
Components
Soft Keys
Power Switch
Magneto-Optical
Transducer Holders Disk Drive
ECG and Physiologic

Cable Holder Modules
Headphone Connector
Aux CW Transducer Port

MP Transducer Port
DL Transducer Ports
Foot Switch Connector
Wheel Locks

Chapter 1 - Introduction
Imaging Modes The Aspen™ ultrasound system displays ultrasound information in

several imaging modes. The modes available to you depend on the
options installed on your system and the transducer that you are using.
MODE DESCRIPTION
2-D MODE The system displays a two-dimensional image of

the tissues that lie within the scan plane. For
example, you can use 2-D imaging mode to
observe organs such as the heart and peripheral
vasculature. Because the system displays 2-D
images in real-time, you can observe organs in
motion. See Chapter 9 for more information on 2-D
mode.
COLOR Color Doppler imaging allows real-time spatial
DOPPLER visualization of blood flow patterns in the heart
IMAGING MODE and discrete vessels. It also provides Doppler shift
information related to moving cardiac tissue.
There are several imaging options you can use
within Color Doppler mode. Chapter 10 contains
information about Color Doppler mode and
options. Subsequent chapters provide details
about different Color Doppler options.
SPECTRAL Spectral Doppler capabilities allow you to monitor
DOPPLER MODE the flow of blood through vessels or within the
heart. You can display Doppler information either
by itself or simultaneously with the 2-D image. See
Chapter 13 for information on Spectral Doppler
mode.
M-MODE In M-mode the system displays a graphic
representation of a line of interest (within the 2-D
image) and displays a graph that shows how that
line changes over time. Use M-mode to document
cardiac function and precisely measure chamber
dimensions. See Chapter 14 for more information
on M-mode.
COLOR M-MODE Color M-mode displays M-mode together with
Color Doppler mode. Color M-mode displays
timing information from the Color Doppler
display, and supports the display characteristics
and features of standard M-mode. For more
information, see Chapter 15.

Power On/Off Procedure
Power On/Off The system power button is located on the left side of the system above
Procedure the keyboard. For additional information on the proper power on/off
procedure, see your Safety Manual.
When powering on the system:
• Make sure the system is plugged into an appropriate wall outlet.
• Make sure the Main On/Off switch on the rear of the system is On.
When powering off the system:
• Wait for the system shutdown messages to display and disappear
before unplugging the system from the wall outlet. (The display
should be completely black.) The system saves data to the internal
hard disk during the shutdown procedure. If the system is
unplugged during this process data could be lost and the internal
hard disk could be damaged.
IMPORTANT: Do not use the Main On/Off switch on the rear of the system to turn off
the system. If you turn off the system using the Main On/Off switch,
data may be lost or corrupted.
Transducer The Aspen system has both DL and MP transducer ports, and storage
Connections ports that accept either transducer type. The number and type of
transducer ports depends on your specific system configuration. You
must use transducers that are compatible with the connectors on your
system.
◆ To connect a transducer to the system:
1. Insert the transducer connector into one of the active transducer
ports. Insert DL transducers with the cable down. Insert MP
transducers with the cable up. The sliding doors that cover the MP
transducer port open automatically.
2. Rotate the transducer lock handle clockwise to lock the transducer
connector in place.
◆ To disconnect a transducer from the system:
1. Rotate the transducer lock handle counterclockwise to unlock the
transducer.
2. Pull the transducer connector away from the port.
3. Properly store the transducer.
Switching You can connect up to three transducers simultaneously on the Aspen

Transducer Ports system.
◆ To switch the active transducer port, press XDUCER and press
the soft key corresponding to the transducer you want to use.
The name of the connected transducer appears in the soft key label
corresponding to its position. If there is no transducer connected,
[NO XDCER] appears in the corresponding soft key. If the transducer
is invalid, a message appears telling you to remove the transducer.

Transducer Formats Acuson transducers for the Aspen system are optimized for imaging
and Characteristics many different areas within the body. It is important to understand their
different characteristics. For a listing of transducer specifications, see
your Transducer Specifications Manual.
There are Acuson transducers for use both inside and outside the body.
External transducers are placed on the skin to view structures beneath the
skin. Internal transducers are used inside body cavities to view tissues
that can be imaged at higher frequencies using the intracavity approach,
or that may be difficult to observe with an external transducer.
Your Aspen system supports internal transducers for intraoperative,
endovaginal, endorectal, and transesophageal exams. The distinction
between external and internal transducers is important because internal
transducers require special preparation and disinfection procedures. For
more information about transducer care and safety, see your Safety
Manual.
The addition of the new multiplexer with high density array (HDA) in
combination with the variable line density (VLD) option gives the ability
to obtain higher resolution and better quality images. The HDA feature
increases the amount of channels available for use with transducers,
while the VLD option optimizes the additional channel data. The result
being a higher resolution with better quality image.
The format of a 2-D image depends on both the pattern of ultrasound
waves or scan lines the transducer forms and the shape of the transducer
footprint. Depending on how your Aspen system is configured, the
following imaging formats may be available: linear array, Vector® wide
view imaging array, sector array, NewView enhanced access imaging
format, and high-performance curved array format.
FORMAT DESCRIPTION
Linear A linear transducer has a medium to large footprint that

Array uses parallel ultrasound scan lines that are perpendicular to
the face of the transducer to produce a rectangular image.
Linear transducers usually have a large footprint, thus they
typically produce a wide, near field of view.
Vector Vector is Acuson’s trademark for its proprietary

Wide View omni-steerable, omni-originating image formation
Array technology. A Vector wide view array transducer forms
ultrasound scan lines that can originate from any point on
the transducer face and can be steered in any direction. A
Vector wide view array transducer has a small footprint for
imaging when access is difficult; however the near field
image width is almost as wide as the transducer footprint.
Sector A sector array transducer forms ultrasound scan lines that

Array are steered from a single point on the transducer face and
extend through a 90° angle to produce a pie shaped image.

Changing Transducer Frequency
FORMAT DESCRIPTION
NewView NewView enhanced access imaging format is similar to

Enhanced Vector wide view array format, with the image apex offset
Access above the transducer face. The result is an image that has
the shape of a teepee. NewView format is supported on
selected Vector array transducers.
Curved A high-performance curved array transducer forms

Array ultrasound scan lines that are perpendicular to the face of
the transducer. Because the face of the transducer is curved,
it produces an image with a wider far field than near field.
Changing In 2-D imaging mode, Native® Tissue Harmonic Imaging (NTHI) mode,
Transducer Color Doppler (CD) imaging mode, M-mode, and Color M-mode, the
Frequency MultiHertz® multiple frequency imaging feature extends the usefulness
of several transducers by enabling them to operate at multiple
independent imaging frequencies. This capability on a single transducer
provides better 2-D resolution at higher frequencies and better 2-D and
CD penetration at lower frequencies. In addition, the lower frequencies
provide increased CD velocity scales to reduce aliasing.
Each multi-frequency transducer provides a primary frequency and an
alternate (lower) frequency. Some transducers also provide a third
frequency that is higher than the primary frequency or lower than the
alternate frequency.
EF extended frequency imaging transducers form an image over a
range of frequencies. For example, the primary frequency range might be
10-5 MHz and the alternate frequency range might be 7-3 MHz.
For more information on frequency options provided by each transducer,
see your Transducer Specifications Manual.
Transducer
Data Field Frequency
◆ To change the imaging frequency, press MULTIHZ.

For more information on using this feature in different operating modes,
see the chapters specific to those operating modes.
Changing the Currently within the United States, the FDA has established guideline
Transducer Output ultrasound power limits for various clinical applications. Within the
Power Level United States, manufacturers may not market diagnostic equipment for
routine clinical use in a particular application if it exceeds the relevant
guideline levels. For more information about power limits, guideline
levels, and power values provided by specific transducers, see your
Transducer Specifications Manual.

The Exam Preset that you are using determines the default power level.
For more information about Exam Presets, see Chapter 4.
◆ To change the output power level for the active transducer, turn
the power knob clockwise to increase the power level or
counterclockwise to decrease the power level.
The current power level always appears in the Output Display monitor,
on the keyboard. See “Output Display”, next. You can set up the system
to also display the power level on the screen. See “Setting up the Output
Display” on page 9.
Output Display The Aspen system includes a built-in Output Display system that lets you
monitor acoustic output levels for the active transducer and imaging
modes during an exam. The Output Display provides an indication of the
potential for bioeffects that might be caused by the ultrasound energy
being emitted. With this information, you can better control the
diagnostic ultrasound equipment and examination to ensure that needed
diagnostic information is obtained with minimum risk to the patient. The
Output Display system provides the following output measurements.
ABBREVIATION MEASUREMENT DESCRIPTION
MI Mechanical Index Used for scanning in 2-D

Imaging mode only.
TIC Thermal Index, Recommended for adult or

Bone at Surface neonatal cephalic scanning.
TIB Thermal Index, Recommended for second

Bone at Focus and third trimester fetal
scanning.
TIS Thermal Index, Recommended for soft-tissue

Soft Tissue at scanning; may also be used
Surface for second and third trimester
fetal scanning depending on
position of fetus.
TISF Thermal Index, Indicates focal region TIS for

Soft Tissue at Focus M-mode, Pulsed Wave
Doppler, and Continuous
Wave Doppler modes.
Non-ODS Transducers Some Aspen transducers do not support these Output Display
measurements. When you use one of these non-ODS transducers, the
FDA guideline level (<800, <500, <100, or <50 I-SPTA) appears on the
Output Display monitor.

Monitor/Keyboard Adjustments
Setting up the Output You can choose which output values appear on the Output Display.
Display
◆ To set up the Output Display, press SETUP and select SCREEN
DATA: OUTPUT from the Setup menu, then use the following
controls.
CONTROL USE
[PWR ON/OFF] Controls whether the transducer power value

appears in the Output Display. Select either ON or
OFF.
This soft key label does not appear if TIB, C, or S
is selected in the [TIX/TIB, C, S] soft key label.
[TISF ON/OFF] Controls whether the TISF index appears in the
Output Display. Select either ON or OFF.
This soft key label does not appear if TIB, C, S is
selected in the [TIX/TIB, C, S] soft key label or if 2-
D imaging mode is active.
[TIX/TIB, C, S] Controls whether the Output Display reports one
of the TIB, TIC, and TIS indexes (you choose
which one) or all three.
To display either the TIB, TIC, or TIS index, select
TIX (where X represents the third letter in the
index name: B (bone at focus), C (bone at surface),
or S (soft tissue at surface)). Push OUTPUT
DISPLAY until the soft key label displays the index
you want.
To display the TIB, TIC, and TIS indexes
simultaneously, select TIB, C, S.
[MONITOR ON/OFF] Controls whether output values are displayed on
the system monitor. Output values always appear
on the keyboard Output Display.
Monitor/Keyboard ◆ To adjust the monitor position:

Adjustments
Push in handle to Pull out handle

unlock to lock
1. Push the monitor handle in to unlock it.

2. Using both hands, swivel the monitor from side to side, or up and
down.
3. When you are done, pull the monitor handle out to lock it.

Wheel Adjustments The system’s two front wheels lock to restrict the system from moving or
unlock to allow movement. The wheel locks are located directly on the
wheels and have two positions, labeled OFF and ON.
Wheel Unlocked Wheel Locked
To unlock the To lock the

wheels, push wheels, push
down on the down on the
front side of back side of
the locking the locking
mechanism. mechanism.
Foot Switch You can use the system foot switch to perform frequently performed
functions, such as printing. The foot switch settings available to you
depend on the options installed on your system. For instructions on
setting up foot switch functions, see Chapter 29.
Safety For information on safety issues regarding Acuson Ultrasound systems,

see your Safety Manual. The manual contains detailed information on the
following topics.
System Requirements Environmental Requirements

Electrical Requirements
Electrical Safety
Input and Output Power Ratings
System Operation and Turning the System On and Off

Maintenance Moving the System
Cleaning the System
Adjusting the VCR Signal Output
Caring for and Cleaning Using Transducer Covers

Transducers Using Ultrasound Gel
Precleaning Transducers
Disinfecting and Sterilizing
Transducers
Transducer Decontamination
Storing Transducers
System Measurement Measurements in Color Doppler

Accuracy Caliper Measurements

Keyboards
CHAPTER 2
SYSTEM CONTROLS
You use the controls on the keyboard and objects on the display to
customize an image, take measurements, make notes, record images, and
so on. This section explains basic techniques for using the keyboard and
controls.
Keyboards The controls on the keyboard are grouped by function to make it easier
for you to find the control you need.
AEGIS (top row) Setup and

Other
Features
Image
Exam Set-up
Processing
and Power |
Annotation
VCR Controls (bottom row)
Doppler
AEGIS Group
Measurements Field of
View
and Calculations
Major Modes
Home Area and Documentation
Code Keys To access some functions that appear in blue on an alphanumeric key,
press the CODE key and then press the alphanumeric function key. There
are two CODE keys, one at each side of the alphanumeric function
keypad.
When this guide describes how to use a function that requires you to
press the CODE key, it instructs you to press CODE + the alphanumeric
key. For example, press CODE + DATA POS.

Chapter 2 - System Controls
Soft Keys The four unlabeled keys immediately below the screen are soft keys. They
correspond to soft key menus that appear at the bottom of the screen. The
labels and functions of the soft keys change depending on the function
you are using. To select a menu option, press the corresponding soft key.
When there are no options to select, no soft key menu is displayed. This
manual displays soft keys in brackets, for example: [ROTATE/MOVE].
Soft Key Menu
There are two types of toggling soft keys:

• One type toggles between two or more options in the soft key label.
Press the soft key until the option you want is highlighted.
• The other type of soft key displays only the active option. Press the
soft key until the one you want appears.
In most cases, you can remove a soft key menu by pressing RETURN.
Trackball Use the trackball to highlight selection options, or move the pointer and
other objects on the display. Roll the trackball in the direction that you
want to move the pointer.
◆ To change what the trackball controls, toggle PRIORITY until the
function you want becomes active.
Trackball control options are directly related to the system setup.
Trackball in 2-D Mode When in the 2-D mode, you may change trackball sensitivity to a faster
trackball response or leave the it at the default setting of NORMAL. The
settings are SET-AND-FORGET VALUES stored in BBM. The following
list shows the options with this new faster trackball response.
• Aegis Review Cursor
• Begin Screen Cursor
• CD Pan Box
• Pop-up Menus
• Res Pan Box
• Velocity Tag
◆ To change the trackball sensitivity settings:
1. Press the SETUP hardkey.
2. Highlight 2-D and press [SELECT].
3. Select the desired trackball speed, NORMAL or FAST.
4. Press [EXIT].

Select Keys
Select Keys The select keys on either side of the trackball are like mouse buttons. You
click them to select objects, choose items from menus, and so on. You can
also double click (click quickly twice) to access other functions.
Image
Store Clip
Cine
Store
Print VC
Rec R
iew ord
Rev
Select Key Select Key
When you see the single-click icon (()) in a soft key label (for example,
[()END TRACE]), you can select that menu item by clicking either select
key once. If you see the double click icon ((())), you can select that item by
quickly clicking either select key twice.
Pop-up Menus Some functions display a pop-up menu that contains a list of choices.
Unlike toggling soft keys, a highlighted item is only active when it is
selected.
CONTROL USE
TRACKBALL Roll up or down until the item you want is

highlighted.
[SELECT] Press to select the item and remove the menu.
[HIDE MENU] Press either key to remove a menu without choosing
RETURN an item. Or, press the key that activated the menu.

Full-Screen Menus Some functions display a menu that takes up the full screen. For example,
calculation packages have a full-screen setup menu that lets you
customize calculations.
Use the following keys with a full-screen menu.
CONTROL USE
TRACKBALL Roll up or down until the item you want is

highlighted.
[ON/OFF] Press to turn a selected item on or off.
[SELECT] Press to view additional steps for using or customizing
the selected item.
[PAGE] Press to switch pages in a full-screen menu with
multiple pages.
[EXIT] Press to exit a full-screen menu.
Dialog Boxes Dialog boxes contain pop-up menus, option buttons, and command
buttons that you use to customize a function.
Command Buttons
Click to display
additional options.
Option Buttons
Click to turn on or off.
Red buttons are on. Click on the arrow to
Pop-up Menu display network
Click to display the status.
menu and click to
choose the option Click to apply
you want. changes and leave
the function.

Moving the Data Display Box
Moving the Data The system uses a data display box to display on-screen information from
Display Box measurements and calculations. You can move the data display box, and
save its location.
◆ To move the data display box, press CODE + DATA POS to move
the data display box between the preset locations.
Editing Text There are two different formats for entering text with the alphanumeric
keys on the Acuson system.
• Text fields that you can edit appear shaded. Text fields appear in
several reports and the patient demographic page.
• In the annotation function, you can make notes directly on an
ultrasound image.
Use these controls for editing text. Chapter 5 describes additional controls
for annotating images.
CONTROL USE
CURSOR Shows the current type-in point. This is where any text
that you type appears.
SPACE BAR Press to move the cursor to the right within a text field.
RETURN Press or use the trackball to move the cursor between
TAB text fields or to the next line.
HOME Moves the cursor to its home position, usually the
upper-left corner of the display or upper-most text
field. For information about setting the HOME position,
see “Text Function” on page 27.
END Press to move the cursor to its end position, the
lower-right corner of the display or the lower-most text
field.
BACKSPACE Press to erase the character before the cursor.
CODE + DEL Deletes from the cursor position to the end of the text
LINE field or line.
CODE + CAPS Press to switch between typing uppercase or lowercase
LOCK letters. The system default is uppercase.
SHIFT Hold down while pressing an alphanumeric key to
override the CAPS LOCK setting for that keystroke.
[UNDO] Press to undo your last change to a report.
[DELETE] Press to delete the current value in a report field and
replace it with the default value.


PART 2
BASIC EXAM OPERATIONS

Basic Exam Operations describes features you use while performing an
exam. It includes the following chapters:
Chapter 3 Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Chapter 4 Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter 5 Annotating Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 6 ECG and Physio Module . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chapter 7 Freeze and Cine Functions . . . . . . . . . . . . . . . . . . . . . . . . 39
Chapter 8 Data Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Beginning a Study
CHAPTER 3
STUDIES
Beginning a Study A study is the collection of patient information, calculation data, and
stored images and clips for a specific patient and exam. Studies are stored
on the system’s internal hard disk and can be copied to magneto-optical
disks and network servers.
You typically begin a study by recording information about the patient
such as the patient’s name and an identification (ID) number on the
patient demographic page. The patient demographic page can also
contain additional patient information, such as the patient’s age, height,
and weight. You can customize the patient demographic page to contain
the type of patient information you want to record. See Chapter 29 for
more information.
The Aspen system has an optional DICOM worklist feature that speeds
the process of entering patient information on the patient demographic
page. The worklist feature enables the Acuson system to communicate
with a Hospital Information System (HIS) or Radiology Information
System (RIS) to obtain a list of patients scheduled for ultrasound exams.
The Acuson system obtains this information from a DICOM worklist
server that is part of the HIS or RIS. (If your system has this optional
feature, your Acuson Customer Engineer configures your system to
connect to the worklist server.)
During a study you can store images and clips (series of images) using
the system’s onboard AEGIS® digital image and data management
software. Ending a study clears patient information and sets up the
system to begin a new study. You can review or restart completed studies
later using the AEGIS system software. For more information about
AEGIS system software, see Chapter 8.
Entering Patient If your Aspen system has the DICOM worklist option, you can retrieve
Information patient information on a DICOM worklist server. If your system does not
have the DICOM worklist option or if information for the current patient
is not stored on the worklist server, you can enter patient information
manually.

Chapter 3 - Studies
Retrieving Patient ◆ To enter patient information for a new study on a system with
Information from the DICOM worklist function:
Worklist Server
1. Press BEGIN/END.
2. In the patient information fields, enter enough information to identify

the patient.
Enter the patient name in this format: Last, First, Middle, Suffix,
Prefix. Use commas to separate the different components of the name.
(You can omit or include spaces before or after commas; the system
ignores them.)
3. Press [QUERY].
If there is one match, the patient demographic page fills with the patient
information. If there is more than one match, the Scheduled Studies page
appears. The Scheduled Studies page lists all scheduled patients who
matched the information you entered.
Filter Fields
Patient List

Entering Patient Information
4. Use the following controls to locate the patient you want on the
Scheduled Studies page.
CONTROL USE
PATIENT NAME Enter full or partial patient data in any of these

ACCESSION# filter fields to refine your search for a
STUDY TYPE particular study.
DATE fields
Patient list Double-click a patient to select that patient and

load the stored patient information.
Click one of the column headings at the top of
the list (PATIENT NAME, ACCESSION#, STUDY
TYPE, or DATE) to sort the list by that column.
[QUERY] Updates the patient list based on information

in the filter fields.
[PRIOR] Returns to the patient demographic page,
without transferring patient information.
[CLEAR FILTER] Clears all current filters.
[SAVE] Press to save the list of patients (and their
information) to the Acuson system’s hard
drive.
Saving the patient list is useful if you intend to
perform portable exams, where the Acuson
system will not be connected to your network.
You can also configure the Acuson system to
automatically connect to the HIS at the
beginning of each day and store the day’s
scheduled studies to disk. For more
information, see your Administrator Manual.
If your system is set up to automatically
retrieve the day’s studies, pressing [SAVE]
overwrites the previously stored studies for
the current day.
Entering Patient ◆ To enter patient information for a new study on systems without
Information Manually the DICOM worklist function:
1. Press BEGIN END to display the patient demographic page.
2. Enter the patient name and/or ID.
3. Press [STUDY TYPE] and choose a Study Type from the pop-up menu
that appears. The Study Type determines which patient demographic
fields appear.
4. Enter patient information in the patient information fields.
Press RETURN to move the cursor between patient information fields.
5. Press [IMAGE] to return to the image screen and begin the exam.

Chapter 3 - Studies
Changing Patient ◆ To change patient information during a study:

Information During a 1. Press BEGIN END.
Study
2. Press [MODIFY].
3. Change patient information.
4. Press [IMAGE] to return to the image screen and continue the exam.
Ending a Study ◆ To end a study and return to the patient demographic page:
1. Press BEGIN END.
2. Press [START NEW PT].
IMPORTANT: Depending on how your system is set up to save images and clips, a
study may delete unsaved images and clips. For information on saving
images, see Chapter 8. For information on setting up your system to
save images and clips, see “Aegis Software Setup” on page 218.
Restarting a Study You can only restart studies that have ended within the last 24 hours. You
can perform the same functions within a restarted study as if it had not
been closed.
◆ To restart a study:
1. Press BEGIN END.
2. Press [START NEW PT] to display the patient demographic page for a
new study.
3. Press [RESTART LIST] to display the list of available studies.
4. Select a study or press [PRIOR MENU] to return to the previous patient
demographic page.
NOTE: You can restart studies stored on the system’s internal hard disk
or on magneto-optical (MO) disks from another Aspen or Sequoia
system. You cannot restart studies from other ultrasound systems.

Overview
CHAPTER 4
PRESETS
Overview Exam Presets and Image Presets make selecting scanning parameters
simple and fast. An Image Preset is a collection of system parameters, for
each imaging mode, that affect the look of the image. Image Presets
represents the imaging goal, the clinical application, or anatomy. An
Exam Preset is a collection of Image Presets. An Exam Preset also includes
information regarding the format of the screen and other system setup
information. Each Exam Preset contains Image Presets for 2-D, Color
Doppler, M-mode, and spectral Doppler modes.
Acuson Exam The Aspen system includes the following Exam Presets. An next to the
Presets Preset name identifies the Acuson-provided Presets. You cannot delete or
modify the Acuson Presets; however, you can create your own additional
Presets and change the order in which they are displayed. For more
information about changing Preset display order see your Administrator
Manual.
EXAM PRESET NAME TYPES OF EXAM PRESET NAME TYPES OF

EXAMS EXAMS
ABDOMEN Abdomen NEONATAL ECHO Cardiac
BREAST Breast OB OB
CAI - A Cardiac contrast PEDIATRIC ECHO Cardiac
CAI - A FLOW LVO Cardiac contrast PELVIS Pelvis
CAI- A INV LMI Cardiac contrast PHARM STRESS 4 Cardiac
CAI-A PH STRESS Cardiac contrast PHARM STRESS 7 Cardiac
CAI-B Cardiac contrast PROSTATE Prostate
CAI - B FLOW LVO Cardiac contrast PV ARTERIAL Arterial
CAI- B INV LMI Cardiac contrast PV VENOUS Venous
CAI-B PH STRESS Cardiac contrast SMALL PARTS Small parts
CARDIAC DIFFICULT Cardiac TCI 219 Transcranial,
CARDIAC EASY Cardiac TCI ORB 219 Transcranial
CAROTID Carotid artery TCI 4V2 Transcranial
ENDOVAGINAL Endovaginal TCI ORB 4V2 Transcranial
EXERCISE STRESS Cardiac TEE Cardiac
INTRACARDIAC Cardiac TESTICLE Testicle
MUSCULO Musculoskeletal THYROID Thyroid

Chapter 4 - Presets
Recalling Exam ◆ To recall an Exam Preset, press EXAM PRESETS and select the
Presets Exam Preset from the pop-up menu.
Recalling Image ◆ To recall an Image Preset, use either of the following methods:
Presets • Turn the IMAGE knob clockwise or counterclockwise to cycle through
the available Image Presets.
As you turn the knob, you see the result of the changed selection on
the image immediately.
• Press IMAGE to display the Image Preset menu, then turn IMAGE to
make a selection. Press IMAGE or a trackball select key to activate
your selection.
Creating a New ◆ To create a new Exam or Image Preset:

Preset 1. Recall an existing Preset to use as the basis for the new one.
2. Change any system parameters, as desired.
3. Press SETUP and select PRESETS from the Setup menu.
4. Enter a name for the new Preset in the NEW EXAM PRESET or NEW
IMAGE PRESET text box and click the STORE button next to the text
box.
NOTE: If you do not specify a name for a new Preset created from an
Acuson-protected one, the new preset will have the same name as the
Acuson-protect Preset, without the in front.
5. To specify the default Image Preset for a new Exam Preset, select the
Image Preset from the Image Preset list and click Set Default.
NOTE: You cannot add Image Presets to an Acuson-protected Exam
preset.
6. Press [EXIT].
Changing Presets You cannot modify an Acuson protected Exam Preset. Acuson-protected
Presets have an Acuson in front of their names.
◆ To change settings for an Exam or Image Preset:
1. Recall the Preset you want to modify.
2. Change any system parameters, as desired.
4. To change the Exam Preset, click the STORE button below the Exam
Preset list.
5. To change the Image Preset, click the STORE button below the Image
Preset list.
6. To change the default Image Preset for this Exam Preset, select the
Image Preset you want to use as the default from the Image Preset list
and click Set Default.
7. Press [EXIT].

Deleting Presets
Deleting Presets You cannot delete an Acuson-protected, power-up, or active Preset.

◆ To remove an Exam or Image Preset:
2. Select the Exam or Image Preset you want to remove, and click the
corresponding DELETE button.
• To remove an Exam Preset, click the DELETE button below the
Exam Preset list.
• To remove an Image Preset, click the DELETE button below the
Image Preset list.
3. To confirm the deletion, press [DELETE] (soft key) or DELETE
(keyboard key). To cancel, press [CANCEL] or click the CANCEL
button.
4. Press [EXIT].
Setting Default You can use the Presets Library function to control which subset of the
Exam Presets Acuson-provided Exam Presets are available on your system. For
complete Preset instructions, see your Administrator Manual.
Managing Acuson- You cannot delete an Acuson-protected preset, but you can turn them on
protected Preset or off via the LIBRARY softkey.
◆ To turn off an Acuson-protected Preset
1. Press SETUP and select Presets.
2. Press the first softkey [SHOW LIBRARY].
3. Turn the desired Presets on.
4. Turn the desired presets off.
5. Press EXIT.

Chapter 4 - Presets

Text Function
CHAPTER 5
ANNOTATING IMAGES
Text Function The text function is your basic tool for labeling images. In the text
function, you can enter text anywhere on the screen. The text function
displays a single cursor to show where text you type will appear.
◆ To enter the text function:
1. Press TEXT or TEXT START (SPACE BAR).
2. Use standard text editing techniques and the keys in the following
table when you are editing (annotating) text in images.
3. When you finish, press TEXT to leave the text function.
KEY FUNCTION
[HOME] Places the cursor in your default starting position for

typing. (See [HOME SET]).
[HOME SET] Defines the home position.
Move the cursor where you want the home position
to be and press [HOME SET].
[TEXT 1&2] Selects a text layer. Your choices are:
[TEXT 1] Add, change, or delete text in TEXT 1
[TEXT 2] Add, change, or delete text in TEXT 2
[TEXT 1&2] Add, change, or delete text in TEXT 1
while viewing both TEXT 1 and TEXT 2
CODE + CLEAR Removes all the text in a selected text layer.
TRACKBALL Moves the cursor.
Annotation Keys Annotation keys are shortcut methods that you can use to make notes
directly on the display. The six keys to the right of the TEXT START key
are programmable annotation keys that you can program to represent up
to 15 annotation terms each. Programmable annotation keys can be
customized to cycle between annotations or display a pop-up menu of
annotation options. Annotation keys are available at all times during an
exam.

Chapter 5 - Annotating Images
Programming You can program an annotation key to change the terms associated with it
Annotation Keys and change the way it functions: as a pop-up or cycling key.
◆ To program an annotation key, press CODE + the annotation key
and use the following controls.
CONTROL FUNCTION
Trackball Positions the cursor within the list of terms.

[INSERT] Inserts a blank line in the list of terms, above the
current cursor position. Type a new term (up to 15
characters) and press RETURN.
[DELETE] Deletes the term on which the cursor is positioned.
[method] Selects the key function: CYCLE or MENU.
[EXIT] Saves your changes and exits the setup function.
Cycling Annotation Key ◆ To use a cycling annotation key:

1. Press TEXT or TEXT START to enter the text function.
2. Position the text cursor where you want the term to appear.
3. Press the annotation key to display an annotation term at the cursor
position.
4. If the term that appears is not the one you want, press the key again
until the term you want appears.
Pop-up Menu Annotation ◆ To use a menu annotation key:
Keys
1. Press TEXT or TEXT START to enter the text function.
2. Press the annotation key to display a pop-up menu.
3. Select the annotation term in the menu.
You can drag an annotation term from the menu to the image, or you can
select a position on the image and transfer the annotation term to that
position.
◆ To drag and place the annotation term:
1. Select the annotation term on the menu and press [SELECT].
2. Use the trackball to position the term on the image and press [WRITE].
◆ To transfer the annotation term:
1. Position the cursor where you want the annotation term to appear.
2. Select the annotation term on the menu.
3. Press [WRITE].
NOTE: If the term is in a position where annotations are not allowed,
[WRITE] does not appear.
◆ To remove an annotation menu from the screen, press [EXIT].

Body Markers
Body Markers A body marker is a graphical representation of the anatomy being

examined. The body marker indicator (a line) can point to an area of
interest or show the transducer orientation for the exam. You can use a
body marker as a shortcut method for identifying the type of exam.
Body Marker
Indicator
Body Marker
Body markers are grouped by anatomical area. Within each group, there
are individual markers that represent different views of the anatomy.
Using Body Markers ◆ To display a body marker:

1. Press BODY MARKER.
2. Press the first soft key until the anatomy group you want appears.
3. Use the following keys with the body marker function.
CONTROL FUNCTION
Second soft key Press to select a view.

[ROTATE/MOVE] Highlight ROTATE or MOVE and use the
trackball to move or rotate the body
marker indicator.
[POSITION] Press and use the trackball to move or
rotate the fetal lie body markers.
[_/I] Press - (hyphen) to quickly rotate the

indicator to the horizontal orientation.
Press | (vertical bar) to quickly rotate the
indicator to the vertical orientation.
4. To exit the body marker function, press BODY MARKER.

◆ To move the body marker:
1. Press CODE + BODY MARKER.
2. Use the trackball to position the body marker.
3. Press CODE + BODY MARKER to exit this function, or press BODY
MARKER to display the body marker soft key menu and update the
body marker.

Chapter 5 - Annotating Images
Available Body The Aspen ultrasound system provides the following body markers:
Markers
ANATOMY MARKER
GROUP
ABDOMEN SUPINE, RPO, LPO, LATERAL, PRONE, RLD, LLD

CHEST SUPINE, L OBLIQUE, R OBLIQUE, LATERAL,
POSTERIOR
NECK NECK
HEAD LT LATERAL, RT LATERAL, CROWN
LEGS LOWER, UPPER, R MEDIAL, L MEDIAL,
R LATERAL, L LATERAL
EYE EYE
PELVIS PELVIS
TESTICLES RIGHT, LEFT
SCROTUM SCROTUM
PROSTATE AP, CROSS SECTION, LATERAL
UTERUS ENDOVAGINAL, LONG
CAROTID LONG, LONG INVERT
CIRCLE OF LT ACA, RT ACA
WILLIS
NEONATAL CORONAL, LT LATERAL, RT LATERAL

HEAD
FETAL LIE LT, RT

BREAST BREAST

Triggers
CHAPTER 6
ECG AND PHYSIO MODULE
The Aspen™ ultrasound system has two physiologic monitoring

modules. The ECG module consists of an ECG channel and an auxiliary
channel. The Physiologic Module consists of a phono channel and a
pulse/respiration channel. Your system may have an ECG module or
both an ECG and a Physiologic Module; it cannot have a Physiologic
Module without an ECG module.
For ECG and Physio module safety considerations, see your Safety
Manual.
ECG Channel Aux Channel Phono Channel Respiration/Pulse

Channel
The following table describes the use of each physiologic monitoring

channel.
CHANNEL USE
ECG ECG trace
Auxiliary Preconditioned ECG trace or other physiologic DC Input
Phono Heartsounds trace

DC Input
Pulse Pulse trace

DC Input
Respiration Respiration trace

DC Input
Triggers If you are displaying an ECG or auxiliary signal, you can mark trigger
points along the trace. These points determine the update interval for the
2-D or CD image. For details, see “Triggered Images” on page 60.

Chapter 6 - ECG and Physio Module
ECG Channel The ECG channel lets you display either a standard or monitoring ECG
trace at any point during an exam. The two types of traces use different
filters.
◆ To display an ECG trace:
1. Align the pins of the ECG cable connector with the dot on the
PATIENT CONNECTION socket and push the connector securely into
place.
2. Use the following ECG controls.
ECG Controls
CONTROL USE
ECG SWITCH Set to STD to display a standard ECG trace, or MON

to display a monitoring ECG trace.
Set to OFF to turn off the ECG trace.
POS Turn clockwise to move the baseline up or
counterclockwise to move it down.
The trace baseline position is fixed in 2-D and
Color Doppler imaging modes.
GAIN To turn on automatic gain control, turn
counterclockwise to set the dial to AUTO.
To manually control gain, turn clockwise (away
from AUTO), then turn clockwise to increase gain
or counterclockwise to decrease it.
RESET/CAL Push up to reset the ECG baseline to horizontal.
Use when the ECG baselines deviates from
horizontal, usually due to physical characteristics
of the patient.
Push down to display a 1 mV calibration signal.

Auxiliary Channel
Auxiliary Channel Use the auxiliary channel to measure other important physiologic
parameters. You can display the signal from any compatible physiologic
accessory or monitor.
◆ To display an auxiliary trace:
1. Insert the auxiliary cable plug in the AUX socket.
2. Connect the other end to the output jack of a monitoring device or a
signal conditioning instrument.
3. Push the connectors securely into place.
4. Use the following Aux controls.
Aux Controls
CONTROL USE
AUX SWITCH Set to VIEW to turn on a standard auxiliary trace.

Set to TRIG to turn on an auxiliary trace that
functions with the T: trigger point.
Set to OFF to turn off an auxiliary trace.
POS Turn clockwise to move the auxiliary trace
baseline up or counterclockwise to move the
baseline down.
The trace baseline position is fixed in 2-D and
Color Doppler imaging modes.
GAIN Turn clockwise to increase gain and
counterclockwise to decrease it.
The gain is adjustable from 0.2 to 20 volts/volt.

Phono Channel You can use the phono channel to display heartsounds information or any
auxiliary signal. The phono channel has five heartsounds filters that you
can use to filter heartsounds information for a specific clinical
application.
FILTER HIGH PASS LOW PASS ADDITIONAL USE

(100 HZ) FILTER FILTER GAIN
0.5–1 50 Hz 100 Hz 10 dB Low pitched heartsounds such as gallops
1–2 100 Hz 200 Hz 14 dB Low pitched murmurs, mitral stenosis

(MS), gallops, first and second heart
sounds, and mid-frequency systolic
murmurs
1–8 100 Hz 800 Hz 14 dB Higher-pitched heartsounds such as

aortic insufficiency, mild mitral
regurgitation sounds, closely-timed
sounds, and systolic ejection murmur
3.5–8 350 Hz 800 Hz 26 dB Higher-pitched heartsounds such as

aortic insufficiency, mild mitral
regurgitation sounds, closely-timed
sounds, and systolic ejection murmur
0.3–8 30 Hz 800 Hz 0 dB Greatest range of heartsounds
You can use the phono channel to display either a heartsounds or DC

input trace. Use a heartsounds trace to correlate ultrasound information
with a patient’s heartsounds. Use a DC input trace to measure auxiliary
physiologic parameters.
◆ To display a heartsounds trace:
1. Plug the heartsounds transducer into the PHONO jack.
2. Position the transducer microphone on the patient to monitor
heartsounds.
3. Optionally, connect headphones to the AUDIO PHONES jack.
4. Use the Phono controls in the following table.
◆ To display a DC input trace:
1. Connect an approved DC input to the PHONO jack.
The maximum allowable signal is ± 5 volts.
2. Use the Phono controls in the following table.

Phono Channel
Phono Controls
CONTROL HEARTSOUNDS TRACE DC INPUT TRACE
PHONO SWITCH Set to VIEW to turn on a standard Not used.

auxiliary trace.
Set to TRIG to turn on an auxiliary
trace that functions with the T: trigger
point.
FILTER Set to one of the five filter settings. See Set to DC.
SELECTOR DIAL previous table.
Set to OFF to turn off the DC input
Set to OFF to turn off the heartsounds trace.
trace.
POS Turn clockwise to move the trace baseline up or counterclockwise to move the
baseline down.
The trace baseline position is fixed in 2-D and Color Doppler imaging modes.
GAIN Turn so that the calibration mark is pointing straight up. Turn clockwise to
increase gain and counterclockwise to decrease it.
For heartsounds traces, the gain is adjustable from 20 to 2000 volts/volt (26 dB
to 66 dB).
For DC input traces, gain is adjustable from 0.2 to 20 volts/volt.
RESET/MARKER Push RESET/MARKER to MARKER to mark a trace event.
While you do this, the system raises the baseline by 10%. When you release it,
the baseline lowers to its original position.

Pulse/Respiration The pulse/respiration channel has two inputs. You can use it to display
Channel pulse information, respiration information, or auxiliary inputs. When you
connect auxiliary inputs to the pulse/respiration channel, you choose
whether to display the signal from one input or the difference between
the signals from two inputs. Display a pulse trace to correlate ultrasound
information with a patient’s pulse.
◆ To display a pulse trace:
1. Plug the pulse transducer into the PULSE/A jack.
2. Position the transducer over the pulse point you want to monitor.
3. Use the Pulse/Respiration controls in the following table.
Display a respiration trace to correlate ultrasound information with the
patient’s respiratory cycle. Inspirations appear as upward deflections and
expirations appear as downward deflections.
◆ To display a respiration trace:
1. Plug the nasal thermistor transducer into the RESP/B jack.
2. Insert the nasal thermistor into the patient’s nostrils or mouth.1
3. Use the Pulse/Respiration controls in the following table.
Pulse/Respiration
Controls
CONTROL PULSE TRACE RESPIRATION TRACE
TRACE Set to P. Set to R.

SELECTOR DIAL
Set to OFF to turn off the pulse trace. Set to OFF to turn off the respiration
trace.
POS Turn clockwise to move the trace baseline up or counterclockwise to move the
baseline down.
The trace baseline position is fixed in 2-D and Color Doppler imaging modes.
GAIN Turn so that the calibration mark is pointing straight up. Turn clockwise to
increase gain and counterclockwise to decrease it.
For pulse traces, the gain is adjustable from 2 to 200 volts/volt.
For respiration traces, the gain is adjustable from 5 to 500 volts/volt.
RESET/MARKER Push RESET/MARKER to RESET to reset the baseline.
Push RESET/MARKER to MARKER to mark an event on the trace. While you do
this, the system raises the baseline by 10%. When you release it, the baseline
lowers to its original position.
1. Position the thermistor for best air flow. If the thermistor touches the skin
or tissues, its sensitivity is reduced.
In neonatal use, the nose clip and transducer assembly may occlude the
nasal passage because of their relative sizes. In such cases, detach the nose
clip from the transducer cable and use adhesive tape to secure the
transducer to the patient’s upper lip. Be sure the transducer is properly
positioned in the path of air flow through the nasal passage.

Using the ECG Module With Electrosurgery Devices
Using the ECG The Acuson ECG electrodes and leads and the Acuson ECG module have
Module With been designed and qualified to AAMI Standard ANSI/AAMI ES1-1993,
Electrosurgery “Safe current limits for electromedical apparatus.” The standard suggests
Devices that any other equipment designed and qualified to this standard may be
used safely with our ECG equipment. However, many electrosurgical
devices do not meet this standard and could pose a substantial hazard to
the patient. Consult your surgical equipment operation manual before
using the ECG module in conjunction with electrosurgery or diathermy
equipment. Acuson has not tested or verified the operation of the ECG
module with electrosurgery or diathermy devices.
Use of electrosurgery or diathermy equipment in conjunction with the
ECG module may cause noise in the ultrasound image.


Overview
CHAPTER 7
FREEZE AND CINE FUNCTIONS
Overview Cine memory stores and displays ultrasound information with no loss of
signal quality. Cine memory is constantly updated during image or strip
acquisition. You have the following options for stopping an ongoing
exam and viewing ultrasound information in Cine memory:
• The Freeze function freezes the system at the current 2-D or CD frame
or the current point in time in a spectral Doppler or M-mode strip.
• The Extended Freeze function lets you quickly review Cine memory
by scrolling back and forth through available frames. Extended
Freeze is available only in 2-D and CD modes.
• The Cine function gives you increased options for viewing the
information in Cine memory. You can scroll through available
information, play a continuous loop, and set margins.
Imaging functions that change the content of the live image clear Cine
memory, for example, DEPTH and SCALE. Functions that change the
presentation of the image do not clear Cine memory. Many of these
functions (for example, B-color and Postprocessing) can be adjusted while
in the Cine function.

Chapter 7 - Freeze and Cine Functions
Imaging Cine Cine memory captured from a 2-D or Color Doppler image is called
imaging Cine memory. In imaging Cine memory, the data field displays
the number of the frame you are reviewing (next to the transducer). Data
field parameters that were changed during capture are updated as they
change.
Strip Cine
Frame Number
Cine memory captured from strip modes (spectral Doppler and M-mode)
and combined image strip modes is called Strip Cine memory. In Strip
Cine memory, the data field initially displays the number of seconds of
strip information available for review. As you review Cine memory, the
data field displays the current time (in seconds) within the review
information.
Time

Using Cine
Using Cine There are two Cine modes:

• Cine Browse displays a frozen picture of Cine memory that you can
scroll through frame by frame.
• Cine Play plays the contents of Cine memory as a continuous loop.
◆ To enter Cine, press CINE and use the following keys.
CONTROL USE
GAIN/FRZ/RUN Press to toggle between Cine Play and Cine Browse.
To view Cine memory frame-by-frame, use the
Extended Freeze function. See “Extended Freeze” on
page 41.
RUN/STOP] Press to toggle between Cine Play (RUN) and Cine
Browse (STOP).
[SET LEFT] Use in Cine Browse to adjust margins (review length)
[SET RIGHT] for Cine Play.
Scroll to the frame you want to use as a margin and
press the corresponding key: [SET LEFT] for left
margin or [SET RIGHT] for right margin.
[CLEAR LEFT] Use in Cine Browse to clear margins for Cine Play.
[CLEAR RIGHT]
Press to reset the corresponding margin to the first
([CLEAR LEFT]) or last ([CLEAR RIGHT]) frame.
[SPEED ¦] Press [SPEED ↑] to increase or [SPEED ↓] to decrease
[SPEED Ø] the speed of Cine Play.
[NORMAL] Press to return to reviewing at real-time rate.
[←/→] Press to switch direction of the Strip Cine display.
Extended Freeze You can quickly access Cine while viewing a frozen image. This feature
allows for quick review when you want to select a particular frame for
measurements or documentation.
1. Press GAIN/FRZ/RUN to freeze the 2-D image.
2. Rotate GAIN/FRZ/RUN to scroll through Cine memory.
3. Press GAIN/FRZ/RUN to return to the live image.

Chapter 7 - Freeze and Cine Functions

Printing Images
CHAPTER 8
DATA MANAGEMENT
Your system supports several methods of capturing, storing, and

reviewing ultrasound data.
• You can print images to system printers. See “Printing Images,” next.
• You can record exams on videotape. See “Video Controls” on page 43.
• You can store images digitally using AEGIS® digital image and data
management system. See “AEGIS System” on page 44.
• You can review stored images from your PC via the Internet. See
“WebPro Software” on page 51.
New capabilities for your system include:
• Enhanced Dicom Store/Print.
• Cardiac Calc Support for KinetDx™ system
• In-progress Store of all OB and Cardiac data to the KinetDx system cardiac
workstation.
• Persistent Auto-retry. The system resubmits a failed print job or study
store one minute after the initial attempt. If the resubmit attempt fails,
the system again resubmits the print job or study. This applies to both
Calc data and images. A failed print job and study save from the
previous power cycle will be tried again as a new print job or study
save.
Printing Images You can print the information that appears on the screen to a variety of
printers and cameras. Use the Setup function to select system printers
and system behavior when printing. See Chapter 29.
◆ To print the current image, press PRINT.
◆ To remove the soft key menu before printing, press RETURN.
Video Controls You can use the system’s on-board VCR controls to record exams on
videotape. For instructions on taking measurements from videotape, see
“Taking Measurements from a Videotaped Exam” on page 124.
CONTROL DESCRIPTION
VCR RECORD Begins and pauses recording.

PLAY Plays back recorded exam.
PAUSE Pauses playback. Use the GAIN/FRZ/RUN wheel to step
through the videotape frame by frame.
STOP/EJECT Stops playback or ejects stopped videotape.

Chapter 8 - Data Management
CONTROL DESCRIPTION
SHUTTLE Lets you search through a videotape by turning the

GAIN/FRZ/RUN wheel.
REW Rewinds the videotape.

FF Fast forwards the videotape.
VCR CTRL Resets or changes the tape counter when tape is not
playing. Allows adjustment of brightness, contrast,
and color while tape is playing.
AEGIS System The Acuson system contains the DIMAQ™ integrated ultrasound
workstation, which runs the on-board AEGIS system software. The
on-board AEGIS system allows you to capture studies digitally on the
Aspen system local hard disk and on 3.5-inch magneto-optical (MO)
disks. You can review the stored studies to ensure thoroughness, analyze
or compare data, and perform measurements, calculations, and
annotations.
The following AEGIS system options are available:
• Standard, on-board AEGIS system lets you store studies on the
system’s local hard disk and on an MO disk.
• Optional DICOM software lets you store and print studies to
networked DICOM servers and printers. The DICOM software
supports the DICOM standard.
Use the Setup function to configure AEGIS system software for your
Aspen system. For instructions, see Chapter 29.
Using On-board There are two enhancements to the on-board AEGIS system. You can
AEGIS System now:
• Use the PAGE key to switch between stages and protocol capture
types.
• Configure a primary and alternate duration per beat for a protocol.
For more information about using on-board AEGIS system, see your User
Manual. For more information about configuring AEGIS system
protocols, see your Administrator Manual.
Using the PAGE Key to You can use the PAGE key to switch between stages during a staged
Switch Stages protocol.
• Press PAGE up to return to the previous stage.
• Press PAGE down to advance to the next stage.
Primary and Alternate You can configure free-form and staged protocols so that they have a
Duration Per Beat primary duration per beat and an alternate duration per beat.
◆ To set the duration per beat and alternate duration per beat for a
protocol:
1. Select AEGIS PROGRAM SPECIFIC FUNCTIONS from the Setup menu.

Using On-board AEGIS System
2. Select Protocol Capture Types and type in a new name or press

[SHOW MENU] to select a name from a pop-up menu of existing
capture types.
3. Press [ADD] to add the new name or [MODIFY] to change the settings
for an existing name.
The Clip Store Settings menu appears.
4. Select a DURATION PER BEAT, enter the primary duration per beat,
and select FRAMES, MS, or BEAT from the popup menu.
5. To specify an alternate duration per beat, CLIP DURATION must be set
to 1 BEAT.
6. Select ALTERNATE DURATION PER BEAT and enter the alternate
duration per beat. Enter 0 if you do not want the stage to have an
alternate duration per beat. Select FRAMES, MS, or BEAT from the
popup menu.
7. Press [PRIOR] to return to the AEGIS Program Customization menu.
8. Press [IMAGE] to return to the image.
If you defined an alternate segment length for a protocol, the primary and
alternate lengths appear in the third soft key label as you perform the
protocol. For example, [400ms/300ms].
◆ To switch between the two segment lengths, press the third soft
key to select the length you want.

Storing Studies and The Aspen system’s local hard disk capacity is 1 GB, which is equal to
Making Backup Copies approximately 4,000 static images, 100 general imaging studies, 25 very
complete cardiac echo studies, or 250 pharmacological stress echo
studies. When the disk becomes full, the oldest studies are removed to
make room for additional studies. Use the Study Utilities function (see
“Study Management” on page 49) to monitor available disk space. There
are several ways to keep a backup copy of studies:
• If an MO disk is loaded into the system, studies are simultaneously
stored on the MO disk and on the local hard disk.
• You can manually copy studies to an MO disk or DICOM server (if
your system has the DICOM option) using the Study Utilities
function. See “Study Management” on page 49.
• If your system has the DICOM option, you can set it up to
automatically copy studies to a file server. For instructions, see your
Administrator Manual.
Storing Images You can store live, frozen, Cine, and VCR images, text screens, calculation
reports, and the patient demographic page.
◆ To store the current image, press IMAGE STORE.
Wait for the IMAGE STORE light to turn off before pressing IMAGE STORE
again to store another image.
Storing Clips The on-board AEGIS system allows you to store both clips and images. A
clip can be a full-screen (full size), condensed (one quarter size) or a
selected region of interest (ROI).
Clips are stored under either a Staged protocol or a Free Form protocol. A
Staged protocol divides a study into stages, and stages can be divided
into views. A stress echo study is an example of a Staged study, in which
there are two stages, Rest and Post, and each stage includes images from
several different views of the heart.
A Free Form protocol does not divide a study, and allows for
straightforward storing and reviewing of clips with different
characteristics. You can set up a free-form protocol to store 1, 2, 4, 8, or an
indefinite number of clips each time you press the CLIP STORE key. You
also specify the segments per clip, segment length, and alternate segment
length for captured clips. If you have an ECG displayed, you can capture
clips at the R-wave of the heart cycle.
You use the Setup function to select and configure protocols. See Chapter
29.
Use these controls to store clips.
CONTROL USE
CLIP CTRL Select full-screen clip or condensed clip (CON).

Turn on (select) [CONDENSED] to select condensed
clips. Turn off [CONDENSED] to select full-screen clips.

Using On-board AEGIS System
CONTROL USE
ROI Activates the ROI clip function.

If you have an ECG or AUX trace displayed, use [ECG
CAPT: OFF/↑/↓] to choose whether the trace is removed
from the clip (OFF), displayed within the ROI box (↑),
or displayed at the bottom of the screen (↓).
TRACKBALL For an ROI clip, place the ROI box over the area you
want to store.
PROTOCOL Press to display a soft key menu for choosing the
protocol type. Press again to exit.
CLIP STORE Begins storing a clip. If you are storing a clip of
indefinite length, press CLIP STORE again to end the
clip.
Wait for the CLIP STORE light to turn off before
pressing CLIP STORE again to store another clip.
NOTE: CLIP STORE stores a static image for real-time spectral Doppler
and M-mode strips, frozen images, and full-screen text.
Saving Images and Clips All images must be saved in order to be stored permanently. Static images
are saved automatically. You can change AEGIS system settings to select
how the system saves clips:
• Automatically when you store them
• Only when you mark them as part of the Select Set during AEGIS
system review
See Chapter 29 for more information on customizing the AEGIS system.
Both static images and dynamic clips can be included in a Select Set. The
items in a Select Set appear in the order in which they are selected, as
opposed to the numeric order in which they were stored or in the order in
which they are listed in the AEGIS Setup page.
You specify which images and clips are in the Select Set while reviewing
them. See “Reviewing Images,” next.
Reviewing Images ◆ To review images in the current exam, press REVIEW and use the
following controls.
NOTE: To review images from a previous exam, use the Study Utilities
function; see “Study Management” on page 49.
CONTROL DESCRIPTION
QUAD Switches between single-image and quad-image
formats for review.
TRACKBALL Highlights an image or clip in quad format.
[ALL/SELECTED] Select ALL to display all images or clips in the order
they were acquired. Select SELECTED to display only
images or clips in the Select Set in the order they were
added to the set.

CONTROL DESCRIPTION
[SELECT] Adds the highlighted image/clip to the Select Set.
[UNSELECT] Removes the highlighted image/clip from the Select
Set.
DELETE Deletes the highlighted image or clip. Press DELETE
again to undelete. Images and clips are permanently
deleted when the exam is closed.
SAVE Toggles the save status of the highlighted clip. Clips
that are not marked to be saved are deleted when you
end the study or exit Review (if configured in AEGIS
setup).
PAGE Press up to display the previous page or down to
display the next page of images.
HOME Displays the first page of images or clips.
END Displays the last page of images or clips.
[STAGE/VIEW] Appears when you are reviewing the Select Set in a
staged protocol. Select STAGE to display Select Set
images for a particular stage. Select VIEW to display
Select Set images for a particular view, across stages.
PROTOCOL Displays a soft key menu for customizing clip
display.
[LABELS:1/2/3] selects the number of lines of labeling
information to display on the clips. [DEFINE VIEWS]
assigns a view name to the selected clip; press and
then press a select button to display a pop-up menu
with your choices.
GAIN/FRZ/RUN Turn to increase or reduce the speed of the selected
clip.
Press to freeze the selected clip, and then turn to
review clip frame by frame. From the soft key menu
that appears, press [SET LEFT] or [SET RIGHT] to set
margins for clip playback. Press [CLEAR LEFT] or
[CLEAR RIGHT] to clear the margins. Press GAIN/FRZ/
RUN again to return to playback.
Printing During Review Your printing options depend on which AEGIS system you are using.
If your Aspen system uses the on-board AEGIS system, press PRINT to
print the selected images during review. You can also use the Setup
function to configure the system to automatically print each image that
you store when you press STORE, or print all images at once when you
exit a study (bulk printing).

Study Management
Study Management The study utilities function lets you perform study management
functions such as loading completed studies, copying studies to MO disk
or a network server, bulk printing of studies, and more.
IMPORTANT: When the local hard disk becomes full, the oldest studies are
automatically deleted. (This method of storing/removing data is often
called first-in, first-out.) If you wish to maintain a study archive for
future reference, be sure to copy studies to a DICOM server or to an MO
disk for storage.
◆ To access the study utilities function, press STUDY UTIL to

display the study utilities screen.
Use the following controls to perform study management functions.
CONTROL DESCRIPTION
STUDY LIST Selects the source from which you want to display the list
FOR of stored studies: MO Disk or Local Disk.
[SELECT] Selects the highlighted study for storing, printing, or
review.
[IMAGE] Exits the study utilities screen and returns to imaging.
[EJECT Ejects the MO disk.
M.O.]
ID: Enter the study ID of the study you want to make current.
ALL DATES Select an age to use as a filter for the study list. Your choices
are ALL DATES, <1 DAY, <1 WEEK, <1 MONTH, and <1 YEAR.
SELECT Selects all studies in the list.
ALL
UNSELECT Deselects all studies in the list.

ALL
QUERY Updates the list of studies.

SORT Chooses the sorting method for the study list.

CONTROL DESCRIPTION
ERASE Erases the selected studies.

REVIEW Reviews the selected study.
PRINT Prints all images from the selected studies to a DICOM
printer. (This feature is called bulk printing, and requires
the DICOM option.)
COPY TO Copies the selected studies to the selected destination: MO
Disk, Local Disk, or DICOM file server. (The DICOM
option is required to save to a DICOM file server.)
PG UP Scrolls the study list up to display studies earlier in the list.
PG DN Scrolls the study list down to display studies later in the
list.
HOME Scrolls to the top of the study list.
END Scrolls to the end of the study list.
Trackball Use the trackball to move the pointer inside the study list,
and A-Z then press an alphabet key (A-Z) to move to a specific area
keys of the list, based on the study name. For example, if you
press G, you scroll the list to show studies whose name
begins with G.
REVIEW Displays the images and clips for the selected study.
When reviewing a prior study, you can view the All Set or
the Select Set (if one was created). You can create a
temporary Select Set, take measurements, and perform
calculations. You cannot change the prior study. The study
returns to its original state when you close it.

WebPro Software
WebPro Software The WebPro™ Web-Based Package is an optional feature that allows you
to view ultrasound exams from a stand-alone computer. A standard PC
that is outfitted with suitable hardware and software can be transformed
into a primary ultrasound review station.
A computer must be linked to the ultrasound system via a modem, ISDN
line, or a local intranet in order to use the WebPro Package software.
Intranet, ISDN, and modem configuration is your responsibility.
Protection against unauthorized access is provided by requiring each user
to supply a user name and password to access this feature. The customer
is responsible for the overall security of the network to which the
ultrasound system and computer are attached through the use of network
firewalls or other similar security measures.
The host name and IP address will be set by an Acuson service
representative or by your hospital network administrator.
Minimum PC The WebPro Package is designed to transform a standard PC into a
Requirements primary ultrasound review station and, as such, it requires the following
minimum computer specifications:
• A PC (running Windows 95 or Windows NT 4.0 or greater)
• A modem, ISDN line, or a local intranet connection
• One of these Web browsers:
Netscape Communicator, version 4.02 or greater
Microsoft Internet Explorer, version 4.0 or greater
For best performance, Acuson recommends the following minimum
hardware:
• For remote access, an ISDN connection or a 56K modem
• A 200-MHz Pentium Processor with MMX technology
• 64 megabytes of RAM
• A 4-megabyte video card that supports 24-bit color at 1024 x 768
resolution
• A monitor that supports 1024 x 768 resolution
Recommended Plug-Ins You need a QuickTime-compatible plug-in (or helper application) to view
clips. If you do not have this software, clicking on a clip automatically
prompts you to download a QuickTime™ plug-in from the Internet. If the
PC you are using is not connected to the Internet, you will have to install
QuickTime yourself. Contact Apple Computer for information on
obtaining QuickTime software, or download the QuickTime plug-in from
the Internet using a computer that has access to the Internet at the
following URL:
http://www.quicktime.apple.com
Using WebPro Software WebPro Package software is factory loaded onto your system when you
purchase it. When your Aspen system arrives, the appropriate network
configuration must be completed by an Acuson customer engineer or
local site administrator. WebPro Package software is invisible on your
ultrasound system. It is accessed from a PC that has been configured to
act as a WebPro Package review station.

NOTE: The Aspen system must be left on to use this feature.

For complete instructions, please refer to the on-line Help page that
serves as the instruction manual for the WebPro Package. A HELP button
and a LOG OUT button appear on every WebPro Package page. To log into
the WebPro Package:
1. From a suitably outfitted PC, start your Web browser and type either
of the following in the Location (Netscape Navigator) or Address
(Microsoft Internet Explorer) text box:
• http://IP address
where IP address is the IP address of the ultrasound system
• http://host name
where host name is the name assigned to the ultrasound system.
2. On the Login page that appears, enter your user name and password.
For a first-time login, to set up a name and password, use Admin as
the user name and admin as the password.
3. Once logged in, use the following controls to review images and clips
stored in studies.
CONTROL DESCRIPTION
SEARCH BUTTON Displays a list of exams stored on the

ultrasound system.
ALL IMAGES BUTTON Previews all images from the selected study.
SELECT SET BUTTON Previews only those images included in the
select set for the selected study.
PREVIEW IMAGE/CLIP Displays an image or clip in full size.
LOG OUT BUTTON Disconnects from the ultrasound system.
You can review an open study that is currently in progress. Use your Web
browser’s Forward and Back buttons to update the image set as new
images and clips are captured.

PART 3
IMAGING MODES
Imaging Modes describes the operating modes you can use to perform an
exam. It includes the following chapters:
Chapter 9 2-D Imaging Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Chapter 10 Color Doppler Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Chapter 11 VEL, ENE, and CONV . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Chapter 12 Doppler Tissue Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Chapter 13 Spectral Doppler Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Chapter 14 M-Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Chapter 15 Color M-Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Chapter 16 Perspective™ Advanced Display Option. . . . . . . . . . . . 95

Overview
CHAPTER 9
2-D IMAGING MODE
Overview 2-D imaging is the basic mode for observing anatomy and determining
areas of interest that you may want to examine with other modes. You can
display a 2-D image at the same time as you display a spectral Doppler or
M-mode strip, or with Color Doppler (CD) information.
◆ To enter 2-D mode:
1. Turn on the system.
2. Connect a transducer.
3. Use IMAGE to select the appropriate Image Preset. See “Recalling
Image Presets” on page 24.
◆ To return to 2-D mode, press 2D ONLY.
Patient Name
and I.D.
Grayscale Bar Data Field

shows scan
orientation. It
corresponds to a
groove in the
transducer.
DGC Curve
Transmit Zone

Chapter 9 - 2-D Imaging Mode
Data Field
Frame Rate (Real-Time
Date Image) or Cine Frame
Permanent Time Number (Frozen Image)
System Data Transducer
Frequency Depth
Field Exam Preset
Image Preset
VCR Counter
Preprocessing Edge
Persistence
Power Display
Removable Dynamic Range Postprocessing
Data Field Overall Gain
Number of Stored Clips
Number of Stored Images Available Memory
Image Format
Controls
CONTROL USE
DEPTH Adjusts the field of view up or down.

DUAL Splits the screen to view a frozen image and a
live image. The frozen image is a snapshot of
the image displayed when you press DUAL.
This function is available only with linear
array transducers.
[()DUAL L/R] Changes the active window from one side to
another.
IMAGE WIDTH Adjusts the image width to show just an area
of interest. (This feature is not available on
linear array transducers.)
TRANS ZONE Press to increment the number of transmit
POSITION zones.
Turn to position the transmit zones.
FRAME RATE Adjusts the rate at which the system displays
new images.
L/R Flips the image from left to right.
U/D Flips the image up and down.
SIZE Changes the image size.

Image Optimization Controls
Image Optimization
Controls
CONTROL USE
DYN RANGE Turn clockwise to increase the dynamic range, or

counterclockwise to decrease the dynamic range.
PERSIST Controls how rapidly an image appears to change over
time. Use lower levels for rapidly changing anatomy.
Use higher levels to provide a smoother image for slow
moving structures.
Use the soft key menu to select a persistence level.
DGC Each slider adjusts gain at the corresponding depth.
SLIDERS
POST Adjusts the assignment of gray levels to echo

amplitude. Use soft keys to select a postprocessing
map. Options range from low to high contrast.
2D GAIN Turn clockwise to increase overall gain, or
counterclockwise to decrease overall gain.
EDGE Press up for sharper borders or down for smoother
borders.
DELTA Adjusts DELTA® differential echo amplification. Use
DELTA amplification to control the degree of contrast
resolution within an image. Press up to use a higher
level of contrast resolution, or down to use a lower
level of contrast resolution.
B COLOR Selects a mapping between different colors or hues of a
color and echo amplitude.
GAIN/ Turning the GAIN/FRZ/RUN wheel while on a live image
FREEZE/ has the same effect as turning the gain knob. Gain
RUN change applies to the current operating mode only, 2-D
WHEEL or M-mode. (Some systems may not have this function
installed.)
MULTI HZ MultiHertz multiple frequency imaging. Press up to
increase the imaging frequency or down to decrease
the imaging frequency.

RES Enhanced RES® Enhanced Resolution Imaging lets you enhance the resolution of a
Resolution Imaging portion of the image and view it in real-time. You can perform all
functions on the enhanced image, including using other operating modes.
1. Press RES to display the RES box. 2. Position the RES box then press RES
to enhance the image.
CONTROL USE
[EXPAND BOX] Increases the size of the RES box, up to three times.
[RES] Activates the RES function.
[()RES POS/SIZE] Controls whether the trackball adjusts the RES box
position (POS) or size (SIZE).
You can customize the system to increase the size
of the RES box with either the center point
anchored or the upper-left corner anchored. For
instructions, see your Administrator Manual.
TRACKBALL Adjusts position or size of RES box.
[EXIT] Removes the RES box and exits the RES function.

Native Tissue Harmonic Imaging
Native Tissue The Native® Tissue Harmonic Imaging (NTHI) option is a 2-D image
Harmonic Imaging optimization technique that produces improved images in the scanning
of technically difficult patients. NTHI may help to reduce clutter noise,
resulting in image clarity with better tissue contrast and information
content. See your Transducer Specifications Manual for a list of transducers
that support the NTHI option.
◆ To use Native Tissue Harmonic Imaging, press MULTI HZ up until
you see the H indicator in the data field. For example:
H3.5MHZ 180mm
When you use NTHI, 2-D image brightness is matched across all
frequencies. Overall image contrast (the balance between dark and light
areas) appears darker. You may need to adjust the following image
optimization controls when using NTHI:
• Overall gain
• Dynamic range
• DGC sliders
• Edge
• Postprocessing
• DELTA amplification
Because 2-D imaging frequency can be independent of Color Doppler
frequency, your 2-D image can remain in Native Tissue Harmonic
Imaging while using Color Doppler and spectral Doppler modes. Color
M-mode cannot function with 2D NTHI frequencies.

Triggered Images You can use triggers to update the 2-D or Color Doppler image at regular
intervals. There are three types of triggers: timed triggers, single and dual
R-wave triggers (ECG-based).
ECG and Auxiliary If you are displaying an ECG or Auxiliary signal, you can update the 2-D
Triggers or Color Doppler image at trigger points along the signal. There are two
trigger points, labeled ∆T1 and ∆T2. If you have single triggers selected
∆T1 is the only active trigger. With dual triggers selected, both ∆T1 and
∆T2 are active. You can place ∆T2 on an ECG and ∆T1 on either an ECG or
an auxiliary signal. For more information about displaying an ECG, see
Chapter 6.
Use the trackball to place an ECG-based trigger point at any point in the
cardiac cycle. You can also set an interval (N) for triggering, based on the
number of beats. N=1 updates the image every beat, N=2 updates the
image every second beat, and so on up to every 9 beats. If you mark two
trigger points, the system displays two images from each heart cycle.
To set ECG triggers, you must first display an ECG trace. If there is no
ECG trace, entering the trigger function activates a timed trigger.
Removing the trace exits the ECG trigger function.
When the ECG trigger function is active, trigger markers (solid and
dashed lines) appear across the ECG to indicate where frames were
acquired relative to the ECG. ∆T1 must be positioned before ∆T2 can be
positioned. The data field reports the current values for the trigger points
and the beat interval (for example, N=1) for triggering.
DISPLAY DESCRIPTION
∆T1= Time (msec) after Nth R-wave at which to

acquire 2-D image for first trigger.
∆T2= Time (msec) after Nth R-wave at which to
acquire 2-D image for second trigger. Appears
only when two triggers are active.
N= Number of R-waves to count before acquiring
triggered images.
When the AUX function is active, two ECGs are displayed converting T1
and T2 into two single R-wave trigger points. T1 is used on the AUX trace
and T2 is placed on the ECG trace, creating one trigger per frame on both
traces. When AUX is the T1 source (T1 is not displayed), T2 can be moved
on the R-wave.
Use the trackball to control trigger points and set these trigger
parameters. See “Using Triggers” on page 62. (When moving the
Trackball to change a trigger delta, one movement equals one 5ms
change.)

Triggered Images
Delayed Trigger Delayed trigger acquisition occurs and a warning message displays,
Acquisition when the conditions listed in the following table take place:
CONDITION ADJUSTMENT
Triggers are too close Move T2 away from T1. T2 can be too close
together - Trigger to the starting point or the end point of T1.
acquisition delayed
Trigger occurs too often The heart beat rate is very high and too
high to trigger on every beat.
Timed trigger is too fast to trigger on each
interval.
Increase the frame rate by:
• Changing the Exam depth.
• Remove if Flow mode is active,
remove the Color Pan Box
While displaying ECG Turn off EGC graphics.

waveform, timed trigger
interval drops below
100ms
Timed Triggers You can set a timed trigger to display an image at regular intervals
without respect to an ECG waveform.
You can set a timed trigger to trigger a frame from 25 ms to 15000 ms, or
for any number of seconds between 25 and 15000ms.
Setting Up Triggers ◆ To set up the trigger function, press CODE + QRS and then use
the following soft keys.
CONTROL USE
[DT1=ECG/AUX] Selects the source for the first trigger (DT1):

either ECG or Auxiliary signal.
[DT2=ECG] For information purposes only. Indicates that

ECG is always the source for the second
trigger.
[R BEEPER=ON/OFF] Turns on or off the R-wave beeper.
[EXIT] Exits the trigger setup function.

Using Triggers ◆ To position triggers, press TRIG and use the following controls:
CONTROL USE
[SINGLE/DUAL] Switch between one or two triggers.

When SINGLE is highlighted, only one trigger
is active (DT1). Moving the trackball positions
this trigger.
When DUAL is highlighted, two triggers are
active. Moving the trackball positions the
second (DT2) trigger.
[R-WAVE/TIMED] Switches between ECG (R-WAVE) trigger or
timed trigger function.
TRACKBALL Positions the trigger along the signal.

Overview
CHAPTER 10
COLOR DOPPLER BASICS
Overview Color Doppler (CD) information appears within the 2-D image,
displaying blood flow velocity (Color Doppler Velocity) or red blood cell
energy (Color Doppler Energy) information in real-time. It uses color
representation to display either the velocity, energy, or a combination of
the two (Convergent Color Doppler) at the sample area.
Color Bar
Color Doppler
Box
You can select different Color Doppler options as listed in the following
table. Refer to the appropriate chapter for more information.
OPTIONS CHAPTER
CDE(ENE) Color Doppler Energy. See Chapter 11.

CDV(VEL) Color Doppler Velocity. See Chapter 11.
CONV Convergent™ Color Doppler. See Chapter 11.
DTI Doppler Tissue Imaging. See Chapter 12.

Chapter 10 - Color Doppler Basics
Entering and Exiting ◆ To enter Color Doppler mode:

Color Doppler 1. Press D COLOR.
2. Use the following controls to select alternate Color Doppler options
and to adjust the position of the Color Doppler box.
CONTROL USE
[ANGLE L/C/R] Press to adjust the incident angle to flow for linear
transducers that provide electronic steering.
You can use the Strip Mode Setup function to link
the Color Box to the spectral Doppler cursor so that
when you steer the cursor the Color Box steers
automatically. The Strip Mode Setup function also
lets you link the ANGLE and INVERT functions so
that when you steer the cursor the strip display
inverts automatically. See Chapter 29.
[(())CD POS/SIZE] Select POS to adjust the position of the Color
Doppler box.
Select SIZE to adjust the size of the Color Doppler
box.
You can select the default size of the Color Box (in
triplex mode) and how the SIZE function works by
changing Color Doppler imaging options in the
Setup menu. See Chapter 29.
[ / ] For non-linear transducers, selects the full-height

or truncated Color Doppler box.
[CD RES] Expands CD box to full size of image (CD RES
function).
[LAST/CURR] Switches between last and current color mode.
OPTIONS Displays a menu of Color Doppler modes.
D COLOR Exits Color Doppler mode.


Using Color Doppler with RES
Using Color Doppler You can use Color Doppler mode with the 2-D RES enhanced resolution
with RES imaging function to expand the 2-D image and CD information.
Expand a 2-D image and add color
Press RES Press D COLOR
Press D COLOR
Press RES
Expand a 2-D image and CD information
Press RES Press D COLOR
Press RES
Press [EXPAND BOX]
OR [POS/SIZE]
Basic Formatting
Controls
CONTROL USE
BASELINE Press up or down to display a larger range of signals

below or above the baseline, respectively. The scale
values change proportionally, but the total range
does not.
GATE Press up or down to increase or decrease the size of
the Doppler gate. Increasing the gate size increases
color sensitivity. Reducing the gate size increases
color resolution.
INVERT Press to toggle between a normal and inverted Color
Doppler bar display.
the ANGLE and INVERT functions so that when you
steer the cursor the strip display inverts
automatically. See Chapter 29.
PRIORITY In combined Doppler mode, you view Color
Doppler information on the 2-D image and spectral
Doppler information in a strip at the same time.
Press until the function you want is active.

Chapter 10 - Color Doppler Basics

Using VEL
CHAPTER 11
VEL, ENE, AND CONV
Color Doppler Velocity (VEL), Color Doppler Energy (ENE), and

Convergent Color Doppler (CONV) use different colors to display
velocity or energy information of blood flow on the 2-D image.
Using VEL The Color Doppler Velocity (VEL) option uses color to represent the
direction and velocity of blood flow.
Color Bar
Removable CD
Data Field
Color Doppler Box
VEL Data Field
Edge Persistence
Preprocessing Postprocessing
Gate Frequency
Filter
Color Option
CD Gain

Chapter 11 - VEL, ENE, and CONV
Using ENE The Color Doppler Energy (ENE) option on select transducers assigns a
color to the energy measurement generated by moving reflectors (blood
flow). Color Doppler Energy displays the energy from the returning
Doppler signal. Color Doppler Energy is more sensitive than Color
Doppler Velocity, relatively angle independent, and free of aliasing. Color
Doppler Energy is especially useful in the detection of small-volume, low
amplitude, low velocities and deep flows.
Color Bar
CD Data Field
Color Doppler Box
ENE Data Field
Edge Persistence
Gate Frequency
Filter
Color Option Dynamic Range

Gain

Using CONV
Using CONV The CONVERGENT™ Color Doppler (CONV) capability combines

energy and velocity information on one display. Like Color Doppler
Energy, CONVERGENT Color Doppler provides increased sensitivity for
perfusion imaging and jet detection where Doppler signals are low in
amplitude. It also provides directional flow information for higher-
energy signals. In general, the CONV option color bar maps energy
signals along the horizontal axis and velocity signals along the vertical
axis. The different CONV option postprocessing maps and the balance
feature give you added control over how the CONV option displays
velocity and energy information.
Color Bar
CD Data Field
Color Box
CONV Data Field
Edge Persistence
Preprocessing CD Postprocessing
Gate CD Frequency
Filter
Balance
CONV option Dynamic Range
CD Gain

Entering and Exiting ◆ To enter Color Doppler options:

Color Doppler 1. Press D COLOR to enter Color Doppler mode.
Options
2. Press OPTIONS to display the CD option menu and select the color
option you want.
3. Use these soft keys to adjust the characteristics of the Color Doppler
box.
CONTROL USE
[CD POS/SIZE] Press to highlight POS and to adjust the position of

the Color Doppler box.
Press to highlight SIZE and to adjust the size of the
Color Doppler box.
[ / ] For non-linear transducers, press to use the full-

height ( ) or the truncated ( ) Color Doppler
box.
function).

5. Press D COLOR or 2-D ONLY to exit Color Doppler mode.

Image Format Controls
Image Format
Controls
CONTROL USE
GATE Press up or down to increase or decrease the size of

the Color Doppler gate. Increasing the gate size
increases color sensitivity. Reducing the gate size
increases color resolution.
INVERT Press to toggle between normal and inverted Color
Doppler bar display.
You can use the Strip Mode Setup function to link the
ANGLE and INVERT functions so that when you steer
the cursor the strip display inverts automatically. See
Chapter 29.
D GAIN CD gain is independent of 2-D and spectral Doppler
gain. Turn D GAIN clockwise to increase the amount
of color displayed, or counterclockwise to decrease
it.
For some transducers in ENE and CONV: CD gain
changes simultaneously with the 2-D DGC, except
during Cine. Move each DGC slider to the right to
increase the amount of color displayed, or left to
decrease it.
MULTI HZ MultiHertz multiple frequency imaging. Press to
increase or decrease the color imaging frequency.

Image Optimization
Controls
CONTROL USE
BALANCE Press up to increase the color balance or down to

(CONV only) decrease it. Balance affects the CONV maps in the
following ways.
Directional energy maps: Adjusting the balance
shifts the point at which the directional energy maps
color changes occur. Use high balance to enhance
low energy signals.
Threshold maps: Use lower balance levels to make
the display look like a VEL option display, and
higher levels to look like an ENE option display.
Contour maps: Contour maps show both energy and
velocity information in a two-dimensional mapping.
The balance function changes the mapping to
emphasize either velocity or energy. Use lower
balance levels to emphasize velocity, and higher
levels to emphasize energy.
See “Postprocessing” on page 73.
FILTER Press up to use a higher filter or down to use a lower
filter. Higher filter settings produce greater degrees
of motion discrimination.
EDGE Smooths color. Press up for sharper color distinction
or down for smoother color distinction.
DYN RANGE Turn to adjust the dynamic range until the level you
(ENE and want appears. Higher levels provide greater
CONV only) sensitivity to the low energy component of the
signal.
PERSIST Controls how rapidly an image appears to change
over time. Use lower levels for rapidly changing
anatomy. Use higher levels to provide a smoother
image for slow moving structures.
You cannot display Edge and Persistence at the same
time.
POST See “Postprocessing” on page 73.
SCALE Press up or down to change the velocity range and
display higher or lower velocity signals.

Postprocessing The postprocessing maps control which colors represent different levels
of CD mean velocity, variance, or energy information. The different color
options provide multiple postprocessing maps that you can modify to
accent some of the velocities, mix color information with the gray scale
information, or tag a range of velocities. The following sections describe
the postprocessing maps for each CD option, and what features you can
use to modify them.
ENE The ENE option provides energy color maps.
MAPS ILLUSTRATION DESCRIPTION
ENERGY Displays colors that correspond to

COLOR the different levels of energy found
in an image. Lower energy levels
appear to the left of the color bar, and
higher energy levels appear to the
right.
Energy
VEL The VEL option provides the following types of postprocessing maps.
VELOCITY The velocity function assigns color

COLOR MAP shades to the direction and velocity
of blood flow. The upper portion of
the color bar represents flow toward
Velocity
the transducer and the lower portion
represents flow away from the
transducer. The saturation or hue of
the color indicates the velocity of the
blood flow. Darker shades indicate
low velocities, and lighter shades
indicate high velocities.
VELOCITY- The velocity-variance function
VARIANCE assigns colors to mean velocity and
COLOR MAP variance of blood flow at a specific
Velocity velocity level. Many sample volumes
can have the same mean, yet be
distinctly different. The amount of
variance represents the range, or
spread, of different velocities
Variance contributing to the mean velocity
within a given sample volume. For
example, blood moving at a constant
velocity has very little variance.

CONV The CONV option provides the following types of postprocessing maps.
MAP ILLUSTRATION DESCRIPTION
DIRECTIONAL Displays data regarding

ENERGY (DE) signal energy and the
Flow toward direction of flow, using two
transducer energy bars. Especially
suited for large vessels with
Flow away
high energy flows, such as
from
carotids and hepatic
transducer
vessels.
Energy
THRESHOLD Displays energy

(T) Velocity information below a preset
towards threshold level and velocity
transducer information above that
level.
Velocity
away from
transducer
Energy
CONTOUR (C) Contour maps provide a

true mix of energy and
velocity. They are well
Velocity suited for larger cardiac
vessels and high velocity
Velocity imaging. They are also
appropriate for low energy
flow where a clean signal is
Energy easily obtained, such as
thyroid and testicular
flows.

Selecting a Postprocessing Map
Selecting a ◆ To select and modify a postprocessing map in any of the CD

Postprocessing Map options:
1. Press POST.
2. Press [MAP] to select the map you want.
3. If [MODIFY] appears, press it to display the modification soft keys.
4. To leave the map function, press POST.
FEATURE CD OPTION MODIFY
ACCENT VEL Turns on or off the Accent feature. Accent highlights

differences between high velocity/disturbed flow and low
velocity/background flow by changing the relative brightness
of the colors. You can use Accent with Mix in velocity or
velocity-variance maps.
MIX VEL, ENE, AND Selects the Mix level. The Mix feature combines 2-D gray scale
CONV and CD information to create a more translucent appearance.
BACKGROUND CONV, ENE Turns on or off the Background feature. When Background is
on, the 2-D image within the color box is tinted with color.
Background is not available on cardiac transducers.
VELOCITY TAG VEL Lets you emphasize, or tag, a range of velocities within the CD
display. Tagged velocities appear in a contrasting color in the
color bar and on the CD display. There are four options:
OFF No velocity tag
+ Velocities above a selected value are tagged
- Velocities below a selected value are tagged
± A selectable range of velocities are tagged
Use the trackball select key to adjust the size of the velocity tag
range.


Overview
CHAPTER 12
DOPPLER TISSUE IMAGING
Overview DTI™ Doppler Tissue Imaging is an additional option available in Color

Doppler mode on select transducers. Doppler Tissue Imaging
color-encodes the Doppler shift information from the moving tissue of
the myocardium (or any moving tissue). It presents tissue movement in
the way Color Doppler Velocity (VEL) presents blood flow.
Doppler Tissue Imaging enables tissue motion to be illustrated in three
ways.
• Doppler Tissue Velocity (DTV)—Color presentation of mean
velocities of tissue in the sample area.
• Doppler Tissue Energy (DTE)—Color presentation of Doppler signal
energies returning from the tissue.
• Doppler Tissue Acceleration (DTA)—Color presentation of the rate of
change of velocities in the sample area.
Color Bar
CD Data Field
Color Doppler Box
Data Field
Edge Persistence
Gate Frequency
Filter
DT I Option
Gain

Chapter 12 - Doppler Tissue Imaging
Entering and Exiting ◆ To enter Doppler Tissue Imaging:

Doppler Tissue 1. Press D COLOR to enter Color Doppler mode. The system enters the
Imaging Color Doppler mode last used.
2. Press OPTIONS to display the CD option menu and select DT
VELOCITY, DT ENERGY, or DT ACCEL.
3. Use these soft keys to adjust the characteristics of the Color Doppler
box.
CONTROL USE
[CD POS/SIZE] Press to highlight POS and to adjust the position of

the Color Doppler box.
Press to highlight SIZE and to adjust the size of the
Color Doppler box.
[ / ] For non-linear transducers, selects the full-height

( ) or the truncated ( ) Color Doppler box.
function).

5. Press D COLOR or 2-D ONLY to exit Color Doppler mode.

Image Optimization Controls
Image Optimization Doppler Tissue Imaging uses most of the Color Doppler controls
Controls described in Chapter 10 and Chapter 11. The following table describes
specific Doppler Tissue Imaging functions.
CONTROL USE
DGC controls Start with all of the controls centered and then use
to adjust the color gain.
FILTER The four Doppler Tissue Imaging filter settings
have the effect of rejecting more signals as you
increase the filter setting. There are four filter
settings.
Filter 1—Allows the display of all velocities,
including stationary echoes.
Filter 2—Rejects the lowest velocity signals.
Filter 3—Rejects more low velocity signals than
Filter 2.
Filter 4—Similar to Filter 3 with additional filtering
for very high amplitude signals.
Press FILTER up to use a higher filter setting or
down to use a lower filter setting.
DYN RANGE Turn to adjust the dynamic range until the level
(DTE ONLY) you want appears. Adjusting the dynamic range
changes the way the energy colors are displayed.
POST See “Postprocessing,” next.

Postprocessing Doppler Tissue Imaging postprocessing allows you to change the

appearance of the color information by assigning a different
postprocessing map. The following section describes the Doppler Tissue
Imaging postprocessing maps and what features you can use to modify
them.
DIRECTIONAL Displays data regarding

COLOR direction of flow or rate of
(DTV AND DTA) Flow toward change using two velocity
transducer bars.
Flow away
from
transducer
NONDIRECTIONAL Assigns color shades to the

COLOR velocity of moving tissue
(DTV AND DTA) without regard to direction.
Outer portions of the color
bar represent the highest
velocities and inner
portions represent the
lowest velocities.
ENERGY COLOR Displays colors that

correspond to the different
levels of energy found in an
image. Lower energy levels
appear on the left of the
color bar, and higher
energy levels appear on the
right.
Energy

Selecting a Postprocessing Map
Selecting a ◆ To select and modify a postprocessing map in any of the

Postprocessing Map Doppler Tissue Imaging options:
1. Press [POST].
2. Press [MAP] to select the map you want.
3. Use the soft keys shown in the following table to modify the
postprocessing map. You may need to press [MODIFY] to see some of
these controls.
4. To leave the map function, press [POST].
FEATURE MODIFY
ACCENT Turns on or off the Accent feature. Accent

(DTV AND DTA) highlights differences between high velocity/
disturbed flow and low velocity/background flow
by changing the relative brightness of the colors.
MIX Selects the Mix level. The Mix feature combines 2-D
gray scale and CD information to create a more
translucent appearance.
BACKGROUND Turns on or off the Background feature. When
(DTE ONLY) Background is on, the 2-D image within the color
box is tinted with color.
VELOCITY TAG Lets you emphasize, or tag a range of velocities
(DTA and DTV within the CD display. Tagged velocities appear in
only) a contrasting color in the color bar and on the CD
display. There are four options:
OFF No velocity tag
+ Velocities above a selected value are tagged
- Velocities below a selected value are tagged
± A selectable range of velocities are tagged
Use the trackball select key to adjust the size of the
velocity tag range.
Using Doppler You can also combine Doppler Tissue Imaging and M-mode information.
Tissue Imaging Strip Doppler Tissue Imaging strip mode uses color to show tissue motion at a
Mode specific point in the Doppler Tissue Imaging image.
◆ To use Doppler Tissue Image strip mode:
1. Press D COLOR to display CD information on the 2-D image.
2. Press OPTIONS to select DTV or DTE mode from the options menu.
3. Press M MODE to display a color strip and frozen 2-D image.
4. Press UPDATE or click a trackball select key to freeze the Doppler
Tissue Imaging strip and activate the 2-D image.
Doppler Tissue Doppler Tissue Pulsed Wave (DTPW) is a spectral Doppler mode that is
Pulsed Wave optimized for use with Doppler Tissue Imaging. For more information,
see Chapter 13.


Overview
CHAPTER 13
SPECTRAL DOPPLER MODE
Overview Spectral Doppler Mode graphs both direction and velocity of blood flow
within chambers and vessels on a spectral display. There are several
spectral Doppler modes.
MODE USE
PULSED WAVE Displays velocities within the range axially

DOPPLER bounded by the Doppler gate on the cursor placed
within the 2-D image.
CONTINUOUS Displays velocities all along the Doppler cursor
WAVE DOPPLER placed within the 2-D image.
DTPW DOPPLER DTPW Doppler is a Pulsed Wave Doppler mode
with all settings optimized for use with Doppler
Tissue Imaging mode.
HPRF Allows increased velocity detection at depth and
localization of flow. Use when you want a higher
Doppler velocity scale than Pulsed Wave Doppler
can provide.
Press SCALE up to enter HPRF mode.
AUXILIARY Uses a special small-size non-imaging auxiliary
CONTINUOUS transducer that allows improved access to areas
WAVE DOPPLER requiring documentation of blood flow.
Spectral
Data Field

Chapter 13 - Spectral Doppler Mode
Data Field
PW Doppler Data Field

Edge
Preprocessing Persistence
Dynamic Range Postprocessing
Gate Size Filter
Gate Depth
CW and AUX CW Doppler Data Field

Edge
Filter Persistence
Depth of CW Doppler Gate
(CW Doppler only)
Entering and Exiting ◆ To enter and exit Spectral Doppler:

Spectral Doppler 1. Use the trackball to position the Doppler cursor on the area of interest
in the 2-D image.
If the cursor is not displayed, press CURSOR to display it. If the
cursor is displayed, but not active (the trackball doesn’t move it),
press PRIORITY to activate the cursor.
A PW Doppler cursor appears as a line with a Doppler gate (two
bars) across it. A CW Doppler cursor appears as a line with a single
bar across it. An M-mode cursor appears as a line with a dot that
shows where the gate or focus bar would be in one of the Doppler
modes.
To change the cursor type, press [PW/CW/MM] to select the type you
want. (This soft key only displays modes that are available on the
current transducer. If the transducer does not support CW Doppler,
for example, it appears as [PW/MM].
2. Press the key for the Doppler mode you want.
PW—Enters Pulsed Wave Doppler mode. The system enters DTPW
mode if you are displaying a DTI™ Doppler Tissue Imaging image or
an Exam Preset that specifies Doppler Tissue Imaging as the default
color mode.
CW—Enters Continuous Wave Doppler mode.
AUX—Enters Auxiliary Continuous Wave Doppler mode. (AUX CW
does not use cursor position.)
4. Press the Doppler mode key or 2D ONLY to exit.

Image Format Controls
When you exit, the Doppler cursor remains on the image. Move it to
the right side of the image, so that it is available to quickly position
when you enter spectral Doppler mode again. You can customize
your system so that the cursor does not remain when you exit
spectral Doppler mode. For instructions, see Chapter 29.
Image Format
Controls
CONTROL USE
CURSOR Activates the cursor line (or removes an active

cursor). Use the trackball to position the cursor.
the ANGLE, INVERT, and BASELINE functions so
that when you steer the cursor the strip display
inverts automatically and the baseline
automatically shifts. See Chapter 29.
MIC Selects audio channels: LEFT, RIGHT, or L/R (both).
BASELINE Press up to display a larger range of signals below
the baseline, or down to display a larger range of
signals above it.
SWEEP Press up to increase the sweep speed of the strip
or down to decrease it.
INVERT Press to toggle between normal and inverted
spectral display.
SIZE Switches between a full-screen Doppler display
and combined 2-D and Doppler display.
For a combined 2-D and Doppler display, use the
Setup function to select which portion of the
screen is allocated to each mode. See Chapter 29.
UPDATE Press to switch between simultaneous and
interval update imaging.
Use the Setup function to change the update
interval of 2-D update imaging. See Chapter 29.
VOLUME You can control the volume of the speakers or
headphones.
To use the headphones, insert the headphone jack
into the right side of the system.
Turn the VOLUME knob (located on the monitor
below the soft keys) clockwise to increase the
audio volume, or counterclockwise to decrease it.

Chapter 13 - Spectral Doppler Mode
Strip Optimization
Controls
CONTROL USE
ANGLE Press to display the angle indicator, and then turn

to adjust incident angle to flow.
B COLOR Selects a mapping between different colors or hues
of a color and echo amplitude. Use soft keys to
select a color map.
D GAIN Turn clockwise to increase the amount of gain or
counterclockwise to decrease it.
FILTER Press up to use a higher filter or down to use a
lower filter. Higher filter settings eliminate lower
Doppler frequency shifts.
GATE Press up to increase the size of the Doppler sample
gate or down to decrease the size of the gate.
you want appears. Adjusting the dynamic range
determines the way levels of sound intensity are
displayed.
SCALE Adjust to change the velocity range and display
higher or lower velocity signals. When you
increase the scale higher than that which Pulsed
Wave supports, the system enters HPRF (on
transducers that support it).

Overview
CHAPTER 14
M-MODE
Overview You use M-mode to display a graphic representation of a line of interest

within the 2-D display. M-mode displays a graph that shows how the line
you selected changes over time.
M-mode Data Field
2-D Display
M-mode Strip
Data Field
Edge

Chapter 14 - M-Mode
Entering and Exiting ◆ To enter and exit M-mode:

M-mode 1. Use the trackball to position the cursor on the area of interest in the
2-D image.
modes.
2. Press M MODE.
4. Press M MODE or 2-D ONLY to exit M-mode.
When you exit, the M-mode cursor remains. Move it to the right side
of the image, so that it is available to quickly position when you enter
M-mode again. You can customize your system so that the cursor
does not remain when you exit M-mode. For instructions, see
Chapter 29.
Image Format Use the following keys with M-mode.

Controls
CONTROL USE
CURSOR Activates the cursor line. Use the trackball to

position the cursor.
CODE + SELECT For a combined 2-D and Doppler display, selects
SIZE which portion of the screen is allocated to each
mode.
SIZE Switches between a full-screen Doppler display
and combined 2-D and Doppler display.
Setup function to select which portion of the screen
is allocated to each mode. See Chapter 29.
SWEEP Press up to increase the sweep speed of the strip or
down to decrease it.
TRACKBALL Roll down to reduce the cursor to half its original
length and expand the M-mode data to twice its
original size (2:1 expansion). Roll up to return to
standard M-mode.

Strip Optimization Controls
Strip Optimization
Controls
CONTROL USE
M GAIN Turn clockwise to increase the amount of M-mode

gain or counterclockwise to decrease it.
you want appears. Adjusting the dynamic range
determines the way levels of sound intensity are
displayed.
EDGE Press up to use a higher level or down to use a
lower level. Higher levels produce sharper
borders. Lower levels produce smoother borders.
GAIN/ Turning the GAIN/FRZ/RUN wheel while on a live
FREEZE/ image has the same effect as turning the gain knob.
RUN Gain change applies to the current operating mode
WHEEL only, 2-D or M-mode. (Some systems may not have
this function installed.)
B COLOR Selects a mapping between different colors or hues
of a color and echo amplitude. Use soft keys to
select a color map.

Chapter 14 - M-Mode

CHAPTER 15
COLOR M-MODE
You use Color M-mode to display a graphic representation of an area of

interest within the Color Doppler display. Color M-mode displays timing
information from the CD display, and supports the display characteristics
and features of standard M-mode.
NOTE: Color M-mode is not available within the NTHI option. (See
“Native Tissue Harmonic Imaging” on page 59.) You must exit the NTHI
option before you can enter Color M-mode.

Chapter 15 - Color M-Mode
Entering and Exiting You can enter Color M-mode from Color Doppler or from M-mode.
Color M-mode
From Color Doppler ◆ To enter Color M-mode from Color Doppler:
1. Enter Color Doppler mode and optimize the Color Doppler display.
For instructions, see Chapter 11.
2. Use the trackball to position the cursor on the area of interest in the
2-D image.
modes.
3. Press M-MODE to enter Color M-mode.
From M-mode ◆ To enter Color M-mode from M-mode:
1. Optimize the M-mode display. For instructions see Chapter 14.
2. Press D COLOR to enter Color Doppler mode and switch to Color
M-mode.
Switching the Active ◆ To switch the active Mode from CD to Color M-mode, press
Mode UPDATE or click the trackball select key.
When the CD image is active, all CD features and controls are
available. When the Color M-mode strip is active, all M-mode
controls and some CD controls are available.
Exiting Color M-mode ◆ To exit Color M-mode, press CD, M-MODE or 2-D ONLY.
Strip Format
Controls
CONTROL USE
CURSOR Activates or deactivates the cursor line. Use the

trackball to reposition the cursor.
SIZE Press to change the image size. Toggle between a
full-screen M-mode strip or a combined screen
containing both a 2-D image and an M-mode strip.
Setup function to select which portion of the screen
is allocated to each mode. See Chapter 29.
SWEEP Press down to decrease the speed at which
information is displayed. Press up to increase the
speed.

Strip Optimization Controls
Strip Optimization
Controls
CONTROL USE
D-GAIN Turn clockwise to increase the amount of Color

M-mode gain or counterclockwise to decrease it.
Color M-mode gain is independent of 2-D gain and
M-mode gain
DYN RANGE Turn to adjust the dynamic range. In Color
Doppler Energy modes (CDE and DTE), you can
adjust the Color M-mode dynamic range. Changes
that you make to Color M-mode dynamic range
affect only the Color M-mode strip.
EDGE Press up to use a higher level or down to use a
lower level. Higher levels produce sharper
borders. Lower levels produce smoother borders.
Your changes apply to the Color M-mode strip and
the next CD frame.
FILTER Press up or down to change the filter setting.
Changing the Color Doppler filter setting changes
both the CD and Color M-mode filter.
GATE Press up to increase the gate size and the system’s
sensitivity to Color Doppler information. Press
down to decrease the gate size. Changing the gate
sizes changes both the Color Doppler and Color
M-mode displays.
POST See Chapter 11 for more information on
postprocessing.

Chapter 15 - Color M-Mode

Perspective™ Advanced Display Option Overview
CHAPTER 16
PERSPECTIVE™ ADVANCED DISPLAY

OPTION
This section covers the following topics:

• Perspective™ Advanced Display Option Overview
• Freestyle™ Extended Imaging
• FreeStyle™ Compounding
• 3-D Surface Rendering
• 3-D MultiPlanar Reconstruction
Perspective™ You can use the Perspective display option to enhance the imaging
Advanced Display capabilities of your Acuson system beyond traditional, 2-D ultrasound
Option Overview applications. The Perspective display option provides the following
features for advanced imaging:
• FreeStyle extended imaging pieces together a series of 2-D frames to
create a single, extended 2-D image.
• FreeStyle compounding is an extension of FreeStyle extended-field-
of-view (EFOV) in that it uses the same FreeStyle clip, but
compounds more of the image during EFOV reconstruction. This
results in improved contrast and resolution.
• 3-D Surface Rendering constructs a three-dimensional (3-D) surface
rendering of a fetus or other anatomy surrounded by or filled with
fluid.
• 3-D MultiPlanar Reconstruction simultaneously constructs a cube of
echo information, a cross-section of which can be viewed in any of
three orthogonal planes.
The Perspective display option is available during real-time 2-D imaging.
For each feature, the Perspective display option adds specific functions to
captured clips and processes them to create enhanced images.
The Perspective display option adds a proprietary, dedicated computer in
the peripheral bay of your Acuson system. The Acuson system uses the
computer to process the ultrasound information and render images in
different formats.
IMPORTANT: The dedicated computer must be powered from one of the isolated
accessory outlets on the Acuson system.

Chapter 16 - Perspective™ Advanced Display Option
FreeStyle Extended The FreeStyle extended imaging feature extends your field of view by
Imaging piecing together multiple 2-D frames into a single, extended 2-D image.
Use this feature, for example, to view a complete thyroid or liver.
FreeStyle extending imaging works best for imaging areas that are mainly
static. Avoid including objects that cast shadows, and avoid scanning
regions with significant pulsatility effects, such as major arteries near the
heart.
IMPORTANT: The Freestyle™ Extended Imaging Option is approved by the United

States Federal Drug Administration (FDA) for use with general imaging
transducers (linear and curved array transducers work best). It is not
approved for use with transcranial or cardiology transducers. For
complete transducer specifications, including applications, see your
Transducer Manual.
Capturing an EFOV ◆ To create a FreeStyle extended image:

Image
1. Apply a generous amount of coupling gel across the area you want to
image.
2. Press PERSPECTIVE.
3. Select [FREESTYLE].
4. Position the transducer at one end of the area you want to image. The
face of the transducer should be parallel to the region you want to
view as illustrated in the following diagram.
5. Set image format and optimization controls before beginning the

capture. Do not change these controls during a capture.
Set the image depth so that it includes the area you are interested in
and does not extend far beyond it. (This is especially important when
scanning around a curved object.) Shallow depths and high
frequencies produce the best images.
Optimize gain throughout the image.
6. Instruct the patient to remain still. If it is safe to do so, instruct the
patient to hold his or her breath.
7. Start scanning, then press CLIP STORE to begin the clip capture. (The
system uses the first frames to determine the direction of motion.)

FreeStyle Extended Imaging
8. Move the transducer across the region you want to view as shown in
the diagram.
Make sure that you move the transducer in one smooth, continuous
motion. To help maintain the position of the transducer
perpendicular to the skin, keep your little finger in contact with the
skin adjacent to the transducer.
As you move the transducer, watch the image ahead of the center
region of the image frame. If this area seems to be moving out of the
plane of interest, adjust the transducer position carefully.
9. When you reach the opposite end of the region you want to view,
press CLIP STORE to exit the capture function.
10. While the system constructs the EFOV image, you will see a status
message.
If you want to view the extended field-of-view image later, select
[POSTPONE]. If you want to discard the captured clip, select
[DELETE]. Otherwise, wait until the extended field-of-view image
appears.
Reviewing the EFOV When you perform an EFOV clip capture, the system automatically
Image constructs and displays the EFOV image. When you use the on-board
AEGIS system to review images, FreeStyle acquisitions appear with an
icon on them. Click the icon to initiate the reconstruction. Use the
following controls to review a FreeStyle image.
CONTROL USE
[COMP:0/1/2/3] Appears only when Compounding is enabled. When

FreeStyle is invoked from Perspective acquisition,
[COMP:0/1/2/3] replaces [DELETE]. The 0/1/2/3
corresponds to the level of image compounding, “0”
meaning no compounding.
[DELETE] Appears only if you’ve entered the review function
immediately after capturing a FreeStyle extended
imaging clip. Deletes the clip and returns to the live
imaging.
You should delete any images that do not cover the
region of interest or that appear discontinuous in any
way (tissue appears to suddenly move or disappear). Re-
scan to acquire the image again.
[EXIT] Exits review.
[RESTORE] Restores the image to its original position and
orientation.

CONTROL USE
[ROTATE/ Selects one of the three functions for manipulating the

ZOOM/PAN] image.
When ROTATE is selected, move the trackball up or to the
right to rotate the image clockwise. Move the trackball
down or to the left to rotate counterclockwise.
When ZOOM is selected, move the trackball up or to the
right to increase the magnification (scale) of the image
size. Move the trackball down or to the left to decrease
the image magnification.
When PAN is selected, move the trackball to move the
image in the same direction.
Assessing Image Quality Because there are many variables that affect the acquisition of an image, it
is important that you assess the quality of the resulting image before you
use it for diagnostic purposes or take measurements from it. If an image
does not meet the following criteria, you should delete it and acquire it
again:
• The image is continuous (no areas where tissue appears to suddenly
move or disappear).
• There are no shadows within the image.
• The anatomy is well defined (no evidence of distortions).
• The skin line is continuous.
• The image acquisition is from a single, flat plane.
• There are no large black regions within the image.
• The image contains the appropriate 2-D slice of the organ of interest.
Using the incorrect slice to take measurements can result in
misleading measurements. See “Taking Measurements During
Review”, next.

The following illustrations show examples of images unsuitable for

diagnostic use:
Line in image (usually

vertical) indicates a
discontinuous image
Large black region
Uneven skin line
Taking Measurements The FreeStyle extended imaging feature allows you to take
During Review measurements with one pair of calipers. You should take measurements
only from high-quality images as defined in “Assessing Image Quality”
on page 98.
IMPORTANT: When it is possible to take the same measurement from a standard 2-D
image, it is recommended that you do so. The accuracy of 2-D
measurements is generally superior.

For information about the accuracy of FreeStyle extended imaging

measurements, see “Linear Distance Measurement Range and Accuracy
of FreeStyle Extended Images” on page 101.
When taking measurements from curved acquisitions, be sure not to
measure across a black region.
OK
Not OK

◆ To take measurements, use the following controls.
CALIPERS ON/ Press to position a caliper within the image.

OFF
ADD CALIPER Press to position a second caliper within the image and
display the distance (to the nearest millimeter) between
the two calipers.
The FreeStyle extended imaging feature supports only
one pair of calipers. For information about the accuracy
of measurements, see “Linear Distance Measurement
Range and Accuracy of FreeStyle Extended Images”,
next.
Linear Distance The following table provides accuracy information for FreeStyle extended
Measurement Range and imaging measurements. This table assumes tissue velocity of 1540 m/s
Accuracy of FreeStyle and that the acquisition is made using a single flat scan plane.
Extended Images
TRANSDUCER RANGE TOLERANCE OR VALUE

FORMAT
LINEAR 0-70 cm 4% or 1.5 mm; whichever is greater

CURVED LINEAR 0-70 cm 9.5% or 1.5 mm; whichever is greater
VECTOR WIDE 0-70cm 7% or 1.5 mm; whichever is greater
VIEW ARRAY

3-D Surface The 3-D Surface Rendering feature constructs a 3-D rendering from a clip
Rendering that contains a series of 2-D “slices.” You can use the option to create a
3-D view of any anatomy surrounded by or filled with fluid (for example,
a fetal face).
Follow these general steps to create a 3-D rendering:
• Capture a 2-D clip of the anatomy that you want to reconstruct as a
3-D clip. See “Capturing the 3-D Image” on page 102.
• Enter the AEGIS system review function and assess the quality of the
image within the clip before you continue the reconstruction process.
See “Selecting an Image for Reconstruction” on page 103.
• Within the clip, mark a region of interest (ROI). The ROI separates the
anatomy you want to reconstruct from surrounding tissues. See
“Setting the ROI” on page 104.
• Review the 3-D rendering created from the 3-D clip. You have several
options for optimizing the 3-D rendering. See “Reviewing the 3-D
Rendering” on page 105.
• Finally, you can animate the 3-D rendering to view it from different
angles and in motion. See “Animating the 3-D View” on page 110.
Capturing the 3-D Image ◆ To capture the image:

1. Press PERSPECTIVE.
2. Select [3D SURFACE].
3. Position the transducer at one end of the area you want to image. The
face of the transducer should be perpendicular to the region you
want to view as illustrated in the following diagram.
IMPORTANT: Move the transducer at a constant rate from left to right during the
capture. Change in sweep rate may result in distortion of
structures within the 3-D rendering. Position the transducer notch
on the left relative to direction of the scan. The illustration has the
notch facing the hand or on the lefthand side in relation to the
transducer motion.
4. Press CLIP STORE to begin the 3-D clip capture.

5. When you reach the opposite end of the region you want to view,
press CLIP STORE to exit the capture function.

3-D Surface Rendering
Selecting an Image for ◆ To select a 3-D image for reconstruction:

Reconstruction
1. Press REVIEW to enter the on-board AEGIS system review function.
2. Press PAGE up or down to page through captured images and clips
until you see the 3-D clip, marked with a icon.
3. Assess the quality of the clip before you continue. See “Assessing
Image Quality”, next.
is a good idea to assess the quality of the acquired clip before you use it to
create a 3-D rendering. If the image quality does not meet the following
criteria, you should delete it and acquire it again:
• The patient (including a fetus) was still during the acquisition.
• The transducer was held perpendicular to the skin line throughout
the acquisition.
• Movement of the transducer was at a constant speed with no twisting
or rotation throughout the acquisition.

Setting the ROI You specify the region of interest for the 3-D view by drawing an outline
using the Trace tool. The ROI separates the anatomy you want to review
in three dimensions from surrounding tissues. You must draw the ROI in
the plane parallel to the scan plane.
◆ To draw the ROI while in AEGIS system review:
1. Press FREEZE/CINE to freeze the clip.
2. Press TRACE to display the Acuson system’s trace tool.
NOTE: As an option, click the 3-D icon to enter the 3-D reconstruction
package and draw the ROI using the ROI editing tools. For instructions,
see “Changing the ROI” on page 109. When you use the Acuson system’s
trace tool, the system begins processing the 3-D information in the
background while you work, so the overall reconstruction process can be
faster. Another option is to press [SHOW 3D SURFACE] or double click a
trackball select key to enter 3-D view.
3. Use the trace tool to draw or mark the outline of the ROI.
For more information about using the trace tool, see your User
Manual.
4. Press [END TRACE] to complete the trace.
5. Press [SHOW 3D SURFACE] to create the 3-D reconstruction.

Reviewing the 3-D The system initially creates the 3-D rendering using default settings. As
Rendering you review the 3-D rendering, you can:
• Change the orientation
• Erase parts of the image
• Optimize reconstruction settings
• Redraw the ROI
Press [EXIT] at any time to exit the 3-D review function and return to
standard AEGIS system review.
Changing the Orientation ◆ To review the image from different orientations, use the
following controls.
CONTROL USE
(())
[ ADJUST ON/OFF] Turns on or off adjustment controls (third and
fourth soft keys).
[()FLIP/ROTATE] When FLIP is selected, move the trackball up or
down to flip the image across the horizontal axis.
Move the trackball to the left or right to flip the
image across the vertical axis.
When ROTATE is selected, move the trackball in
the direction that you want to rotate the image.
When [PAN/ZOOM] is selected, both of these
options are deselected.
[PAN/ZOOM] When PAN is selected, move the trackball to
move the image around the screen. The image
moves in the same direction as the trackball.
When ZOOM is selected, move the trackball up or
to the right to increase (scale) the image size.
Move the trackball down or to the left to decrease
the image size.

Erasing Parts of the Image As you review the 3-D rendering, you may notice areas that you may not
want included. You can use the Eraser or the Scalpel tool to remove parts
of the image.
• The Eraser removes the information as you move the eraser over the
image in the same way that an eraser works on paper. You can set the
depth for the Eraser to erase in three dimensions.
• The Scalpel lets you draw the outline of an area you want to remove,
and then remove it. You draw the outline in the same way you draw
the ROI, but the results are the opposite; the region you outlined is
discarded.
To produce a very “clean” 3-D rendering, with all of the irrelevant areas
removed, may take several iterations. For example, you may want to
view the 3-D rendering from one angle, use the Scalpel to erase an area,
rotate the 3-D rendering to view it from a different angle, and then use the
Eraser to erase more. To make it easy to flip or rotate the image while you
are working with the Scalpel or Eraser, the pointer automatically switches
between these functions. When you have the Scalpel or Eraser selected
and the pointer is within the 3-D reconstruction, it performs the Scalpel or
Erase function. If you move the pointer outside the 3-D representation, it
switches to the flip/rotate function.
◆ To select the depth of the Eraser:
1. Click the Eraser button to activate the 3-D Eraser tool.
2. Move the pointer over the Eraser button again. Press and hold a
select key to display the Eraser depth pop-up menu.
3. Move the trackball to highlight the depth you want and then release
the select key to engage that depth.
◆ To erase using the Eraser:
1. Click the Eraser button to activate the 3-D Eraser tool. When you
move it over the 3-D rendering, the pointer changes to an eraser.
2. Press and hold a select key and then use the trackball to move the
eraser over the part of the 3-D rendering that you want to erase.
To undo or redo the last erasure, the eraser or scalpel tool must be
active, and then click the Undo or Redo button. Once exiting
eraser, the user is no longer able to undo erasures or scalpels.

◆ To erase using the Scalpel:

1. Click the Scalpel button to activate the Scalpel tool. When you
move it over the 3-D rendering, the pointer changes to a crosshair
(“+”).
2. Use the trackball and the select keys to draw an outline of the region
you want to remove.
TO: DO THIS:
Mark the bounding points of the Use the trackball to move the
outline pointer to each desired bounding
point, then click either select key.
Complete the outline Press [END SCALPEL] or double-

click either select key. (The system
automatically draws a line
segment to close the outline.)
Move an existing bounding point Position the pointer over the

bounding point, press and hold a
trackball select key, then use the
trackball to drag the bounding
point to a new location.
Insert a bounding point within a Position the pointer over the

completed outline outline where you want the new
bounding point, then click a
trackball select key.
Erase the last line segment Press [BACK UP].
Delete a bounding point Position the pointer over the

bounding point you want to
delete, double click a trackball
select key.
Move the outline Position the pointer into the center

of the region defined by the
outline, simultaneously press a
trackball select key, and use the
trackball to drag the outline to a
new location.
3. To remove the area you’ve outlined, press [DELETE] or double-click

either select key.
To undo or redo the last erasure, the eraser or scalpel tool must be
active, and then click the Undo or Redo button. Once exiting
eraser, the user is no longer able to undo erasures or scalpels.

Optimizing the 3-D ◆ To optimize the 3-D reconstruction, use the following controls.
Reconstruction
CONTROL USE
THRESHOLD Use this slider to eliminate noise and low-level

echoes from the 3-D reconstruction.
Ultrasound information (represented as
shades of gray) below the threshold level is not
included in the 3-D image. Shades of gray
below this level appear black (or cut out).
Drag to the left for a lower threshold level or to
the right for a higher threshold level.
TRANSPARENCY Use this slider to set the degree of transparency
in the 3-D reconstruction. Higher transparency
settings give the 3-D construction more of an
X-ray appearance.
Drag to the left for a more opaque image or to
the right for a more transparent image.
TEXTURE/ Use this slider to control the ratio between
GRADIENT texture and gradient rendering. Texture
settings produce a smoother image with
increased texture emphasis. Gradient settings
accentuate the sense of depth or topography.
Drag toward texture (left) for a smoother
image. Drag toward gradient (right) for a more
detailed image.
BRIGHTNESS Use this slider to control the overall brightness
of the 3-D reconstruction. It is especially
important to adjust this setting when using a
Texture setting on the Texture/Gradient
slider.
SLICE THICKNESS Use this slider to control the spacing of the
acquired ultrasound images in space and
contract or expand the 3-D rendering.
Drag this slider to contract (left) or expand
(right) the 3-D construction along the axis of
transducer movement.
B-COLOR Tints the 3-D reconstruction with color, which
may enhance contours and the perception of
depth. Some color maps enhance soft tissue
components well and others enhance
extremities and bones. Choose a color map
from the pop-up menu.

Changing the ROI If you decide that your 3-D reconstruction would be better with a
different ROI, you can use the 3-D reconstruction package to draw a new
ROI.
◆ To redraw the ROI: (Refer to “To draw the ROI while in AEGIS
system review:” on page 104)
1. Click the Set ROI button.
2. Use the trackball and the select keys to draw an outline of the region.
TO: DO THIS:
Mark the bounding points of the Use the trackball to move the
outline pointer to each bounding point,
then click either select key.
Complete the outline Press [END ROI] or double-click

either select key. (The system
automatically draws a line
segment to close the outline.)
Move an existing bounding point Position the pointer over the

bounding point, press and hold a
trackball to drag the bounding
point to a new location.
Insert a bounding point within a Position the pointer over the

completed outline outline where you want the new
bounding point. Then click a
trackball select key.
Erase the last line segment Press [BACK UP].
Delete a bounding point Position the pointer over the

bounding point you want to
delete, double click a trackball
select key.

TO: DO THIS:
Move the ROI outline Position the pointer into the center
of the ROI, press and hold a
trackball to drag the outline to a
new location.
3. Play or scroll through the clip to ensure that the ROI you drew
encloses the area that you want to see in three dimensions throughout
the clip. If necessary, adjust the ROI.
It is important to set margins to eliminate extraneous information. Set
margins to restrict the clip to only those frames you want to include
in the 3-D reconstruction.
Use the scroll bar and bookends at the bottom of the display and the
following controls.
CONTROL USE
CINE WHEEL Turn to scroll through the clip, frame-by-frame.
Shows the location of the current frame within the

clip. Click inside the scroll bar to move to a specific
Scroll box frame.
Sets the left margin of the rendering. Move the

pointer over the Left bookend. Press and hold a
Left bookend trackball select button, then use the trackball to drag
the bookend to the frame you want to use as the left
margin.
Sets the right margin of the rendering. Move the

pointer over the Right bookend. Press and hold a
Right bookend trackball select button, then use the trackball to drag
the bookend to the frame you want to use as the right
margin.
4. When the ROI is complete, click SET ROI (or double-click a select
key).
Animating the 3-D View Animating the image may make it easier to perceive subtle changes in the
3-D construction.
◆ To animate the 3-D image:
1. Press the ANIMATE button.
2. If you have MPR, press GAIN/FRZ/RUN until its light is off to begin
animation.
3. Press GAIN/FRZ/RUN again to turn on the light and stop the
animation.

3-D MultiPlanar Reconstruction
3-D MultiPlanar The 3-D MultiPlanar Reconstruction (MPR) feature constructs a cube, a
Reconstruction cross-section of which can be viewed in any of three orthogonal planes.
You can use the option to create a MPR view of any anatomy.
Follow these general steps to create an MPR display:
• Capture the anatomy that you want for MPR reconstruction in a 3-D
clip. See “Capturing the 3-D Image”, next.
• Enter the AEGIS system review function.
• Review the 3-D rendering created from the 2-D clip. You have several
options for optimizing the 3-D rendering. See “Reviewing the
MultiPlanar Reconstruction” on page 112.
NOTE: You can create both 3-D surface renderings (“3-D Surface
Rendering” on page 102) and MultiPlanar reconstructions from the same
3-D capture. When you switch between these two 3-D views of the same
clip, changes that you make in the 3-D surface rendered view (including
creating a ROI, erasing part of the image, or changing the slice thickness)
also apply to the MPR view. If you change the slice thickness in the MPR
view, this change also applies to the 3-D surface rendered view.
Capturing the 3-D Image ◆ Refer to “3-D Surface Rendering” and “Capturing the 3-D Image”
for detailed instructions.
Selecting an Image for ◆ To select a 3-D image for reconstruction:

Reconstruction
1. Press AEGIS REVIEW to enter the on-board AEGIS system software
review function.
2. Press PAGE up or down to page through captured images and clips
until you see the 3-D clip, marked with a icon.
3. Assess the quality of the clip before you continue. See “Assessing
Image Quality”, next.
is a good idea to assess the quality of the acquired image before you use it
to create a 3-D rendering. If the image quality does not meet the following
criteria, you should delete it and acquire it again:
• The patient (including a fetus) was still during the acquisition.
• The transducer was held perpendicular to the skinline throughout
the acquisition.
• Movement of the transducer was at a constant speed with no twisting
or rotation throughout the acquisition.

Reviewing the ◆ To view the MultiPlanar reconstruction, click VIEW PLANES.

MultiPlanar
Reconstruction The multiplanar reconstruction consists of one image view for each of the
three planes. It has these components:
• A reference cube in the lower right area of the display, shows the
orientation of each of the three planar views.
• Cut plane lines at the side of each view correspond to cut plane lines
in the reference cube.
• A reference dot within each view shows the point of intersection of
all three cut planes.
• Each view is identified by different color cut plane lines, corners, and
an Acuson (in the upper left corner identifying the active
quadrant). Clicking in a view makes it active.
As you review the MultiPlanar reconstruction, you can:

• Make adjustments to the image
• Navigate through the cut planes
• Navigate through the clip
Press [EXIT] at any time to exit the 3-D review function and return to
standard AEGIS system review.

Adjusting the Image You can make adjustments to the appearance of the 3-D image. Use the
Appearance following controls.
CONTROL USE
CONTRAST Drag this slider to control the overall contrast of the

3-D reconstruction.
BRIGHTNESS Drag this slider to control the overall brightness of
the 3-D reconstruction.
SLICE THICKNESS Use this slider to control the spacing of the acquired
ultrasound images in space and contract or expand
the 3-D reconstruction.
Drag this slider to contract (left) or expand (right) the
3-D construction along the axis of transducer
movement.
Adjusting Cut Plane Views Use the following controls to change your view of the cut planes.
CONTROL USE
[CENTER] Centers the reference dot within the active view.

[SINGLE/QUAD] Switches between quad display (which shows three
cut planes and the reference cube) and single display
(where the active cut plane view takes up the whole
screen).
[ZOOM] Lets you change the magnification of the active view.
After you press this key, it is highlighted and you can
use the trackball to either increase or decrease the
magnification. Press this key again or press a
trackball select key to exit Zoom mode.
Navigating Through Cut You can navigate through the cut planes to see various views of the
Planes anatomy you captured. Any time you change one view, the other views
and the reference cube update as appropriate. Use the trackball and select
keys in the following ways:
• Click and drag on an image view (pan) to look at a different region
within that cut plane.
• Click and drag on the reference point in an image view to change the
point of intersection of the three planes. This process allows you to
move the intersection and change the rotation of the cut planes.
• Click and drag within the reference cube to rotate the cube and
change your view of the cut planes

CONTROL USE
RESET Resets some MPR functions including negative steps,

image orientation, overlays, and zoom.
UNDO/REDO Undo or redo single step actions in MPR.
SHOW OVERLAY Adds or removes Cut Plane lines and Reference Dots
from all three quadrants.
Navigating Through the Navigating through the clip lets you locate an area of interest within the
Clip anatomy that you captured. You can rotate the clip along its x-, y-, or z-
axis or adjust the depth of the multiplanar reconstruction within the clip.
Any changes you make update all of the views and the reference cube. To
navigate through the clip, make one of the cut plane views active and
then use the following keyboard controls:
CONTROL USE
DYN RANGE Rotates the MPR image around its x-axis.

POSITION Rotates the MPR image around its y-axis.
DEPTH Adjusts the depth of the MPR image within the
captured clip.
2D GAIN Rotates the MPR image around its z-axis.
A legend at the lower right side of the display shows the mapping
between these navigation options and the keyboard keys.

PART 4
MEASUREMENTS AND CALCULATIONS

Measurements and Calculations describes how to take measurements
from images and how to use the system’s calculation packages. It
includes the following chapters:
Chapter 17 Measurement Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
Chapter 18 Auto Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Chapter 19 Obstetrical Calculations . . . . . . . . . . . . . . . . . . . . . . . . . 131
Chapter 20 Vascular Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Chapter 21 Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Data Display Box
CHAPTER 17
MEASUREMENT TOOLS
Data Display Box Measurements appear in a data display box that contains measurements
reported by all measurement tools.
◆ To scroll the data display box, use the following keys.
CONTROL USE
PAGE Push up to scroll up, or down to scroll down.

HOME To display the first measurement.
END To display the last measurement.
You can also move the data display box and save it in a location that you
choose. See Chapter 2 for information.
Data Display Box
Calipers
Caliper Calipers are available for taking measurements in each of the major
Measurements operating modes. Calipers have the following requirements.
MODE REQUIREMENT
2-D Mode The display does not have to be frozen.
CD Mode The display must be frozen for velocity

measurements.
Spectral Doppler The display must be frozen. The system ensures

Mode, M-mode that two calipers in the same set are on the same
side of the erase bar.

Chapter 17 - Measurement Tools
2-D, CD, and M-mode The following caliper measurements are available in each operating
Calipers mode.
MODE SINGLE-CALIPER MEASUREMENTS TWO-CALIPER MEASUREMENTS

DISPLAY DESCRIPTION DISPLAY DESCRIPTION
2-D DPTH Depth from transducer DIST Distance between
face along ultrasound line calipers (cm)
Color V Mean velocity (m/s) DV Difference in mean
Doppler velocity (m/s)
(VEL or DTV)
ANGL Incident angle (CDV) DIST Distancebetween
calipers(cm)
Color DEPTH Depth from transducer DIST Distance between
Doppler face along ultrasound line calipers (cm)
(ENE or DTE)
Color Mean velocity (m/s) D Difference in mean
Doppler velocity (m/s)
(CONV)
E Energy (dB) DE Difference in energy
(dB)
ANGL Incident angle DIST Distance between
calipers (cm)
Color DV Rate of change of mean DD V Difference in rate of
Doppler velocity (m/s) change in mean
velocity
(DTA)
ANGL Incident angle DIST Distance between
calipers (cm)
M-mode DPTH Depth (cm) ∆D Distance between
calipers
∆T Difference in time (s)
HR Heart rate (bpm)
SLPE Velocity slope
(cm/s)

Caliper Measurements
Spectral Doppler When you are displaying two calipers in spectral Doppler mode, you can
Calipers select what type of information the calipers report. You can choose to
display information from each caliper position (DCAL option) or you can
display the difference measurements between the two caliper positions
(DDCAL option). You select an option using the [DCAL/DDCAL] soft key,
described in “Using the Calipers Function” on page 120.
Spectral Doppler calipers display different measurements when an ECG
is active. The following table shows all spectral Doppler measurement
options.
ECG SINGLE-CALIPER DCAL TWO-CALIPER ∆DCAL TWO-CALIPER

ACTIVE? MEASUREMENTS MEASUREMENTS MEASUREMENTS
DISPLAY DESCRIPTION DISPLAY DESCRIPTION DISPLAY DESCRIPTION
Without V Velocity (m/s) V1 Velocity (m/s) for ∆V Difference in
ECG caliper 1 velocity (m/s)
MEAN Mean velocity MN1 Mean velocity ∆T Difference in
(m/s) over entire (m/s) over entire time (s)
spectral line spectral line, for
caliper 1
V2 Velocity (m/s) for HR Heart rate
caliper 2 (bpm)
(Only when
ECG is off)
MN2 Mean velocity TAV Time Average
(m/s) over entire Velocity (m/s)
spectral line, for
caliper 2
ACCL Acceleration
(m/s2)
With V Velocity (m/s) V1 Velocity (m/s) for VMAX Maximum
ECG caliper 1 velocity (m/s)
PG Pressure Gradient PG1 Pressure Gradient PG Pressure
(mmHG) (mmHg) for caliper 1 Gradient
(mmHG)
MEAN Mean velocity V2 Velocity (m/s) for ∆T Difference in
(m/s) over entire caliper 2 time (s)
spectral line
PG2 Pressure Gradient ∆V Difference in
(mmHg) for caliper 2 velocity (m/s)
SLPE Slope (m/s2)
PHT Pressure half
time (ms)

Using the Calipers 1. Press CALIPERS ON/OFF or ADD CALIPER.

Function There is only one active caliper at a time, and calipers in an active set
appear brighter than the other calipers. Move the trackball to position
the active caliper within an image or strip.
2. Press CALIPERS ON/OFF to exit the calipers function and remove all
calipers and measurements from the display.
Use the following keys with the caliper function.
CONTROL USE
TRACKBALL If there is only one caliper showing, press to add a

SELECT second one. Also toggles between calipers in the
active set.
ADD CALIPER Adds a caliper to the display, up to two calipers
per set.
[LOCK SET] Completes a set.

[SELECT SET] Activates another caliper set (appears only when
there is an inactive caliper).
[PRIOR DATA] Restores caliper information from a previous
session, when available.
[DCAL/∆DCAL] Switches between display of two-caliper
measurements (∆DCAL) and individual single
caliper measurements (DCAL) when you have two
spectral Doppler caliper markers.
[DELETE SET] Deletes the current caliper set. When you do so, the
previous caliper set becomes active.
ELLIPSE Activates the ellipse function (for 2-D calipers
only). See, “Using the Ellipse Function” on
page 121.
You can you can also press up once to display a
connecting line between the two calipers in the
active set. Press down to remove the connecting
line.
ANGLE Press to turn on angle correction for the active CD

caliper.
Turn to adjust the incident angle of the caliper and
the CD scale.
Press again to turn off angle correction for the
active CD caliper.

Using the Ellipse Function
Using the Ellipse You can use the ellipse function to take area and circumference
Function measurements in a 2-D or CD image (using 2-D calipers). Ellipse reports
the following measurements in a data display box.
MEASUREMENT DESCRIPTION
D1 The major axis of the ellipse (distance between the

two calipers)
D2 The minor axis of the ellipse
CIRC The circumference of the ellipse
AREA The area of the ellipse
◆ To use the Ellipse function:

1. Position the 2-D calipers where you want the major axis of the ellipse.
2. Press ELLIPSE up to display a connecting line between the two
calipers.
Hold ELLIPSE up to expand the size of the ellipse.
Hold ELLIPSE down to decrease the size of the ellipse.
Move the calipers to adjust the ellipse shape.
3. To remove the ellipse, hold ELLIPSE down until the ellipse
disappears, or exit the caliper function.
Using the Trace You can use the trace function in 2-D and spectral Doppler modes to trace
Function the outline of an area of interest. In spectral Doppler mode the image
must be frozen and the trace cannot cross the erase bar. Measurements
appear after you complete the trace. The following trace measurements
appear in the data display box for each operating mode.
MODE TRACE MEASUREMENTS
DISPLAY DESCRIPTION
2-D CIRC Circumference, displayed after

you end the trace (by pressing
[END TRACE]).
PERI Perimeter, displayed while you

perform the trace (before pressing
[END TRACE]). When the trace is
complete, the circumference
measurement replaces this one.
AREA Area, displayed after you end the
trace.
DPTH Depth, displayed when the trace
tool is active and you have not yet
begun tracing (by pressing [MARK]
or [DRAW]).

MODE TRACE MEASUREMENTS
DISPLAY DESCRIPTION
SPECTRAL DOPPLER TAMX Time averaged maximum velocity

(WITHOUT ECG) (m/s)
VTI Velocity time integral (m)
VMAX Maximum velocity traced (m/s)
SPECTRAL DOPPLER VTI Velocity time integral (m)
(WITH ECG)
MEAN Mean velocity (m/s)
MNPG Mean pressure gradient (mmHg)

VMAX Maximum velocity traced (m/s)
PG Peak pressure gradient (mmHg)
There are two methods for tracing an area: marking and drawing. To
mark a trace, you mark points to be connected by the trace line. To draw a
trace, you draw the entire trace line itself.
1. Press TRACE to enter the trace function.
2. Press [MARK] or [DRAW] to select a trace method.
3. Press [EXIT] or TRACE to exit the trace function.
Use the following keys with the trace function.
CONTROL USE
[PRIOR DATA] Returns traces from the previous session to the

display before beginning a new trace.
[ADD] Adds another trace.
[EDIT] Press to edit a completed trace.
[BACK UP] Press to correct a mistake. Release [BACK UP] to

stop erasing.
[REDRAW] Move the edit cursor to one end of a segment to be
replaced and press [REDRAW].
[SELECT] Activates a trace. You can display up to six traces
at the same time; only one can be active.
[DELETE] Deletes a completed trace.
[END TRACE] Completes a trace.
In 2-D mode, completing a trace connects the
beginning and end points.
In spectral Doppler mode, completing a trace
connects the beginning and end points to the
baseline.

Performing 2-D Volume Calculations
Performing 2-D You calculate the volume of a region of interest by measuring the region
Volume Calculations of interest in three planes, using two scan orientations perpendicular to
each other. You can measure the anterior-posterior (depth) and superior-
inferior (length) dimensions using the same scan orientation. You can
measure the width by moving the transducer to the orthogonal scan
plane. You can calculate volume on a live, frozen, or videotaped 2-D
image, and in 2-D Cine.
The volume calculation uses the following formula:
Volume = D1 * D2 * D3 * π/6
where D1, D2, and D3 are the three measurements for the region of
interest.
Entered measurements must be in the range of 0 < x < 99 cm.
The calculated volume will be in the range of 0 < x < 99999 cc. Values
outside the valid range are displayed as “*******”.
◆ To measure the volume of a region of interest:
1. Press CALC and select VOLUME from the pop-up menu.
A single caliper and the data display box appear.
2. Use the trackball select key to position the caliper.
3. Use the following controls to perform the measurement.
CONTROL USE
ADD CALIPER Displays the second caliper for you to position.

[ENTER] Records the measurement.
[CLEAR ALL] Clears all current volume calculation
measurements.
[MEASUREMENT] Selects the measurement you want to take: D1, D2,
or D3. You must take all three distance
measurements to obtain the volume.
CALC Exits the volume calculation function.

Measuring Hip Hip angle measurements are used to determine if dysplasia is present in
Angle the hip joint of young infants. You measure the hip angle by drawing
lines corresponding to the position of bone and cartilage in the hip joint.
Hip angle measurements can be taken on real-time or frozen images. The
hip angle measurement is not available in strip modes.
The first line drawn is the

baseline, followed by the
α and β lines.
The angle that the α line
forms with respect to the
baseline, and the angle
that the β line forms with
respect to the α line, are
used to determine the
state of joint
development.
◆ To perform a Hip Angle measurement:

1. Press CALC to display the calculations pop-up menu.
2. Select Hip Angle from the pop-up menu to display a caliper.
3. Position the caliper where you want to start the baseline.
4. Press [ADD CALIPER] or the trackball select key to display the line.
5. Use the trackball to reposition the caliper, and then double-click to
complete the measurement.
6. Repeat steps 4 and 5 for the α (alpha) and β (beta) measurements.
7. To exit the hip angle measurement function, press CALC.
Taking You can take most 2-D, spectral Doppler, and M-mode measurements and
Measurements from perform calculations from a videotaped exam. Before you can take
a Videotaped Exam measurements or perform calculations from a videotaped exam, you
must freeze the image you want to measure and calibrate the
measurement tools.
Calibrating measurement tools allows you to take measurements from
images (such as videotape or some uncalibrated AEGIS system images).
Calibrating allows you to take all measurements from these types of
images, except the following:
• Color Doppler caliper measurements
• Doppler angle correction
• Auto Doppler measurements
• 2-D, M-mode, and Needle Guide depth measurements
• Single caliper depth measurements
You need to calibrate for each operating mode in which you want to take
measurements.

Taking Measurements from a Videotaped Exam
Displaying the When you press the CALIPERS ON/OFF, ADD CALIPER, TRACE, or CALC
Calibration Menu keys on an uncalibrated image, the Calibration pop-up menu appears
with the options described in the following table.
OPTION USE
Prior Calibration Use the last calibration. If you have just turned
on the system, there is no prior calibration and
this option is dimmed.
2-D Set up 2-D calibration.
Spectral Doppler Set up spectral Doppler calibration.
M-mode Set up M-mode calibration.
You must set up calibration for each operating mode in which you want
to take measurements. The following sections describe the procedure for
each mode.
Setting Up 2-D You calibrate 2-D measurements by selecting a measurement distance
Calibration and marking that distance with calipers.
◆ To set up calibration for 2-D measurements:
1. Choose 2-D from the Calibration pop-up menu to display a
second-level menu listing distances you can use for calibration.
2. Choose a distance to use for the calibration. A calibration scale and a
single caliper appear.
3. Position the caliper on one of the scale markers.
4. Press ADD CALIPER to display a second caliper, and position the
second caliper at the calibration distance you selected from the first
caliper. (Click a trackball select key to switch between the two
calipers and reposition them at the correct distance from each other.)
The calibration distance appears in a data display box as a reminder.
5. Press [ENTER] to record the calibration.
Setting up Strip Mode You calibrate spectral Doppler and M-mode strip measurements both in
Calibration the vertical and horizontal dimension. You calibrate vertically by
choosing a calibration speed (spectral Doppler mode) or distance
(M-mode) and then measuring it with calipers. You calibrate horizontally
by choosing a time interval and then measuring it with calipers.
◆ To set up calibration for spectral Doppler or M-mode strips:
1. Choose Spectral Doppler or M-mode from the Calibration pop-up
menu to display a second-level menu for calibrating vertically.
If you choose Spectral Doppler, the second-level menu lists
calibration units in meters per second. If you choose M-mode, the
second-level menu lists distances you can use for calibration.
2. Choose the calibration units. A calibration scale and a single caliper
appear.

3. In spectral Doppler mode, position the caliper on the baseline. In

M-mode, position the caliper on one of the scale markers and click.
IMPORTANT: In spectral Doppler mode, you must position the first caliper on the
baseline to perform an accurate vertical calibration.
4. Click to display a second caliper, and position it to measure the

calibration units you selected from the second-level pop-up menu.
(Click to switch between the two calipers and reposition them at the
correct distance from each other.)
The calibration measurement appears in a data display box as a
reminder.
5. Press [ENTER] or double-click to record the calibration.
You see a second-level pop-up menu for choosing horizontal
calibration units (in seconds).
6. Choose a calibration units option. A calibration scale and a single
caliper appear.
7. Position the caliper on one of the scale markers.
8. Click to display a second caliper, and position it to measure the time
interval you selected from the second-level pop-up menu. (Click to
switch between the two calipers and reposition them at the correct
distance from each other.)
The calibration measurement appears in a data display box as a
reminder.
9. Press [ENTER] or double-click to record the calibration.

Entering and Exiting Auto Doppler
CHAPTER 18
AUTO DOPPLER
The Auto Doppler function automatically traces the spectral Doppler

waveform and records several measurements on select transducers. You
can use the Auto Doppler function on a real-time PW Doppler strip, a
Cine PW Doppler strip, or a frozen PW Doppler strip.
Entering and Exiting ◆ To enter the Auto Doppler function:

Auto Doppler 1. Display a real-time or frozen spectral Doppler strip while using an
abdominal, vascular, cardiac, or endovaginal transducer.
2. Press AUTO MEASURE.
Data Display Box

Shows Measurements
Auto Doppler
Trace Outlines the
Doppler Waveform
Auto Doppler An Auto Doppler configuration specifies parameter settings and

Configurations determines which measurements are calculated from the Doppler
spectral display. The Aspen ultrasound system provides five preset Auto
Doppler configurations: Carotid, Renal, Ovaries, Tri-phasic, and LVOT.
You can use the Setup function to modify the preset configurations and
add other user-defined configurations. See Chapter 29.
◆ To select a configuration while in the Auto Doppler function:
1. Press OPTIONS to display the Auto Doppler Options pop-up menu.
2. Choose the configuration you want by pressing [()SELECT].
NOTE: The OPTIONS key displays only Auto Doppler configurations
that have been turned on in Auto Doppler Setup.

Chapter 18 - Auto Doppler
Auto Doppler The measurements that were turned on in the Auto Doppler
Measurements Configuration Setup appear in the Auto Doppler data display box.
◆ To record Auto Doppler measurements:
1. Press [HR RANGE] to select the appropriate heart rate range.
2. On a frozen Doppler display, press CALC.
3. Press [SITE] to select the current site.
4. Press [()ENTER] to enter the displayed data into the Auto Doppler
report.
5. On a real-time Doppler display, press [↑/↓] to specify which side of
the Doppler baseline to take measurements from.
OPTION DESCRIPTION
↑ Traces positive portion of waveform (above baseline)

↓ Traces negative portion of waveform (below baseline)
↑/ ↓ Traces waveform on both sides of the baseline
When you invert the Doppler strip, Auto Doppler continues to trace
the same side of the baseline (positive or negative). The tracking is
saved across repeated uses of Auto Doppler.
6. Press[THRESHOLD] and roll the trackball left and right to adjust the
trace threshold.
Using the Auto Velocity Time Integral (VTI) Beat-To-Beat. You can turn on this
Doppler VTI Beat-To- measurement for any Auto Doppler configuration. When the
Beat Calculation measurement is turned on, it appears in the data display box, labelled
VTIbt, when you perform Auto Doppler measurements.
◆ To turn on the VTI Beat-To-Beat measurement for a
configuration:
1. Select AUTO MEASURE: DOPPLER CONFIGURATION FUNCTION from
the Setup menu.
The Doppler Configuration Function menu lists each of the available
configurations and their current status, either on or off.
2. Select the configuration for which you want to turn on the VTI Beat-
To-Beat measurement in the Doppler Configuration Function menu,
and press [MODIFY].
The Auto-Doppler Configuration menu lists measurements for the
selected configuration.

Using Auto Doppler with Cine
3. Select VTI BEAT TO BEAT and press [()OFF/ON] to select the status you
want.
4. Press [PRIOR MENU] to return to the Auto-Doppler Configuration
Function menu, or press [IMAGE] to return to the image.
For more information about setting up Auto Doppler measurements, see
your Administrator Manual. For information about using the Auto
Doppler function, see your User Manual.
Using Auto Doppler If you press Cine while Auto Doppler is active, the Auto Doppler Review
with Cine mode is entered.
◆ To use Auto Doppler with Cine:
1. Press PRIORITY to switch between Cine and Auto Doppler soft keys.
2. If you turn the GAIN/FRZ/RUN wheel, the maximum derived
waveform (MAX DWF) remains displayed. The Cine soft keys
appear.
3. You can select which side of the baseline to evaluate while a Cine
strip is running.
4. Use the trackball and [L/R] to move the delimiters.
OPTION DESCRIPTION
L/R The trackball moves both delimiters at the same time
L The trackball moves the left delimiter
R The trackball moves the right delimiter
5. Repeat these steps for each site.

Chapter 18 - Auto Doppler
Reviewing the Auto ◆ To display the Auto Doppler report:

Doppler Report 1. Press REPORT while the Auto Doppler function is active.
2. You can use these controls to review and edit the report.
CONTROL USE
PAGE Press up to display the previous report page. Press

down to display the next report page.
SITE NAMES Move the cursor to a site name and type to enter a
new name. You cannot change the Acuson
configurations.
[DELETE] Deletes the selected measurement. Permanently
removes all values displayed for that measurement
in the Auto Doppler report.

Entering and Exiting the Calculation Package
CHAPTER 19
OBSTETRICAL CALCULATIONS
The OB calculation package has new enhancements added to the

previous package consisting of Biometric, AFI, and Doppler
measurements. The enhancements are as listed:
• Area measurement capability, as in Fetal Trunk Area (FTA).
• EFW equation entry enhancement adding a third column for
parameter field input. See your Administrator Manual for more
information.
• Optional measurement name lengths for four characters.
• 3-column table entry for the five biometry and three optional
measurements.
• Linear measuement capability for APTD and TTD.
The previous package allows you to record patient information such as
the date of the last menstrual period (LMP) and previous obstetrical data.
You then take fetal measurements, and the system performs calculations.
If you specify a twin exam, the system lets you record separate
measurements for each twin, and easily move back and forth between the
two.
Additional OB calculations using various regression equations are
documented in the Administrator Manual. Note that the equations are
valid only within the limits provided.
You can use the AEGIS System-Wide Functions Setup function to
configure your system to include OB calculation data with stored studies.
For more information, see Chapter 29.
Entering and Exiting ◆ To enter the calculation package:

the Calculation 1. Press CALC.
Package
2. Select OB from the soft key menu.
3. Press CALC to exit the OB calculation package.

Chapter 19 - Obstetrical Calculations
Selecting a There are three programs for calculating the composite menstrual age:
Calculation Program Acuson/M, Acuson/H, and USER. All programs initially default to Dr.
Hadlock’s regression analysis for the individual BPD, HC, AC, FL, and
CRL parameters.
PROGRAM DESCRIPTION
ACUSON/M Uses Dr. Hadlock’s regression analysis for the individual

default parameters (BPD, HC, AC, FL, and CRL). It
derives the composite menstrual age from the arithmetic
mean of the measurement parameters. If you record
optional parameters, they are included in the calculation.
ACUSON/H Uses Dr. Hadlock’s regression analysis for the individual
default parameters (BPD, HC, AC, and FL). It derives the
composite menstrual age from a weighted regression
model using a combination of these parameters.
USER A custom program that lets you enter Biometric
measurements through equation or table entry. You can
modify all default tables and equations (BPD, HC, AC,
FL, and CRL), and add optional parameters. It derives
the composite menstrual age from an arithmetic mean of
all measurement parameters. (The ability to enter and
modify tables is available upon purchase and installation
of Service Update 1. Otherwise, equation entry and
modification is the option installed on your system.)
NOTE: Optional parameters and CRL measurements are not included in

Dr. Hadlock’s weighted regression model. If you record optional
parameters or CRL measurements in addition to the basic measurement
parameters (BPD, HC, AC, and FL), the composite menstrual age is
calculated as an arithmetic mean.
◆ To select a calculation program:
1. Press SETUP and select CALC SETUP from the Setup menu. Then
select OB.
2. Select PROGRAM SELECT.
3. Press [MODIFY] and select one of the programs.
4. Press [EXIT].
If you select a USER program, you can specify:
• MA coefficients for BPD, HC, AC, FL, and CRL biometric
measurements equation or table entry.
• Up to three optional biometric measurements as equation or table
data.
• Optional biometric ratio.
• The EFW equation.
• The LMP PERCENTILE equation.
• Linear Measurements (part of table data entry).

Customize the USER Program
Customize the ◆ To customize the USER program:

USER Program
1. Press SETUP and select CALC SETUP from the Setup menu. Then
select OB SEL.
2. Select the measurement, equation, or option from the OB Calc Select
menu.
3. Press [MODIFY].
4. Press [USER].
5. Make the changes you want and press [PRIOR MENU] to save the
changes and return to the OB Calc Select screen.
6. Press [EXIT].
Taking ◆ To take measurements:

Measurements 1. Enter the OB Calc package.
2. Use the following keys to take measurements.
CONTROL USE
[AFI] Press to take an AFI measurement.

[BIOMETRY] Press to take a biometric measurement.
[SINGLE/A/B] Press SINGLE for single fetus exam, or select A or B
to begin a twin exam.
[MEASUREMENT] When taking biometry measurements, press to
select the measurement you want to perform.
When taking AFI measurements, press to select an
AFI quadrant.
[ENTER] Press to enter the current measurement.
PRINT Enters the current measurement and prints the
display to the selected print device.

Biometric The calculation package supports the following biometric measurements.

Measurements When you select the measurement, the corresponding tool appears.
MEASUREMENT DESCRIPTION TOOL
BPD Biparietal diameter Caliper pair

HC Head circumference Ellipse or Trace
You must use ellipse to calculate
the cephalic index (CI).
AC Abdominal Ellipse or Trace
circumference
FL Femur length Caliper pair
CRL Crown rump length Caliper pair
OP1 - OP3 User-defined Depends on definition
AFI Measurements The OB calculation package supports measurement of the amniotic fluid
and Calculations quadrants and reports the amniotic fluid index (AFI). To calculate the
AFI, you use the caliper tool to measure the amount of amniotic fluid in
the four quadrants of the uterus.
Doppler The OB calculation package reports the following Doppler measurements

Measurements and calculations. You can record Doppler measurements at three
sites.There are two methods for taking spectral Doppler measurements.
• You can use the trace tool to trace the waveform and calculate MAX,
MIN, TAMX, HR, PI, RI, and S/D Ratio.
• You can use individual calipers to mark the minimum and maximum
values for the waveform and calculate MAX, MIN, RI, and S/D Ratio.
LABEL DESCRIPTION TOOL
MAX Maximum velocity Trace or Caliper pair

MIN Minimum velocity Trace or Caliper pair
TAMX Time average Trace only
maximum velocity
HR Heart rate Trace only
PI Pulsatility index Trace only
RI Resistive index Trace or Caliper pair
S/D RATIO Systolic to Diastolic Trace or Caliper pair
ratio

Using the OB Calculation Worksheet and Report
◆ To take Doppler measurements:

1. If you are in the OB calculation package, enter spectral Doppler
mode.
If you are in spectral Doppler mode, press CALC and then select OB
from the pop-up menu to enter the OB calculation package.
2. Select [SITE] to select one of three measurement sites.
3. Press GAIN/FRZ/RUN or CINE to freeze the image and take the
measurements.
Using the OB The OB calculation worksheet displays the results of each measurement
Calculation you take. You can select it at any time while taking a measurement, and
Worksheet and can edit or delete any measurement result.
Report The OB report displays a summary of the information in the OB
worksheet. For example, instead of displaying each value you recorded
for a measurement, it displays the average of all values. You can display
the OB report at any time from the OB worksheet.
◆ To display the OB worksheet, press REPORT.
1. Press [WRKSHT/RPT] to switch between the report and the worksheet.
2. Use standard text editing techniques and the following keys when
you work on the report and worksheet.
CONTROL USE
[FETUS:A/B] Press to move between twins in a twin exam.

PAGE Press to change pages in the worksheet or report.
PRINT Press to print an individual report page.
[IMAGE] Press to exit the report and display the image.
3. Press REPORT to leave the worksheet or report and return to the live
image.
Growth Curves Growth curves show the development of the fetus (or fetuses) graphically
by plotting measurement data from the current exam and data that you
enter from prior exams.
Growth curves are available for all measurements and ratios, with the
exception of CI, for which you have entered values. For twin exams, the
growth curve plots data points for each twin on the same graph; an X
represents a data point for fetus A and a + represents a data point for
fetus B.

Displaying Growth ◆ To display growth curves:

Curves
1. Display the OB report, and press [GROWTH CRV].
2. To view a specific curve, select it from the growth curve pop-up
menu.
The measurement
or ratio you select is
plotted on the
vertical axis.
Growth Curve
Pop-Up Menu
The age is plotted

on the horizontal
axis.
3. To select the MA used for the growth curve, press [MA

SOURCE:CLINICAL MA/DATE] to select CLIN (clinical MA) or US
(ultrasound MA).
4. To exit the growth curve display, do one of the following:
Press [PRIOR MENU] to return to the OB worksheet.
Press REPORT or [IMAGE] to return to imaging.
Entering Previous Exam You can enter data from previous exams on the growth data entry screen.
Data
◆ To enter data:
1. Display growth curves and press [GROWTH DATA].
2. If you are performing a twin exam, press [SINGLE/A/B] to switch
between fetuses. There is a growth data entry screen for each fetus.
3. Press [PRIOR MENU] twice to return to the growth curves display, or
[IMAGE] to return to imaging.

Growth Curves
Table 19-1 Conversion Chart: Pounds and Ounces to Grams
OZ
LBS 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
0 - 28 57 85 113 142 170 198 227 255 284 312 340 369 397 425
1 454 482 510 539 567 595 624 652 680 709 737 765 794 822 850 879
2 907 936 964 992 1021 1049 1077 1106 1134 1162 1191 1219 1247 1276 1304 1332
3 1361 1389 1417 1446 1474 1503 1531 1559 1588 1616 1644 1673 1701 1729 1758 1786
4 1814 1843 1871 1899 1928 1956 1984 2013 2041 2070 2098 2126 2155 2183 2211 2240
5 2268 2296 2325 2353 2381 2410 2438 2466 2495 2523 2551 2580 2608 2637 2665 2693
6 2722 2750 2778 2807 2835 2863 2892 2920 2948 2977 3005 3033 3062 3090 3118 3147
7 3175 3203 3232 3260 3289 3317 3345 3374 3402 3430 3459 3487 3515 3544 3572 3600
8 3629 3657 3685 3714 3742 3770 3799 3827 3856 3884 3912 3941 3969 3997 4026 4054
9 4082 4111 4139 4167 4196 4224 4252 4281 4309 4337 4366 4394 4423 4451 4479 4508
10 4536 4564 4593 4621 4649 4678 4706 4734 4763 4791 4819 4848 4876 4904 4933 4961
11 4989 5018 5046 5075 5103 5131 5160 5188 5216 5245 5273 5301 5330 5358 5386 5415
12 5443 5471 5500 5528 5556 5585 5613 5642 5670 5698 5727 5755 5783 5812 5840 5868
13 5897 5925 5953 5982 6010 6038 6067 6095 6123 6152 6180 6209 6237 6265 6294 6322
14 6350 6379 6407 6435 6464 6492 6520 6549 6577 6605 6634 6662 6690 6719 6747 6776
(27.0 -gm = 1-oz, 16-oz = 1-lbs)


Studies
CHAPTER 20
VASCULAR CALCULATIONS
You can use the vascular calculation package to:

• Take measurements and perform standard vascular calculations.
• Store the measurements and calculations on your system.
• View and print reports with the results of these studies.
See Chapter 29 for information on customizing vascular calculations.
Studies The calculation package consists of the following studies.
LABEL STUDY DESCRIPTION
CAROTID Carotid Reports peak velocities in the carotid arteries.
IC/CC Internal/ Reports the ratio of the maximum velocities in the internal and
Common Carotid common carotid arteries.
PI Pulsatility Index Provides an indication of peripheral resistance by computing

the difference between maximum and minimum velocities and
normalizing it by the time average maximum velocity.
RI Resistivity Index Provides an indication of peripheral resistance by computing

the difference between maximum and minimum velocities and
normalizing it by the maximum velocity.
S/D RATIO Systolic to Reports the ratio of blood flow velocity in systole and diastole.
Diastolic Ratio
VELOCITY User-defined Reports velocities of your choice. You can change the name of
Velocity this study to reflect its use.
RATIO User-defined Reports the ratio of two velocity measurements of your choice.
Velocity Ratio You can change the name of this study to reflect its use.
% STEN D Percent Stenosis Calculates the percent stenosis of a vessel based on the
by Diameter reduction of the residual lumen diameter.
% STEN A Percent Stenosis Calculates the percent stenosis of a vessel based on the
by Area reduction of the residual lumen cross-sectional area.
VOL FLOW D Volume Flow by Measures the volume of blood flowing through a vessel based
Diameter on 2-D diameter measurement and spectral Doppler TAV
measurement.
VOL FLOW A Volume Flow by Measures the volume of blood flowing through a vessel based
Area on 2-D area measurement and spectral Doppler TAV
measurement.

Chapter 20 - Vascular Calculations
Measurements Each study has measurements associated with it. The following table
shows the study’s measurements, the measurement tool you use, and the
imaging mode the measurement is available in.
STUDY MEASUREMENT MEASUREMENT DESCRIPTION IMAGING MODE

SOFT KEY LABEL AND TOOL
CAROTID ICA pk Internal carotid peak velocity Doppler caliper
ICA ed Internal carotid end diastolic Doppler caliper

velocity
ECA pk External carotid peak velocity Doppler caliper
CCA pk Common carotid peak velocity Doppler caliper
IC/CC ICA pk Internal carotid peak velocity Doppler caliper
CCA pk Common carotid peak velocity Doppler caliper
PI MAX Maximum velocity Doppler caliper
MIN Minimum velocity Doppler caliper
TAMX Time average maximum velocity Doppler trace
RI MAX Maximum velocity Doppler caliper
S/D RATIO MAX Maximum velocity Doppler caliper
VELOCITY VEL1 Any velocity Doppler caliper
VEL2 Any velocity Doppler caliper
RATIO NUM Any velocity Doppler caliper
DEN Any velocity Doppler caliper
% STEN D DIAM 1 Diameter 1 2-D calipers
DIAM 2 Diameter 2 2-D calipers
% STEN A AREA 1 Cross section area 1 2-D trace (or ellipse)
AREA 2 Cross section area 2 2-D trace (or ellipse)

Entering and Exiting the Vascular Calculation Package
STUDY MEASUREMENT MEASUREMENT DESCRIPTION IMAGING MODE

SOFT KEY LABEL AND TOOL
VOL FLOW D DIAM Vessel diameter 2-D calipers
+/-TAV, +TAV, Time average velocity Position two Doppler

or -TAV calipers on waveform
peaks to measure TAV
between the peaks.a
VOL FLOW A AREA Vessel area 2-D trace or ellipse.
+/-TAV, +TAV, Time average velocity Position two Doppler

or -TAV calipers on waveform
peaks to measure TAV
between the peaks.a
a. The Doppler mean curves are calculated between the two calipers’ vertical lines. Therefore, the horizontal
bar position on the calipers doesn’t affect TAV value.
Entering and Exiting You can enter the calculation package at any time during a study.
the Vascular ◆ To enter the vascular calculation package:
Calculation Package
1. From PW Doppler mode press GAIN/FRZ/RUN or CINE to freeze the
Doppler strip.
2. Press CALC and select VASCULAR from the pop-up menu.
Selecting a Study ◆ To select a study:

1. Press [STUDY] until the study you want appears in the soft key menu.
2. Press [SELECT] to display the measurement soft key menu for the
study you selected.
The following illustration shows the study soft key menu.

Chapter 20 - Vascular Calculations
Taking ◆ To take measurements within a study:

Measurements 1. Press [MEASUREMENT] until it names the measurement you want to
take.
2. Press [SITE] to select the site for the measurement.
3. Use calipers, ellipse, or trace to take the measurement.
4. Press [ENTER].
The following illustration shows the measurement soft key menu.
Using the Vascular The vascular calculation worksheet displays the results of each
Calculation measurement that you take. The vascular calculation report displays a
Worksheet and summary of all vascular measurements and calculations. You can display
Report either the worksheet or report at any time while you are taking
measurements.
◆ To display the report:
1. Press REPORT.
2. Press [RPT/WRKSHT] to switch between the report and the worksheet.
3. Press REPORT or [IMAGE] to leave the worksheet or report and return
to the live image.
Use standard text editing techniques and the following keys when you
work in the worksheet.
CONTROL USE
IMAGE STORE Press to capture a digital image of a report.

[PAGE] Press up or down to scroll through the report.
[delete] Removes data in current field.
[undo] Reverses deletion or edit.


CHAPTER 21
CARDIAC CALCULATIONS
You can use the cardiac calculation package to:

• Take measurements and perform standard cardiac calculations.
• Store the measurements and calculations on your system.
• View and print reports with the results of these studies.
See Chapter 29 for information on customizing the cardiac calculation
package.
Cardiac calculation pop-up menus are divided into two sections. The top,
gray section displays a hierarchical navigation history. The bottom
section displays a sub-menu of choices that are one hierarchical level
below the last item in the navigation history.
The hierarchy of the cardiac calculation package is as follows:
• Calculation package
• System mode
• Study
• Measurement
As you navigate through the cardiac calculation pop-up menu, you select
items in this order.
Cardiac Package
Mode
Study
Measurement

Chapter 21 - Cardiac Calculations
Entering and Exiting You can enter and exit the calculation package at any time during a study.
the Cardiac Calculation data is saved until you end the study. To take cardiac
Calculation Package measurements in strip modes, you must first press FREEZE or CINE to
stop the strip.
◆ To enter the cardiac calculation package:
1. Press CALC and select CARDIAC from the pop-up menu.
2. When you choose a measurement from the pop-up menu, the pop-up
menu disappears, the measurement tool and soft key menu are
activated, and the data display box appears.
3. Press CALC to exit the cardiac calculation package.
2-D Calculations 2-D length measurements are taken using calipers, and 2-D area and
volume measurements are performed using the trace function. For
information on using these functions, see Chapter 17. 2-D measurements
are divided into six studies. The first five studies each represent a
different view. The sixth study is for wall motion scoring.
STUDY MEASUREMENT MENU LABEL
PLAX Right ventricular wall thickness (diastole) RVWd

(parasternal long axis) Right ventricular wall thickness (systole) RVWs
Right ventricular diameter (diastole) RVDd

Right ventricular diameter (systole) RVDs
Interventricular septal thickness (diastole) IVSd

Interventricular septal thickness (systole) IVSs
Left ventricular diameter (diastole) LVDd

Left ventricular diameter (systole) LVDs
Left ventricular posterior wall thickness (diastole) LVPWd

Left ventricular posterior wall thickness (systole) LVPWs
Aorta diameter (diastole) AOd

Aorta diameter (systole) AOs
Left atrial diameter (diastole) LAd

Left atrial diameter (systole) LAs
Left ventricular outflow tract (LVOT) diameter LVOT Diama
PSAX MV (parasternal Right ventricular wall thickness (diastole) RVWd

short axis at mitral valve) Right ventricular wall thickness (systole) RVWs





2-D Calculations
Left ventricular endo-area (diastole) LVd area

Left ventricular endo-area (systole) LVs area
Left ventricular epi-area (diastole) LVepi area
PSAX AO (parasternal Aorta diameter (diastole) AOd

short axis at aortic valve) Aorta diameter (systole) AOs
Left atrial diameter (diastole) LAd

Main pulmonary artery (diastole) MPAd

Main pulmonary artery (systole) MPAs
Right pulmonary artery (diastole) RPAd

Right pulmonary artery (systole) RPAs
A4C Left ventricular area/length/volume (diastole) LVd area

(apical four chamber) Left ventricular area/length/volume (systole) LVs area
Left ventricular major diameter (diastole) LVd maj

Left ventricular minor diameter (diastole) LVd min
Right ventricular major diameter (diastole) RVd maj

Right ventricular minor diameter (diastole) RVd min
Left atrium major diameter (diastole) LAd maj

Left atrium minor diameter (diastole) LAd min
Right atrium major diameter (diastole) RAd maj

Right atrium minor diameter (diastole) RAd min
A2C Left ventricular area/length/volume (diastole) LVd area

(apical two chamber) Left ventricular area/length/volume (systole) LVs area
a. Results from this measurement automatically appear in spectral Doppler LVOT study.

M-Mode M-mode measurements are taken using two calipers. M-mode

Calculations measurements are organized into four studies: LV, MV, AO/LA and VCF.
Left Ventricular (LV) Right ventricular wall (diastole) RVWd

Right ventricular wall (systole) RVWs
Pericardial effusion PE
Mitral Valve (MV) Mitral valve D-E excursion MV D-E

Mitral valve E-F slope MV E-F
Mitral valve E point to septal separation MV E-Sep
Aortic/Left Atrial Aortic diameter (diastole) AOd

(AO/LA)
Aortic cusp separation AO Cusp Sep
Left ventricular ejection time LVET
Left ventricular pre-ejection period LVPEP
Velocity of Left ventricular diameter (diastole) LVDd

Circumferential Left ventricular diameter (systole) LVDs
Fractional Shortening
(VCF) R-wave interval R-R
Left ventricular ejection time LVET

Spectral Doppler Measurements
Spectral Doppler Spectral Doppler measurements are performed using the trace and
Measurements caliper functions. For information about these tools see Chapter 17.
Spectral Doppler measurements are organized into six studies: AoV,
LVOT, MV, PV, TV, and Qp/Qs.
STUDY MEASUREMENT
VELOCITY TIME PEAK VELOCITY TIME OR SLOPE DIAMETER (DIAM)

INTEGRAL (VTI) (VMAX)
Trace One caliper Two calipers Two 2-D calipers
AoV AoV VTI AoV Vmax AI Slopea
LVOT LVOT VTI LVOT Vmax LVOT Diamb
MV MV VTI Peak E MV IVRT

Peak A MV PHT
PV PV VTI PV Vmax
TV TV VTI TR Vmax
Qp/Qs SYS VTI — SYS Diam*

PUL VTI PUL Diam*
a. The AI PHT is derived with the AI Slope measurement.
b. Measure on a full-screen 2-D image. If the measurement is taken as part of the 2D PLAX study, it
automatically appears here. If taken as part of the Doppler LVOT study, it automatically appears in the 2D
PLAX study.

Performing Wall Wall motion scoring is a method of analyzing a completed stress

Motion Scoring echocardiography exam. During the stress echo exam, you store the
views for all stages (parasternal long axis, parasternal short axis, apical
two chamber and apical four chamber views) in the on-board Aegis®
digital image and data management system. The wall motion scoring
package then displays the views with corresponding diagrams. Once you
score the diagrams based on the wall motion legend, the system reports a
wall motion scoring index.
◆ To perform Wall Motion Scoring:
1. Enter Aegis Review in a staged stress echo protocol.
2. Select 2D from the cardiac calculation pop-up menu.
3. Select Wall Score.
The Review displays the four view clips for this particular stage. The
view in the upper left hand quadrant is automatically selected for
scoring.
4. Select a stage from the Wall Score pop-up menu.
Use the following keys.
CONTROL USE
[HIDE DIAGRAM] Removes the diagram so that the underlying

image may be viewed.
[NEXT VIEW] Advances to the next view in sequence.
TAB Moves between regions.
5. Select a view to score.

6. In the diagram that is associated with your selected view, choose the
region that you want to score.
7. Type a score value between 0 and 5 inclusive for the active region,
based on the degree of movement of the region.
0—Unable to score
1—Normal
2—Hypokinetic
3—Akinetic
4—Dyskinetic
5—Aneurysmal
For any stage, each region can have only one score. Typing a new
number supersedes any previously entered number. Some regions
appear in more than one diagram. For these regions, a score entered
in any view will be displayed in all appropriate views. The score that
was entered last for that region is considered the correct score.
8. Score each region of the diagram.
9. Repeat steps 5 through 8 for each view.
10. Repeat steps 3 through 9 for each stage.

Performing Wall Motion Scoring
Calculations The following calculations are available for each stage of the study:
• Wall score index (sum of scores / number of regions scored)
• Percent normal functioning muscle (number of regions with score of
1 / number of regions scored)
• Sub-score for each of three presumed coronary beds:
LAD (left anterior descending artery)
LCX (left circumflex coronary artery)
RCA (right main coronary artery).
LAD = regions 1, 2, 7, 8, 13, 14, 15, 16
LCX = regions 3, 4, 9, 10
RCA = regions 5, 6, 11, 12
Parasternal Long Axis (PLAX) Parasternal Short Axis (PSAX)
2 1 2
6 15
4 3 12 9
4
Apical 4 Chamber (A4C) Apical 2 Chamber (A2C)
7 8 13 14
6 9 12 15
5 10 11 16

Using the Cardiac The cardiac calculation report allows you to view and edit all of the
Calculation Report measurements you perform and the subsequent calculations results. You
and Worksheet can save the report to the on-board AEGIS system, record it to VCR, or
print it to a local printing device. The worksheet displays the values for
each measurement you performed.
◆ To display the cardiac calculation report:
1. Press [REPORT].
2. Press [RPT/WRKSHT] to switch between the report and the worksheet.
Use standard text editing techniques and the following keys {when you
work on the report and worksheet.
CONTROL USE
[IMAGE] Press to return to the live image.

[EXPAND] Press to include all of the available measurement
and calculation headings. Normally the report
displays only values that have been entered or
calculated.
[EDIT] Press to edit data in the worksheet.
home Press to go to first page of report.

end Press to go to last page of report.
PAGE Press up or down to scroll through the report.


PART 5
CARDIOVASCULAR FEATURES
Cardiovascular Features describes special features for cardiovascular
exams. This part includes the following chapters:
Chapter 22 Stress Echo Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Chapter 23 Transesophageal Transducers . . . . . . . . . . . . . . . . . . . . 155

Customizing Stress Echo
CHAPTER 22
STRESS ECHO STUDIES
Performing a stress echocardiography (stress echo) study involves storing

clips of several views of the heart in various stages of rest and activity,
under a stress echo protocol in the AEGIS digital image and data
management system.Wall motion scoring is then used to analyze the
completed stress echo study. The stored view clips are displayed while
scoring is performed, and once you’ve scored the views for each stage
you can review the calculation results in the cardiac calculation report.
NOTE: You perform wall motion scoring in the cardiac calculation
package, and view the calculation results in the cardiac calculation report.
For more information on the cardiac calculation package, see Chapter 21.
Customizing Stress The AEGIS system protocol parameters for a stress echo study are set up
Echo in the preset Stress Echo Exam Presets. You can use one of these Exam
Presets to perform your study or you can create your own Exam Preset
and your own AEGIS system protocol. For information on customizing
Exam Presets, see Chapter 4.
If you choose to set up your own AEGIS system protocol for a stress echo
study, you should start with the settings recommended by Acuson and
make adjustments to suit your specific needs. The only settings you may
want to change would be for Clips per Store, Clip Duration, Triggered
Delay, and Duration per Beat. If you change Compression, you will
trade off disk space for image quality. If you change Auto Review, you
will enter AEGIS system study review immediately after each clip store.
In most cases, you will not want to change the Capture Size or Save
Clips on Capture settings.
For more information on the AEGIS system, see Chapter 8.

Chapter 22 - Stress Echo Studies
Performing a Stress You store the clips for each view and stage of a stress echo study in the
Echo Study AEGIS system.
◆ To perform a stress echo study:
1. Begin a new study.
For more information on beginning a study, see Chapter 3 .
2. Recall the preset Stress Echo Exam Preset, or your custom Stress Echo
Exam Preset.
For more information on recalling Exam Presets, see Chapter 4.
NOTE: The following steps describe the names and settings used in the
preset Stress Echo Exam Preset. A customized Exam Preset or AEGIS
system protocol may use different names or settings.
3. Press PROTOCOL to choose the first stage for which you want to store
clips, such as Rest or Post for a standard stress echo study.
4. Press CLIP CONTROL to choose ROI and physio trace capture options.
Place the ROI box over the region of the image that you want to
capture.
You need to use ROI to appropriately center and size your image. If
you do not place the ROI box, a default region will be selected.
For more information about using CLIP CONTROL, see “Storing
Clips” on page 46.
5. Store several clips from each of the standard views: PLAX, PSAX,
A4C, and A2C.
6. Press REVIEW to review the stored clips for this stage.
7. Using the trackball, highlight the clip you want to select for your first
view, and press [SELECT] to include it in the Select Set.
Repeat this step for each view and select them in the following order:
PLAX, PSAX, A4C, and A2C. If you are using a customized AEGIS
system protocol, make sure you select the views in the order in which
the view names appear in the AEGIS Program Specific Functions
menu. See Chapter 29 for more information. This is the order that the
wall motion scoring views will appear in. Using the preset order
prevents having to define views manually later.
8. Press [ALL/SELECTED] to choose SELECTED and display only the
four selected clips.
9. Enter the cardiac calculation package to perform wall motion scoring
on the stored clips.
For more information, see Chapter 21 .
10. Press REVIEW to exit review.
11. Press PROTOCOL to select the next stage for which you want to store
clips.
12. Repeat steps 4 through 9 to store clips and perform wall motion
scoring for this stage.

CHAPTER 23
TRANSESOPHAGEAL TRANSDUCERS
Acuson provides the following Transesophageal Transducers optimized

for use in cardiac scanning.
TRANSDUCER IMAGING FORMAT IMAGING PLANES CHANNELS
V5M Vector array Multiplane 64

V510B Vector array Transverse 64
Longitudinal
V705B Vector array Transverse 32
Longitudinal
For the following important safety information concerning

Transesophageal Transducers, see your Safety Manual:
• Transducer power safety considerations
• Clinical contraindications
• Transducer leakage current
• Transducer covers
• Transducer care
• Using ultrasound coupling gels
• Precleaning
• Disinfecting and sterilizing procedures
• Transducer decontamination methods
• Storing transducers

Chapter 23 - Transesophageal Transducers
Monitoring the The system constantly monitors the temperature of the Transesophageal
Sensor Temperature Transducer and displays a series of messages on the screen to inform you
of the temperature and status. Each Transesophageal Transducer has a
thermal sensor that monitors the lens temperature during an exam and
displays it in the upper right corner of the display.
The thermal software contains three temperature limits that prompt the
system to display messages informing you of the temperature and
recommending appropriate responses. The following table lists
transducer temperature limits.
V5M V705B V510B
NEAR THERMAL LIMIT 40.0° C 40.0° C 40.0° C

THERMAL LIMIT 41.0° C 41.0° C 41.0° C
MAXIMUM THERMAL LIMIT 44.0° C 44.0° C 44.0° C
You can turn off the temperature display during normal scanning. If you
do so, the system displays the temperature only when it is at or above the
near thermal limit. To turn off the temperature display when the
temperature is less than 40.0° C:
1. Press THRML.
2. Press [LENS TEMP] to turn on or off the continuous display of the lens
temperature.

Monitoring the Sensor Temperature
Thermal Limit Messages The following table shows how to respond to the different thermal limit
messages.
MESSAGE MEANING ACTION
NEAR THERMAL LIMIT. The temperature is Turn OUTPUT counterclockwise to reduce

between the near thermal the transmit power to prevent the lens
limit and the thermal temperature from reaching the thermal
limit. limit.
AT THERMAL LIMIT The system has reached Press [OVERRIDE] to override and permit the
SYSTEM FROZEN. the thermal limit and transducer temperature to increase up to the
entered freeze mode. maximum thermal limit. The system exits
freeze mode and returns to scanning.
If you do not override, the system remains
frozen until the temperature drops below
the near thermal limit temperature.
MAXIMUM THERMAL The lens temperature has The system is inoperable until you change
LIMIT EXCEEDED. increased to the transducers or reinitialize the system. To
maximum thermal limit; reinitialize the system, disconnect the
the system enters transducer connector and reconnect it.
continuous freeze mode.
TRANSDUCER The system detects sensor 1. Disconnect the transducer connector
INOPERABLE. failure or the thermal from the system.
sensing software is not
2. If you have another transducer, connect
functioning.
it to the system.
3. Contact your Acuson Customer
Engineer for instructions.
If the lens temperature increases to the maximum thermal limit, the

system transmitter shuts down, the system enters a continuous freeze
mode, and the maximum thermal limit exceeded message appears on the
screen.

Inspecting the The Transesophageal Transducer should be carefully inspected before

Transducer each exam. If you find any damage or signs of wear, DO NOT use the
transducer. Check that the following items are working properly:
• Transducer tip and articulation section
• Intracavity and electrical cables
• Steering knobs
• Ratchet buttons that control the locking mechanism
Perform a leakage current test on the transducer at the end of each
transducer high-level disinfection procedure. Retest prior to use if the
transducer has not been used for an extended period of time or to check
the leakage current of the transducer in the event that it was damaged by
being dropped or struck against another object. See your Safety Manual
for more information on performing leakage current tests.
Covering the The transducer flexible neck should be in the straight position.
Transducer ◆ To cover the transducer:
1. Slide the cover over the narrow end of the applicator cone leaving
about 5 cm of the cover’s tip in excess at the narrow end and about 3
cm in excess at the wide end.
2. Fold about 3 cm of the cover under the wide rim of the applicator.
3. Place the plastic tubing on a disposable syringe and fill the syringe
with ultrasound coupling gel.
4. Push the plastic tubing into the applicator through the wide end.
5. Inject a quantity of gel into the tip of the cover and gently squeeze the
end of the cover to ensure that the gel is at the tip of the cover.
6. Remove the syringe and plastic tubing.
7. Insert the applicator over the tip of the transducer until the tip of the
cover contacts the tip of the transducer. Remove any air bubbles
between the tip of the transducer and the cover. Air bubbles can
impede sound wave transmission and should be removed.
Preparing the ◆ To prepare the system:

System 1. Connect and lock the transducer connector to the transducer port on
the front of the system.
2. Place the system in a stand-by mode (freeze the display) while you
prepare the patient.
3. Remove the patient’s dentures and other removable appliances.
4. Ensure that the transducer’s flexible neck can be adjusted smoothly.
5. Ensure the brakes are not applied (that is, make sure that the ratchet
buttons are in the off position).

Inserting the Transducer
Inserting the In an intraoperative procedure, insert the transducer after an

Transducer endotracheal tube is in place. If an endotracheal tube will not be used,
insert the transducer soon after induction of anesthesia. In pediatric
patients with nasotracheal intubation, use direct laryngoscopic vision to
guide the transducer.
To aid in inserting the transducer you may want to use a sterile, water-
soluble lubricating gel (K-Y jelly) on the tip of the transducer cover and
along the intracavity cable. A viscous lubricant may also be applied to the
transducer prior to insertion.
◆ To insert the transducer:
1. If appropriate, apply an aerosol local anesthetic solution to the
patient’s throat. Do not apply an aerosol anesthetic to the intracavity
cable.
2. Position the patient as determined by the physician.
For an outpatient procedure, a commonly used position to reduce the
possibility of aspiration and to optimize insertion is a horizontal and
left lateral decubitus position. Flex the patient’s right knee and place
it in front of the left leg to limit the patient’s mobility.
3. Place the smaller end of the bite guard into the patient’s mouth.
Orient the larger sides of the bite guard toward the patient’s nose and
chin.
WARNING! Damage that occurs from failure to use a bite guard may cause
electrical or mechanical hazard to the patient and is not covered under
warranty or service contract. Use a bite guard to protect the patient and
maintain your warranty and service contract.
4. Orient the transducer with the active face toward the patient’s chin,
as shown in the following illustration.
5. With the patient’s head flexed forward, insert the transducer through
the bite guard. Advance it to the posterior aspect of the tongue. If the
patient is conscious, instruct the patient to breathe gently through the
nose.
6. Using gentle pressure with your fingers, advance the transducer to
the esophageal orifice. If the patient is conscious, ask the patient to
swallow to help direct the transducer into the upper part of the
esophagus.
Mild resistance may be felt at 15 to 18 cm. Advance the transducer firmly
but do not force it. If moderate resistance is encountered the transducer
may be misdirected. Withdraw and redirect it if required. Continue to
insert the transducer until approximately 25 cm of the transducer cable is
inserted beyond the patient’s incisors.
When inserted, the active face of the transducer faces anterior. The
scanning plane is transverse when positioned with the active face anterior
as shown in the following illustration. The initial image of the heart at
approximately 25 cm from the incisors is the short-axis scan at the base of
the heart.

7. Support the transducer handle and cable in your arm and hand or
rest it next to the patient.
8. Adjust the position and orientation of the transducer as described in
“Adjusting the Transducer Tip Position” on page 161.
Active Face Transverse Plane
Selecting an During an exam you can change the position of the transducer tip to
Imaging Plane optimize tissue contact or to angulate the imaging plane to see the area of
interest. The directions for adjusting the flexible neck refer to the patient’s
orientation.
NOTE: You cannot rotate the imaging plane when the display is frozen
or when a Cine display is active.
Biplane Transducers When you begin an exam with a biplane Transesophageal Transducer, the
transverse plane is active. You can switch planes at any time during
Transverse plane real-time imaging. A symbol in the upper-left corner of the screen
T
indicates the active imaging plane.
Longitudinal plane
L ◆ To switch imaging planes, press BIPLANE.
Multiplane Transducers The multiplane Transesophageal Transducer allows you to rotate the
imaging plane by rotating the transducer crystal within the tip of the
Multiplane icon transducer. The starting position, when the transducer is initially plugged
into the system, is 0 degrees, which is equivalent to the transverse plane
in biplane TEE transducers. You can reorient the imaging plane any time
during real-time imaging by using the rotation control switch on the
forward (distal) portion of the transducer control housing.
◆ To reorient the imaging plane:
1. Press the raised portion of the rotation control switch to change the
rotation to a larger angle. (The harder you press, the faster the angle
rotates.)
2. Press the other side of the switch to obtain a smaller angle.
A rotation angle of 90° is equivalent to the longitudinal imaging plane in
biplane Transesophageal Transducers. A rotation angle of 180° results in a
mirror image transverse imaging plane. You can select intermediate
rotation angles to optimize imaging of the area of interest.

Adjusting the Transducer Tip Position
Adjusting the During an exam you can change the position of the transducer tip to
Transducer Tip optimize tissue contact or to angulate the imaging plane to see the area of
Position interest. Hold the transducer in your right hand with the intracavity cable
pointing away from your body.
Intracavity Cable
1. Turn the larger upper
adjustment knob clockwise,
toward the A marking, to move
the transducer tip anteriorly;
turn it counterclockwise, Bite guard
toward the P marking, to move
it posteriorly.
2. Turn the smaller lower

adjustment knob clockwise,
toward the R marking, to move
the transducer tip to the right;
turn it counterclockwise,
toward the L marking, to move
it to the left.
Transducer Cable
A/P Knob
(upper knob)
R
A
Handle
P
L/R Knob
(lower knob)
Removing the ◆ To remove the transducer:

Transducer
1. With your gloves on, ensure that the transducer adjustment is smooth
(not locked).
2. Gently pull the Transesophageal Transducer from the patient.
3. Remove the transducer cover. Regard it as potentially hazardous,
infectious waste and dispose accordingly.
4. Clean and high level disinfect the transducer as described in your
Safety Manual.
5. Check the electrical safety of the transducer as described in your
Safety Manual.

Compact 3-D If your Aspen system has the 3-D imaging option, you can collect a series
Imaging of two-dimensional images that can then be reconstructed into a
three-dimensional rendering. The 3-D feature requires the following:
• V5M transesophageal transducer
• TomTec Compact 3-D unit
• Aspen to Compact 3-D video and control cables (supplied by
TomTec Imaging Systems)
Refer to your Compact 3-D documentation for setup information.
The Aspen system receives trigger signals from the Compact 3-D unit,
and adjusts the V5M transducer by specified increments. Once the
transducer completes the specified rotation, the capture sequence is
completed and the Aspen system returns to normal imaging. The 3-D
image is then available for reconstruction and display on the Compact
3-D unit.
3-D imaging with the Compact is compatible with 2-D imaging only. This
feature is unavailable with Color Doppler, strip, or mixed modes.
◆ To reconstruct a 3-D image:
1. Press 3D to display the 3-D soft key menu.
The Aspen system sets the transducer to 0 degrees (home position)
and enters capture mode.
2. Press [STEP ANGLE = N] to select the number of degrees that the
transducer rotates between each successive 2-D image.
NOTE: The step angle must agree with the step angle selected on the
Compact 3-D unit.
The step angles are limited to factors of 180 degrees. For example, if
you select 18 degrees for the step angle, the transducer rotates 10
times, capturing 10 images.
3. Press [START 3D] to begin the image capture.
When the transducer completes the specified rotation and full
sequence of triggers, the capture sequence is done.
If something interrupts the capture sequence, you can press [EXIT 3D]
to abort the capture sequence.
Refer to your Compact 3-D documentation for Review information.

PART 6
VASCULAR FEATURES
Vascular Features describes special features for vascular exams. This part
includes the following chapter:
Chapter 24 Transcranial Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

CHAPTER 24
TRANSCRANIAL IMAGING
You can use the following approved transducers in 2-D, spectral Doppler,
or Color Doppler (CD) mode to perform adult transcranial (TCI) and
trans-orbital (TCI ORB) exams:
• S219
• 4V2
FDA power output guidelines specify that you must use power levels less
than the ones shown in the following table for transcranial and trans-
orbital exams. Acuson provides specialized Exam Presets that set up the
system to use the appropriate levels.
TRANSCRANIAL EXAMS TRANS-ORBITAL EXAMS
Approved Mechanical Index < 1.9 Mechanical Index < 0.23

Power Levels
(ODS
Transducers)
Approved 480 mW/cm2 I-SPTA < 25 mW/cm2 I-SPTA

Power Levels
(Non-ODS
Transducers)
Acuson provides the following Exam Presets for easy, high-resolution

transcranial imaging.
NAME USE
TCI 219 General transcranial imaging, V2/S219

transducer
TCI ORB 219 Transorbital imaging, V2/S219 transducer
TCI 4V2 General transcranial imaging, 4V2c transducer
TCI ORB 4V2 Transorbital imaging, 4V2c transducer
When you use one of these Exam Presets, FDA power level requirements
may appear in on-screen messages.

Chapter 24 - Transcranial Imaging
Initializing When you initialize a TCI-compatible transducer for use in TCI exams,
Transcranial the system optimizes the transducer for TCI exams and resets it for TCI
Transducers power levels. The TCI format name appears on the screen in place of the
transducer name. The following table lists the TCI transducers and their
corresponding TCI format names.
◆ To automatically initialize a TCI transducer, recall a TCI Exam
Preset.
You can also create your own custom TCI Exam Preset. See Chapter 4.
◆ To manually initialize a TCI transducer, press OPTIONS to display
the Options pop-up menu and select the format you want.

PART 7
GENERAL IMAGING FEATURES

General Imaging Features describes special features for radiology exams.
This part includes the following chapters:
Chapter 25 Using Needle Guides . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Chapter 26 Endocavity Transducers . . . . . . . . . . . . . . . . . . . . . . . . . 185
Chapter 27 Laparoscopic Transducers . . . . . . . . . . . . . . . . . . . . . . . 197
Chapter 28 Intraoperative Transducers. . . . . . . . . . . . . . . . . . . . . . . .211

Using Needle Guides
CHAPTER 25
USING NEEDLE GUIDES
USING NEEDLE GUIDES

This chapter clarifies the procedures for using Needle Guides on
Acuson ultrasound systems. Use it in place of the Needle Guide
chapter in your User’s Manual. (For information about using
Endocavity Needle Guides, see the Endocavity Transducer chapter
in your User’s Manual.)
This chapter covers the following topics:
• Using the Needle Guide Program
• Practicing the Needle Guide Procedure
• Needle Guide Kits
• Preparing a Transducer
• Using Specific Needle Guides
Using the Needle The Needle Guide program displays the projected needle path on
Guide Program the 2-D image. Use the following procedure to perform a biopsy
using the Needle Guide program. Practice this procedure, as
described in “Practicing the Needle Guide Procedure” on page 171,
before using it during an exam.
◆ To perform a biopsy using the Needle Guide program:
1 Connect the transducer you intend to use for the biopsy and begin a
2-D scan of the appropriate anatomy.
For a list of transducers that support Needle Guides, see “Using
Specific Needle Guides” on page 173.
2 Press NEEDL GUIDE to display the needle path.
3 If the Needle Guide you are using supports connecting needles at
different angles, you see a soft key menu for selecting an angle.
Press the soft key corresponding to the angle you intend to use.
4 Display a single caliper and position it along the needle path at the
target site for the biopsy.
The system displays two measurements:
• The minimum needle length measurement (MIN NEEDLE)
reports the minimum needle length required to perform the
biopsy.

Chapter 25 - Using Needle Guides
• The puncture-to-site measurement (PUNCTURE TO SITE)

reports the distance from the puncture site to the caliper
position.
IMPORTANT: The caliper MUST be placed along the needle path. If it is not, the
displayed measurements may be incorrect.
5 Select a needle for the biopsy procedure that is at least as long as the
minimum needle length measurement.
6 Prepare the transducer cover and Needle Guide following the
specific instructions for the transducer you are using in “Using
Specific Needle Guides” on page 173.
7 Return to scanning within the Needle Guide program at the biopsy
site, insert the needle along the displayed needle path, and perform
the biopsy.
The screen shows both the displayed path and the actual needle
path. The displayed path is provided as an indicator only. The
needle may bend or deflect slightly as it moves through the tissue.
You must monitor the progress of the needle tip by watching the
image on the screen. If the motion of the needle on the screen
appears uncoordinated with the needle movement, you may want
to increase the frame rate.
8 Remove the needle, and then disassemble and disinfect the Needle
Guide according to the specific instructions for the transducer you
are using in “Using Specific Needle Guides” on page 173.
9 To exit the Needle Guide Program, press NEEDL GUIDE. To exit, the
Needle Guide must be at the top function. If not, the first key press
will bring it to the top.

Using Needle Guides
Practicing the Acuson recommends that you practice the Needle Guide procedure
Needle Guide with each transducer. The practice procedure allows you to increase
Procedure your skill with these options and to verify that the Needle Guide is
operating properly.
The materials required to perform this practice procedure include:
• A beaker, pail, sink, or paper cup at least 15 cm (6 in) deep
• A straight 18- or 20-gauge needle or cannula, 15 to 25 cm long
• Needle Guide, Needle Guide kit, and compatible transducer
• Acuson system with Needle Guide software
◆ To practice the Needle Guide procedure:
1 Fill the beaker, pail, sink, or paper cup with at least 12 cm of water.
Degassed water, obtained by filling the container with water six to
eight hours prior to performing the procedure, improves visibility
of the needle.
2 Cover the transducer as described in “Preparing a Transducer” on
page 172.
3 Assemble the Needle Guide according to the specific Needle Guide
instructions in “Using Specific Needle Guides” on page 173.
4 Enter the Needle Guide program to display the needle path.
5 If the Needle Guide you are using supports different angles, you see
a soft key menu for selecting an angle. Press the soft key
corresponding to the angle you intend to use.
6 Immerse the active face of the transducer no more than 2 cm.
WARNING! DO NOT immerse the transducer beyond 2 cm. Doing so may

damage the transducer.
7 Insert the needle through the barrel to its maximum depth.

The needle should remain within the needle path displayed on the
screen. If the needle falls outside the displayed path, contact your
Acuson Customer Engineer.
Needle Guide Kits Each Needle Guide starter set contains reusable Needle Guide
adaptors and sterile procedure kits. Each disposable procedure kit
contains the following components:
• Set of sized needle insert barrels
• Transducer cover
• Needle clip (for Slide-On Needle Guides only)
• Sterile packet of coupling gel
You can obtain additional sterile procedure kits from your Amedic
or Civco Sales Representative.

Preparing a Always use a protective transducer cover over the transducer when
Transducer you use a Needle Guide. Some Needle Guides require that you
apply the cover before you assemble the Needle Guide onto the
transducer. Other Needle Guides require that you apply the cover
after you assemble the Needle Guide onto the transducer. Follow
the instructions for your specific Needle Guide in “Using Specific
Needle Guides” on page 173.
Use the following sterile procedure to apply the cover.
IMPORTANT: Use proper sterile technique at all times when removing the
transducer cover and other accessories from the sterile kit. Two
people are required to perform this procedure.
◆ To cover the transducer:

1 For transducers that require Needle Guide assembly before
covering transducer:
Attach Needle Guide onto uncovered transducer following the
instructions in “Using Specific Needle Guides” on page 173.
If assembly is required after covering transducer, skip to step 2.
2 Non-sterile person: Apply a moderate amount of coupling gel to
the active face of the transducer.
3 Sterile person: Remove the transducer cover from the sterile kit and
gather it at the tip.
4 Non-sterile person: Hold the transducer by the cable and place it
into the transducer cover.
5 Sterile person: Pull the cover over the transducer, smoothing the
cover to remove the air bubbles. Air bubbles can impede sound
wave transmission. DO NOT use a transducer cover that is cut,
torn, or otherwise not completely intact. Be careful not to over-
stretch the transducer cover. Covers that are too tight can tear later,
when you attach the Needle Guide to the transducer.
6 Sterile person: Secure the transducer cover in place using the tie
straps at the end.
7 For transducers that require Needle Guide assembly after covering
transducer:
• Sterile person: Attach Needle Guide onto covered transducer
following the instructions in “Using Specific Needle Guides” on
page 173.
• If the Needle Guide is already assembled under the transducer
cover, skip to step 8.
8 Sterile person: Remove and open the tube of sterile gel from the kit
and apply gel to the active face of the transducer.

Using Needle Guides
Using Specific The remainder of this document contains instructions for

Needle Guides assembling, disassembling, and disinfecting specific Needle
Guides.
IMPORTANT: Be sure to follow the instructions for the transducer and Needle
Guide that you are using. There are different procedures for
different Needle Guides.
WARNING! Acuson Needle Guides are designed and manufactured to attach

firmly to designated transducers and should not require excessive
force to assemble or disassemble. If it appears that excessive force
or manipulation is required to assemble or disassemble Needle
Guide components, please contact your Acuson Customer
Engineer before using it.
The following table lists available Needle Guides and tells where, in
this section, to find information on each.
Transducer: For instructions, see:
4C1 “Civco Needle Guides” on page 174
4V1 “Civco Needle Guides” on page 174
5C2g “Civco Needle Guides” on page 174
6C2 “Civco Needle Guides” on page 174
13L5 “Civco Needle Guides” on page 174
C3 “Original Quik-Clip Needle Guides” on page 179
C7 “Quik-Clip Needle Guides” on page 175
L5 “Original Quik-Clip Needle Guides” on page 179
V4 “Original Quik-Clip Needle Guides” on page 179
V328 “Using Slide-On Needle Guides” on page 182

Civco Needle Acuson has contracted with Civco Medical Instruments to design
Guides and produce Needle Guides for some Acuson transducers. These
Needle Guides (which you purchase from Acuson) are shipped
with a manual that describes how to use the Needle Guides with
the Acuson transducers. Follow the instructions in the Civco
manual to learn how to attach, detach, and disinfect the Needle
Guide.
Be sure to check the Civco booklet to learn whether to assemble the
Needle Guide over or under the transducer cover. Also check
disinfecting and sterilizing instructions; Civco Needle Guides have
different requirements from Acuson Needle Guides.
If you need to reorder one of these Needle Guides or order
additional brackets for the Needle Guide, contact your Acuson
Sales Representative.
If you need to reorder sterile biopsy kits, contact Civco Medical
Instruments.
Supported Transducers • 4C1

• 4V1
• 5C2g
• 6C2
• 13L5
Multiple Angle Paths The 4C1 (dual angle) and 4V1 Needle Guides support attaching
needles at different angles. When using the Needle Guide program,
you must press the soft key corresponding to the angle that you are
using to display the correct needle path.

Using Needle Guides
Quik-Clip Needle Acuson Quik-Clip™ Needle Guides are available for use with
Guides several transducers. The C7 transducer uses a unique, plastic
Needle Guide. For information about other Quik-Clip Needle
Guides, see “Original Quik-Clip Needle Guides” on page 179.
The Quik-Clip Needle Guides have two parts. The adapter
assembles onto the transducer. The barrel assembles onto the
adapter and holds the needle. Choose the barrel corresponding to
the gauge of the needle you want to use.
IMPORTANT: The C7 Quik-Clip Needle Guide uses a unique type of barrel. Do

not try to use barrels from other Quik-Clip Needle Guides with
this Needle Guide.
Supported Transducers • C7
Supported Needle Types • Needles from 14 to 22 gauge

• 8 French catheters

Assembling the Needle • Transducers that support the C7 Quik-Clip Needle Guide.
Guide
• C7 Quik-Clip Needle Guide have indentations, called detents, on
either side for holding the guide in place.
H-shape detent
Circular detent
Locator ball
H-shape clip
Use the following procedure to attach the Needle Guide adapter in

the detents and connect the barrel to the adapter.
• To assemble the C7 Quik-Clip Needle Guide
◆ C7 Quik-Clip Needle Guide:
page 172.
2 Place the locator ball on

the inside of the
adapter into the
circular detent on the
transducer.
3 Slide the Quik-Clip

Needle Guide down
into the H-shaped
detents of the
transducer (on the
orientation groove
side).

Using Needle Guides
4 Insert the appropriate

size barrel into the
barrel holder.
5 Twist the barrel to lock

it into position.
6 Insert the needle

through the funnel
opening in the top of
the barrel.
Releasing the Needle • To detach the needle from a C7 Quik-Clip Needle Guide
from the Needle Guide
◆ C7 Quik-Clip Needle Guide:
1 Turn the tab on the barrel clockwise to expose the opening of the
barrel.
2 Slide the transducer with the Needle Guide away from the needle.
The needle is still inserted in tissue.

Disassembling the ◆ To disassemble the C7 Quik-Clip Needle Guide:

Needle Guide
1 Turn the tab on the barrel counter clockwise to unlock the barrel.
2 Press the lever on the Needle Guide towards the transducer to
release the Needle Guide.
3 Dispose of the barrel and transducer cover.
4 Clean, sterilize, and store the Quik-Clip Needle Guide. Clean,
disinfect, and store the transducer.
Disinfecting the Needle Always disinfect a Quik-Clip Needle Guide after each use.
Guide
◆ To disinfect a C7 Quik-Clip Needle Guide after use:
1 Clean the Needle Guide with a brush or cloth that has been
dampened with soap and water or with a specialized soap and
precleaner. You can use any of the precleaning solutions listed in
your system manuals.
2 Sterilize the Needle Guide using one of the following techniques:
• Steam sterilization (autoclaving)
• Ethylene oxide (ETO) sterilization
• Dry heat sterilization
• Liquid sterilization
You can use any of the high-level disinfecting/sterilizing liquids listed in
your system manuals. Follow the sterilizing agent manufacturer’s
instructions for use.

Using Needle Guides
Original Quik-Clip Acuson Quik-Clip™ Needle Guides are available for use with
Needle Guides several transducers. Although these Needle Guides operate in the
same way, be sure only to use the Needle Guide designed for the
specific transducer that you are using.
The Quik-Clip Needle Guides have two parts. The adapter
assembles onto the transducer. The barrel assembles onto the
adapter and holds the needle. Choose the barrel corresponding to
the gauge of the needle you want to use.
IMPORTANT: Do not try to use barrels from the C7 Needle Guide with original
Quik-Clip Needle Guides.
Supported Transducers • C3, C5, L5, L582, L7, V4

• 8 French catheters
Assembling the Needle Transducers that support the original Quik-Clip Needle Guide have
Guide indentations, called detents, on either side for holding the guide in
place.
Vertical detent
Vertical bar
Horizontal
detent
Needle Guide
body
Roller bar
Use the following procedure to attach the Needle Guide adapter in
the detents and connect the barrel to the adapter.
◆ To assemble the original Quik-Clip Needle Guide:
page 172.
2 Place the vertical bar on

the guide in the vertical
detent on the
transducer.
Hold the Needle Guide
body in place with your
thumb.

3 Smooth the transducer

cover as you roll the
Needle Guide roller bar
into the horizontal
detent.
4 Verify that the Needle

Guide is correctly
attached into the detents.
5 Insert the appropriate

size barrel into the barrel
holder.
6 Twist the tab to lock the

barrel into position.

Using Needle Guides
7 Insert the needle through

the funnel opening in the
top of the barrel.
Releasing the Needle ◆ To detach the needle from an original Quik-Clip Needle Guide:
from the Needle Guide
1 Turn the tab on the barrel clockwise to expose the opening of the
barrel.
2 Slide the transducer with the Needle Guide away from the needle
still inserted in tissue.
Disassembling the ◆ To disassemble the original Quik-Clip Needle Guide:

Needle Guide
1 Twist the barrel to unlock it, and then remove it from the guide.
2 Remove the guide by pressing up on the roller bar.
3 Dispose of the barrel and transducer cover.
4 Clean, sterilize, and store the Quik-Clip Needle Guide. Clean,
disinfect, and store the transducer. Dispose of all procedure kit
supplies.
Disinfecting the Needle Always disinfect a Quik-Clip Needle Guide after each use.
Guide
◆ To disinfect a Quik-Clip Needle Guide after use:
precleaner. You can use any of the precleaning solutions listed in the
Transducer Specifications Manual.
2 Sterilize the Needle Guide using one of the following techniques:
• Steam sterilization (autoclaving)
• Ethylene oxide (ETO) sterilization
• Dry heat sterilization
• Liquid sterilization
You can use any of the high-level disinfecting/sterilizing liquids
listed in the Transducer Specifications Manual. Follow the sterilizing
agent manufacturer’s instructions for use

Using Slide-On A Slide-On Needle Guide is available for use with several Aspen
Needle Guides and 128XP transducers. The Slide-On Needle Guide allows you to
attach a needle on either side. The adapter assembles onto the
transducer. One side provides a 15° needle path, and the other
provides a 30° needle path. When using the Needle Guide program,
press the corresponding soft key to select the path you want to use.
Supported Transducers • V328

You can attach a needle clip to either side of the Needle Guide
adapter.

Using Needle Guides
Assembling the Needle ◆ To assemble the Slide-On Needle Guide:

Guide
1 Align the ridge on the
inside of the more
prominent side of the
Needle Guide adapter
with the groove on the
side of the transducer.
The top of the adapter
should point toward
the active face of the
transducer.
2 Place the transducer cable through the opening in the Needle

Guide adapter.
3 Hold the transducer and slide the Needle Guide adapter from the
cable toward the active face of the transducer until it snaps into
place.
DO NOT pull the transducer cable when attaching the Needle
Guide adapter.

page 172.
The sterile person should perform the remaining steps.
5 Select the sterile barrel appropriate for the gauge of the needle you
will use.
6 With the tab pointing upward, insert the barrel into the needle clip
through the “T” cutout.
7 Gently turn the tab toward the transducer to lock it in position.
DO NOT overtighten the barrel tab when locking it in place.
8 Insert the needle

through the barrel.

Releasing the Needle ◆ To detach the needle from a Slide-On Needle Guide:
from the Guide
1 Turn the tab on the barrel away from the transducer to unlock it.
2 Remove the needle from the needle clip and dispose of it
appropriately.
Disinfecting the Needle Slide-On Needle Guide adaptors do not generally require
Guide sterilization because they are used under a sterile sheath.
◆ To disinfect a Slide-On Needle Guide after use:
precleaner.
2 Sterilize the Needle Guide by soaking it in a compatible sterilizing
solution.
See your system manuals for a list of compatible solutions. Follow
the sterilizing agent manufacturer’s instructions for use.

CHAPTER 26
ENDOCAVITY TRANSDUCERS
Acuson endocavity transducers have imaging capabilities similar to other

Acuson transducers including the ability to operate in the following
modes: 2-D imaging mode, M-mode, pulsed Doppler mode, and Color
Doppler (Color Doppler Velocity and Color Doppler Energy) mode.
Acuson provides the following endocavity transducers and Needle
Guides for use with the following transducers.
TRANSDUCER TYPE NEEDLE NEEDLE NEEDLE

GUIDE TYPE GAUGE LENGTH
EVC8 Endovaginal Reusable 16 gauge 25 cm or

and higher more
EV7 Endovaginal Reusable 16 gauge 25 cm or

and higher more
EC7 Endovaginal Disposable 16 gauge 20 cm or

Endorectal and higher more
ER7B Biplane Third-party stepper (seed implant)

Endorectal devices (not provided by Acuson)
For the following important safety information concerning endocavity

transducers, see your Safety Manual:
• Transducer power safety considerations
• Clinical contraindications
• Transducer covers
• Transducer care
• Using ultrasound coupling gels
• Precleaning
• Disinfecting and sterilizing procedures
• Transducer decontamination methods
• FDA warnings for latex products
• Storing transducers

Chapter 26 - Endocavity Transducers
Endocavity Safety Be sure to read your Safety Manual before performing endocavity exams.
and Supplies This section presents additional information about endocavity safety and
supplies.
Using Transducer Kits Endocavity transducer kits include the following material:
• Endocavity transducer
• Plastic card with transducer cleaning instructions
• Plastic carrying and storage case
• Latex transducer covers and elastic bands
Using and Obtaining To use the endocavity transducers, you need the following additional
Additional Items items:
• Protective transducer covers
• Endorectal disposable biopsy kits
• Disinfection/sterilization solution and decontamination containers
• Ultrasound coupling gel
Protect an endocavity transducer with a cover during patient exams. You
can use specially designed latex transducer covers, over-the-counter
condoms (without reservoir ends), or sterile transducer covers. (See your
Safety Manual for important warnings about using latex products.)
Products for High Level Use only the disinfecting and sterilizing solutions listed in your
Disinfection/Sterilization Transducer Specifications Manual as compatible with endocavity
transducers. Use of any other solutions or procedures will void your
transducer warranty.
Only products with specific commercial names listed in your Transducer
Specifications Manual are compatible with the material used in certain
Acuson transducers. Products with variations of these names, or products
that manufacturers insist are equivalent, must be reviewed by Acuson.
Any product that is not on the list is not known to be compatible with
Acuson transducers. For information, please contact Acuson Customer
Information Center (CIC) at 1 (800) 228-4128. Also, contact the
manufacturer of the solution for information regarding the solution’s
FDA and EPA regulatory status for the purpose of cleaning, disinfecting,
and sterilizing.
Refer to your Transducer Specifications Manual for a list of manufacturers.
Contact listed manufacturers for information about obtaining these
solutions.
Ultrasound Coupling Gel Use an ultrasound coupling gel to prepare the transducer for an exam. We
recommend you check with the product’s manufacturer to determine
FDA regulatory status and appropriate use. For additional information
about coupling gels, see your Transducer Specifications Manual.
WARNING! For vaginal imaging, be especially careful when choosing an

ultrasound coupling gel. Certain ultrasound coupling gels may be toxic
to human reproductive cells.

Endocavity Safety and Supplies
Biopsy Instruments The endorectal Needle Guides are compatible with most biopsy
instruments. Biopsy kits and automated biopsy guns are available from
the following sources:
INSTRUMENT MANUFACTURER
Endorectal disposable 102 First Street South
biopsy kits Kalona, IA 52247
800 445-6741
(319) 656-4447
Fax: (319) 656-4451
Automated biopsy Bard Urological Division
guns CR Bard, Inc.
Covington, GA 30209
800-526-4455
Boston Scientific Division of Meditech
480 Pleasant Street
Watertown, MA 02172
(617) 923-1720
800-225-3238
Using Transducer Acuson recommends that you use protective transducer covers to cover
Covers the transducer during patient exams. After each exam, regard the
transducer cover and any other wastes as potentially infectious and
dispose of them accordingly.
Cleaning, Sterilizing, and For transducer cleaning, sterilizing, and high level disinfecting
High Level Disinfecting procedures, see your Safety Manual. For approved cleaning, sterilizing,
and disinfecting solutions, see your Transducer Specifications Manual.
Needle Guide Safety Always follow these basic precautions:
• INSPECT the Needle Guide prior to use to ensure that it is not bent or
misshaped. DO NOT use the Needle Guide if it is deformed in any
way. Contact an Acuson Customer Engineer to inspect it.
• Follow all the basic precautions for endocavity transducer safety and
maintenance described in “Using Endovaginal Transducers” on
page 188.
• STERILIZE reusable endovaginal Needle Guides before each use.
These Needle Guides can be used multiple times and are, therefore,
NOT shipped sterile.
• DO NOT use any disposable Needle Guides after the sterility
expiration date.
Sterilizing Reusable If the Needle Guide is contaminated with blood, body fluids, or other
Needle Guides materials, always high level disinfect it before cleaning.
The Needle Guide must be sterilized using one of the following
procedures prior to use and between exams:
• Steam sterilization
• Gas sterilization
• Soak in a sterilizing solution—only use solutions that are cleared by
FDA and approved by EPA, such as Cidex; follow the disinfecting
agent manufacturer’s instructions for use.

Storing the Needle Guide After you clean and sterilize a Needle Guide, store it in the original
shipping packing or with the endovaginal transducer in its storage case.
Using Endovaginal
Transducers
2. Place a small amount of ultrasound

1. Connect the Endovaginal
coupling gel on the inside surface at
transducer to an active port on the
the tip of the latex transducer cover
front of the system and lock it into
and on the tip of the transducer.
place.
3. Place the transducer cover 4. You can optionally use an 5. Place enough ultrasound coupling
on the transducer so it covers elastic band to hold the gel or lubricating jelly on the end of
the insertable portion of the transducer cover in place at the covered transducer to facilitate
transducer. the transducer handle. insertion.
Using Endovaginal Consider practicing positioning and assembling the Needle Guide and
Needle Guides endovaginal transducer before performing a sterile procedure.
Use the correct preparation and examination procedures described in this
manual for assembling and disassembling Needle Guides.
WARNING! Acuson Needle Guides are designed and manufactured to attach firmly
to designated transducers and should not require excessive force to
position or disassemble. If it appears that excessive force or
manipulation is required to position or disassemble Needle Guide
components, please contact your Acuson Customer Engineer before
using it.
Attaching Needle Guides ◆ To attach a Needle Guide, follow the procedure for your specific
transducer in the following sections.
PROCEDURE SECTION
EV7 Needle Guide “EV7 Needle Guide” on page 190
EC7 Needle Guide “EC7 Needle Guide” on page 190
EVC8 Needle Guide “EVC8 Needle Guide” on page 189

Using Endovaginal Needle Guides
EVC8 Needle Guide ◆ To attach the Needle Guide:

1. Sterilize the Needle Guide.
2. Cover the transducer as described in “Using Endovaginal
Transducers” on page 188.
3. Gather any slack in the transducer cover to the underside of the
transducer. Hold the Needle Guide directly over the transducer and
assemble as shown in the following illustration.
4. Apply a small amount of sterile coupling gel on the transducer cover

at the active face.
5. Optionally cover the transducer and the Needle Guide with the
translucent, loose fitting transducer cover from the Needle Guide kit.
The gel on the first transducer cover couples the two covers.

EV7 Needle Guide
1. Place the Needle Guide

onto the transducer so
that the upper ridge fits
into the upper groove of
the transducer.
;; 2. Tighten the thumbscrew

until it is snug.
DO NOT overtighten.
EC7 Needle Guide

On (down only)
1 2
Gel on Inside
Gel on Outside
O-ring
Transducer Cover
Gel on Inside
Gel on Outside
O-ring
Transducer Cover

Performing Endorectal Exams and Biopsies
Using the Needle Guide ◆ To perform a Needle Guide biopsy, follow the procedures
Program described in “To perform a biopsy using the Needle Guide
program:” on page 169 and “Using the Needle Guide Program”
on page 191.
Disassembling Needle After each exam, regard the transducer covers and any other wastes as
Guides potentially infectious and dispose of them accordingly.
IMPORTANT: Be sure to wear gloves while disassembling a Needle Guide.
◆ To detach a Needle Guide:

1. Reverse the attachment procedure to remove the Needle Guide from
the transducer.
2. Disinfect the Needle Guide and transducer as described in your
Safety Manual.
Performing You can perform endorectal exams with or without a water path.
Endorectal Exams High level disinfect the transducer prior to use and between each exam.
and Biopsies Disconnect the transducer from the system before preparing it for use.
Prepare the transducer as shown in the following illustration.
Preparing with a Cover
Only (No Water Path)
1. Disconnect the transducer 2. Place a small amount of ultrasound coupling gel

from the system. on the inside surface of the tip of the latex
transducer cover.
Transducer Cover Gel on Outside
Gel on Inside
3. Place the transducer cover on the transducer

so it covers the insertable portion of the
transducer.

Preparing for Endorectal Before you begin, fill a 60-cc syringe with degassed water.
Exams with a Water Path
To de-gas tap water or bottled sterile water, set it out overnight in an open
container. After degassing the water, be careful to agitate it as little as
possible to prevent creating new air bubbles.
1. Disconnect the transducer from the system.
2. Roll the transducer cover down the shaft of the transducer.
3. Slide the rubber O-ring over the transducer cover, starting from the
pointed side of the lens (active face), using both thumbs to ease the O-
ring over the transducer head. Secure the O-ring in place in the
groove at the base of the transducer head. The O-ring fit should be
snug. Ensure that there are no folds under the O-ring as it fits into the
groove. Reposition the O-ring or transducer cover to eliminate any
folds, if necessary.
NOTE: Folds in the transducer cover or use of an alternate or wrong-
sized transducer cover might impact the quality of the water path
function.
◆ To fill the transducer cover with water:
1. Attach a stopcock valve to the filled syringe.
2. Connect a section of IV extension tubing to one end of the stopcock
and connect the other end of the tubing to the transducer handle fill
port, as shown in the following illustration.
3. Open the stopcock valve and inject about 30 cc of water into the
transducer. Water fills the transducer cover and surrounds the
insertable end of the transducer. Air bubbles are visible under the
transducer cover.
Transducer Cover O-ring in Place
Fill Port
Syringe Tubing
Stopcock Valve

Beginning an Endorectal Exam
◆ To remove the air bubbles under the transducer cover:

1. Hold the transducer by the handle with the water port facing up.
2. Tilt the active face of the transducer upward, so that the air inside the
transducer cover rises.
3. Withdraw the air into the syringe while gently bumping the
remaining bubbles toward the water port until most of the bubbles
are in the syringe.
4. Close the stopcock and remove the syringe from the IV tubing. Invert
the syringe and expel the air.
5. Reconnect the syringe to the stopcock and repeat Steps 1 through 4
until there are no air bubbles under the transducer cover. Removing
all the air from under the transducer cover can require several
attempts.
6. When all the air has been removed, withdraw all the water from the
transducer cover into the syringe and close the stopcock. The
transducer is now ready to use. Refill the transducer cover with water
once it is inserted into the patient’s rectum.
Leave the transducer IV extension tubing, stopcock, and syringe
connected to the transducer during the exam.
Beginning an Before inserting the transducer, many clinicians and urologists

Endorectal Exam recommend that you perform a digital rectal exam to palpate the prostate
and check for contraindications to insertion of the endorectal transducer.
Also, this digital exam will prepare the patient to more easily accept the
endorectal transducer insertion. Be sure to wear gloves while performing
this procedure.
◆ To begin an exam:
1. Connect the transducer to the Acuson system and lock it in place.
IMPORTANT: The ER7B transducer connects to two DL connector ports. A T appears

in the upper-left corner of the transverse (Curved array) plane; an L
appears in the upper-left corner of the longitudinal (Linear array) plane.
Both of the DL connectors on the ER7B transducer must be connected
and locked into the connector ports on the system before the
transducer will initialize. If both of the DL connectors are connected
but initialization does not occur (an error message does not appear),
remove and reseat both of the DL connectors into the transducer ports.
WARNING! While inserting the transducer into the two ER7B transducer DL
connector ports, do not touch the transducer and the patient
simultaneously.
2. Place enough ultrasound coupling gel or lubricating jelly on the end

of the covered transducer to facilitate insertion.
3. Position the patient as determined by the staff supervising urologist
or radiologist. The most commonly used position is the left-lateral
decubitus position with the patient’s knees bent up toward the chest.

4. Have the system actively scanning, so that you can visualize that the
transducer is correctly inserted and positioned. DO NOT freeze the
image. While the system is actively scanning, the screen shows an
image that indicates the transducer position and depth of insertion.
5. For coronal images, the orientation groove should be in the up
position (toward the patient’s right hip). For longitudinal images, the
orientation groove should be directed posteriorly. (The orientation
may be changed for biopsy procedures.)
6. Insert the transducer into the patient’s rectum while viewing the
depth of insertion on the screen.
Determine and review with your staff urologist or radiologist the
techniques and precautions for inserting the endocavity transducers
into the rectum.
It is sometimes useful to invert the 2-D image when performing
ultrasound exams or biopsies of the prostate. For instructions, see
Chapter 9.
7. If the water path is used, when the transducer is properly positioned
in the rectum, inject water into the fill port to fill the transducer cover.
Use enough degassed water to make contact with the rectal wall to
maximize image quality (normally from 10 cc to 50 cc).
NOTE: Inject additional water into the transducer cover to move the
transducer farther from the rectal wall and the prostate.
Selecting an Imaging The ER7B endorectal transducer provides longitudinal and transverse
Plane imaging planes.
When you begin an exam with the ER7B endorectal transducer, the
transverse plane is active. You can switch planes any time during real-
time imaging. A symbol in the left side of the screen indicates the active
imaging plane/orientation.
SYMBOL IMAGING PLANE
T Transverse plane
L Longitudinal plane
NOTE: You cannot switch imaging planes when the display is frozen or
when a Cine display is active.
When you switch planes, the system maintains all parameter settings
except the 2-D image orientation. For your convenience, the system stores
2-D image orientation settings separately for each imaging plane. When
you switch from one plane to the other, the 2-D image appears with the
orientation last used with that plane. You can save your preferred
orientation for each individual plane in an Application program.
◆ To switch imaging planes, press BIPLANE.

Endorectal Needle Guides
Endorectal Needle Consider practicing positioning and assembling the Needle Guide and
Guides endorectal transducer before performing a sterile procedure.
Use the correct preparation and examination procedures described in this
manual for assembling and disassembling Needle Guides.
WARNING! Acuson Needle Guides are designed and manufactured to attach firmly
to designated transducers and should not require excessive force to
position or disassemble. If it appears that excessive force or
manipulation is required to position or disassemble Needle Guide
components, please contact your Acuson Customer Engineer before
using it.
Before attaching a Needle Guide, prepare the transducer with a cover as

described in “Performing Endorectal Exams and Biopsies” on page 191.
Attaching Needle Guides ◆ To attach a Needle Guide, follow the procedure for your specific
transducer in the following sections.
EC7 Needle Guide
ON: down only

1 2
Gel on inside
Gel on outside
O-ring
Transducer cover
Gel on inside
Gel on outside
O-ring
Transducer cover
◆ To detach a Needle Guide, reverse the attachment procedure.

Verifying Needle You can use the Acuson ER7B Endorectal Transducer with third-party
Visualization on A stepper devices to support brachytherapy applications. (For a list of
Grid Array Display compatible stepper devices, contact your Acuson Customer Engineer.)
The Acuson system displays an onscreen grid array that corresponds to
the grid array template on the stepper device. The RES function is not
available when the grid is displayed. Acuson recommends that you use
the following steps to verify the operation of the stepper device with the
Acuson system.
The materials required to perform this practice procedure include:
• Pail or sink at least 15 cm (6 in) deep
• A straight needle, 15 cm long with the gauge size specified on the
grid array template
• Stepper device kit to support brachytherapy and transducer
• Acuson system with Grid Array software display to support
brachytherapy.
◆ To practice the Grid Array procedure:
1. Fill the pail or sink with at least 15 cm of water.
Degassed water, obtained by filling the container with water six to
eight hours prior to performing the procedure, improves visibility of
the needle.
2. Assemble the stepper device following the manufacturer’s
instructions. For the purpose of this procedure, do not attach the
stepper device to the table.
3. On the Acuson system keyboard, press NEEDL GUIDE to display the
grid array on the screen.
4. Insert the transducer into the stepper device.
5. Position the stepper device assembly so that the transducer is
inserted into the pail or sink at 90°, with the tip down.
Slightly immerse the curved array face of the transducer.
Stabilize the stepper guide assembly on the edge of the container.
6. Insert the needle through the grid array template.
NOTE: Check the needle gauge size printed on the grid array template,
and use only needles of the same gauge size. Do not use smaller diameter
needles.
7. Verify that the needle appears on the screen grid.
The needle location on the screen grid array should correspond to the
grid array template. If the needle does not appear on the screen or its
position does not correspond to the template position, contact your
Acuson Customer Engineer before using the stepper device.

General Safety Guidelines
CHAPTER 27
LAPAROSCOPIC TRANSDUCERS
General Safety This section summarizes important safety procedures for Acuson L7L
Guidelines Transducers. For additional information about general system safety and
maintenance procedures, see your Safety Manual.
Basic Precautions
IMPORTANT: DO NOT use a transducer that has been dropped or struck against
another object; the transducer is fragile and will break.
Damage caused by dropping the transducer, striking it against another

object, pinching, kinking, or twisting the cable, or putting pressure on the
neck may cause an electrical safety or mechanical hazard to the patient.
The types of damage described above are not covered by the warranty
and service contract. In addition, you MUST take the precautions listed
below to maintain your warranty and service contract. Failure to do so
will void your warranty and service contract.
• Perform both a solution conductivity test and a leakage current test at
the end of each disinfecting period or before each exam.
• DO NOT immerse the DL connector as it is not watertight.
• Before high level disinfecting the transducer, lightly brush or swab
the transducer tip to remove any particles. Performing this cleaning
before soaking makes it easier to rinse the transducer after
disinfecting it.
• Use only the disinfecting agents and cleaning procedures approved
by Acuson, cleared by FDA and approved by EPA (for example, as
Cidex). Follow the disinfecting agent manufacturer’s instructions for
use. For compatible disinfecting agents, see your Safety Manual.
WARNING! If you use a solution not cleared by the FDA, a disinfection or

sterilization validation must be completed prior to its use.
In addition, always follow these basic precautions:

• Physical damage to the transducer or transducer electrical cable may
create mechanical and/or electrical hazards to the patient. Visually
and manually inspect the transducer prior to use. DO NOT use the
transducer if the housing is cracked or damaged or if there are cuts,
holes, perforations, dents, or abrasions.
• Disconnect the L7L Transducer from the system before cleaning and
high-level disinfection.

Chapter 27 - Laparoscopic Transducers
• If patient defibrillation is required, disconnect the transducer from

the system by unplugging the transducer connector and remove the
transducer from the patient. Ensure that the transducer is intact
before each exam as a hole or tear may result in burns to the patient
as a result of secondary arcing from internal metal parts of the cable
that could occur during defibrillation. A latex cover does not provide
electrical insulation.
For more information about the Aspen™ Ultrasound System’s electrical
safety features and requirements, see your Safety Manual.
WARNING! The use of electrosurgical units and other devices that introduce radio
frequency electromagnetic fields or currents into the patient can interfere
with the ultrasound circuitry and distort the image. Concurrent failure of
devices and damage to a transducer may cause current from the device
to return along the transducer, which may result in burns to the patient
at the area of transducer damage. Ensure that the transducer is intact
before each exam to reduce this risk. A latex cover does not provide
electrical insulation.
WARNING! If the patient has a pacemaker, you should be aware of any interference
in its operation and immediately turn off your system or unplug the
transducer. Ultrasound, like other medical equipment, uses
high-frequency electrical signals that could interfere with pacemakers.
Electrical Safety Always observe the following electrical safety guidelines.

Leakage Current with When operated with domestic (115V) Aspen systems, the L7L Transducer
Domestic Systems (115V) complies with the leakage current requirements as specified in
Underwriters Laboratories’ Standard for Medical and Electrical
Equipment, UL 2601-1, for Type BF equipment. The leakage current on
the L7L Transducer will not exceed 45 µA.
Leakage Current with The L7L Transducer meets the International Electrotechnical Committee
International Systems Standard for Medical Electrical Equipment, IEC 601, for Type BF
(230V) equipment, when operated with international (230V) systems. The
leakage current on the L7L Transducer will not exceed 100 µA under loss
of ground condition and will not exceed 500 µA under single fault
condition with main voltage applied to the transducer.
Isolated Accessory The Aspen systems have isolated power receptacles within them for
Outlets connecting accessories. Plug only Acuson-approved accessories into these
isolated accessory outlets. Approved accessories are described in detail in
your Safety Manual. The total power available is indicated near the
outlets. Overloading these outlets can cause an overload not only of the
system but also of your building’s wiring. Failure to use isolated outlets
can degrade image quality and increase chassis leakage current.

Using the Transducer Kit
Leakage Current Limits
WARNING! Isolated accessory outlets let you connect approved accessories without
increasing the system leakage current. Connecting accessories powered
from nonisolated sources may cause chassis leakage currents to exceed
safe levels.
WARNING! Plug only the proper connectors in the input and output connectors on
the back of the system. Never apply voltage to output connectors. Doing
so can damage the system and destroy its electrical safety features. For a
complete description of input and output connectors, see your Safety
Manual.
Using the The L7L transducer is part of a transducer kit. The kit includes:
Transducer Kit • L7L Transducer
• L7L Transducer software
• Carrying and storage case
• L7L Leakage Current Tester kit, including:
Electrode assembly
Decontamination container
Tester
Transformer
Acuson strongly recommends the use of sterile protective transducer
sheaths to cover Laparoscopic Transducers during each intraoperative
exam.
Obtaining Transducer Transducer covers are available from:
Covers
• CIVCO Medical Instruments
102 First Street South
Kalona, IA 52247
(800) 445-6741
(319) 656-4447
www.civcomedical.com
CIV-Flex™ Transducer Cover “Small Instrument Cover”
#610-382 (kit of 20) or #612-071 (kit of 10)
• International Medical Products B.V.
International Sales Department
Office: Gerritisenweg 5, NL-7202
BP Zutphen, The Netherlands
Mail: P.O. Box 103, NL 7200
AC Zutphen, The Netherlands
Telephone: (31) 575 596 500
Fax: (31) 575 519 639
Laparoscopic probe cover kit #16565

Transducer IMPORTANT: The laparoscopic transducer should only be handled by

Components personnel trained in its specific use and limitations.
WARNING! The laparoscopic transducer is a delicate, precision surgical instrument.

For proper care and handling of the laparoscopic transducer, always
hold the transducer by the handle.
Transducer Neck
Imaging Crystal
Articulating Levers
Handle
Electrical Cable
WARNING! The laparoscopic transducer is designed to fit standard 10 mm, 10/11

mm, and 11/12 mm cannulas. Do not use 5/10 mm or 10-12 mm
disposable cannulas as these may cause damage to the articulating
section of the transducer.
Damage to the articulating section may compromise the electrical safety
of this transducer.
Damage due to use of incorrectly sized cannulas may not be covered
under Acuson warranty.
Inspecting the
Transducer
IMPORTANT: The laparoscopic transducer must be inspected prior to every exam. If

any damage is detected, do not use the transducer. Return the
transducer to Acuson for service. There are no user-serviceable parts
associated with this instrument.
◆ To inspect the transducer:

1. Run your fingers along the entire surface of the transducer and
transducer cable, carefully inspecting for any signs of mechanical
damage such as cracks, cuts, tears, perforations, or protrusions.
WARNING! Any such damage could compromise the electrical safety of the
transducer or cause lacerations to the patient.

Cleaning, Sterilizing, and High-Level Disinfecting
2. Check that the control levers move freely, without binding, and that
they easily move the transducer through its full range of movement.
3. Articulate the transducer and inspect the bending section for cuts and
tears. Any such damage could trap debris and compromise the safety
of the patient.
Cleaning, Sterilizing, Clean and disinfect the transducer neck, the transducer handle, and
and High-Level electrical cable after each use.
Disinfecting If a transducer is contaminated with body fluids or other materials,
always high-level disinfect the transducer with a disinfectant/sterilant
solution that has been cleared for marketing by the FDA (for example,
Cidex) before cleaning it, and then disinfect or sterilize it again after
cleaning.
Follow the manufacturer’s labeled instructions to either disinfect or
sterilize Acuson transducers. Select only the compatible solutions listed
below for use with the L7L Laparoscopic Transducer.
Cleaning Agents
IMPORTANT: Use only Klenzyme® as the enzymatic cleaning agent for the L7L
Laparoscopic Transducer. Use only Cidex, Gigasept FF, or Milton
as the disinfecting and sterilizing solution for the Laparoscopic
Transducer. Acuson does not attest to the infection control
capabilities of compatible agents. Based on testing done to assess
the effect of these agents on the physical properties and
performance of the Acuson transducers, we confirm these
solutions are acceptable to maintaining the Acuson electrical
safety and performance standards.
Use only Klenzyme, Cidex, Gigasept FF, or Milton to maintain
your system warranty and service contract status in full. Follow
the manufacturers’ instructions for appropriate procedures for the
use of their products. Use of any other solutions or procedures will
void your transducer warranty.
Only Klenzyme, Cidex, Gigasept FF, and Milton are compatible
with the material used in the L7L Laparoscopic Transducer.
Products with variations of these names, or products that
manufacturers insist are equivalent, must be cleared by Acuson.
Also, contact the manufacturer of the solution for information
regarding the solution’s regulatory status for the purpose of
cleaning, disinfecting, and sterilizing.

WARNING! The Milton disinfecting and sterilizing solution is only qualified for use
with the L7L Laparoscopic Transducer. Do NOT use Milton on any
other Acuson transducers.
The precleaning and disinfectant solutions listed in this chapter indicate

compatibility with transducer materials and are not an endorsement of
the products.
Always follow these basic precautions for cleaning and high-level
disinfecting:
• DO NOT immerse the transducer’s DL connector.
• DO NOT soak the transducer in alcohol. Alcohol is nearly inactive
against certain organisms.
• DO NOT rub the transducer with an abrasive sponge. Use a soft
cloth, towel, or gauze. Use a soft brush to remove any contaminant
that may collect in the transducer grooves.
• DO NOT use ultrasonic cleaners or abrasives to clean the transducer.
• DO NOT heat or steam sterilize the transducer. Irreparable damage to
the transducer will result and is not covered under your transducer
warranty.
• Use only a plastic or enameled tray to soak the transducer. Metal
trays may harm the transducer surface.
Cleaning the Transducer ◆ To clean the transducer:
1. Unplug the transducer connector from the system.
2. Immediately after use, wipe the entire transducer clean of all residual
material with a mild detergent.
Use a sponge or soft cloth soaked in a mild detergent solution. DO
NOT use iodine based soaps. Rinse with water.
3. Soak the entire transducer, up to, but not including the DL connector,
in an enzymatic cleaning solution (Klenzyme) to remove any residual
proteinaceous material.
Follow the precleaning solution manufacturer’s instructions carefully
to ensure adequate precleaning.
4. Rinse the transducer with lukewarm high-quality tap water.
Sterilizing the Prior to use, sterilize the transducer following this procedure:
Transducer
1. Fill a disinfecting bath with an accepted high level of disinfectant (for
example, Cidex, Milton, or Gigasept FF).
Follow the disinfecting agent manufacturer’s instructions for
sterilization.
2. Unplug the transducer connector from the system.
3. If buildup of visible debris is noted around the flexible neck, swab
lightly with disinfecting solution.

Cleaning, Sterilizing, and High-Level Disinfecting
4. Submerge the transducer neck, the transducer handle, and the

transducer electrical cable up to, but not including the DL connector.
The transducer and cable may be submerged only up to, but not
including, the strain relief of the transducer connector.
5. Soak the transducer for a length of time as specified by the solution’s
manufacturer in an appropriate sterilizing and disinfecting bath
following the solution manufacturer’s instructions.
IMPORTANT: A longer soaking time may be necessary due to transducer

contamination or the infectious nature of the patient. Follow the
decontamination duration recommendations of your institution
and/or the disinfectant manufacturer.
Acuson DOES NOT recommend soaking transducers in any solution
any longer than the manufacturer’s recommendation. See the
following table.
6. Thoroughly rinse the transducer with sterile water to remove

disinfectant residues.
7. Dry the transducer with sterile gauze.
Please refer to your Transducer Specifications Manual for additional
disinfecting and sterilizing instructions.
Obtaining Precleaning, This section lists the manufacturers of compatible precleaning,
Disinfecting, and disinfecting, and sterilizing solutions for the Laparoscopic Transducer.
Sterilizing Solutions
All solutions listed below have been tested and found to be compatible
with the materials used in the Laparoscopic Transducer. Cidex, however,
is the only solution listed that has been cleared by the FDA for use as of
the writing of this manual.
WARNING! The Milton disinfecting and sterilizing solution is only qualified for use
with the L7L Laparoscopic Transducer. Do NOT use the Milton
solution on any other Acuson transducers.
SOLUTION MANUFACTURER ADDRESS TELEPHONE/FAX ACTIVE MAX

INGREDIENT SOAK
TIME
Cidex Johnson & Johnson P.O. Box 90130 (800) 433-5009 Glutaraldehyde 10 hrs.
Medical, Inc. Arlington, TX (908) 562-3300
www.jnjmedical.com 76004-3130
Gigasept FF Schulke & Mayr Heidbergstrasse (49) 40 2 51 00 0 Succinic 4 hrs.

GmbH 100/Rudolf- Fax: (49) 40 5 21 00 318 Dialdehyde
Schulke-Str.
2000 Norderstedt
Germany
Klenzyme® Steris 5960 Heislex Rd. (800) 548-4873 Proteolytic 2-5

(Precleaning) Mentor, OH Enzymes <5% minutes
44060 Sodium
Tetraborate,
decahydrate <5%

SOLUTION MANUFACTURER ADDRESS TELEPHONE/FAX ACTIVE MAX

INGREDIENT SOAK
TIME
Milton Procter & Gamble 99 Phillip Street 1 800 028 280 Sodium 1 hr.
Australia Pty. Ltd. Parramatta, (Australia only) Hypochlorite
N.S.W. 2150
AUSTRALIA

Testing the Transducer Leakage Current
Testing the The leakage current tester operates by simulating the system under fault
Transducer Leakage conditions and measuring its electrical impedance.
Current
WARNING! If you drop or damage the leakage current tester, DO NOT USE IT.
Contact your Acuson Customer Engineer.
Perform a leakage current test on the transducer at the end of each

transducer high level disinfection procedure. Retest prior to use if the
transducer has not been used for an extended period of time or to check
the leakage current of the transducer in the event that it was damaged by
being dropped or struck against another object.
Passing the leakage current test assures that, at the time of the test, the
leakage current was within acceptable limits. A passing result does not
ensure that a failure will not occur. Damage to the transducer may occur
during insertion or storage, which could render the prior test invalid.
The leakage current tester has a DL connector, as shown in the following
illustration.
L7L LEAKAGE TESTER
PASS FAIL
CAL
TEST
TRANSDUCER
TEST
acuson
ultrasound technology
ELECTRODES
Electrode Retainer
Hole
Electrode
Cables
Top Cap
Fill Line
Electrodes
Leakage Current Test Vessel

Setting Up the Leakage ◆ To set up the leakage test:

Current Test
1. Plug one end of the AC adapter cord into the tester and the other into
an electrical wall outlet.
2. Fill the disinfecting tube with 5% saline solution to a level just below
the fill line.
This allows displacement of the solution to reach the fill line once the
neck of the transducer is placed into the solutions. (See the previous
illustration.)
3. Drop each electrode into the electrode retainer hole.
4. Plug one end of each electrode cable into the top of the electrode.
5. Insert the other end of each electrode cable into the tester. You can
insert either cable into either connector.
Performing the This test consists of two simple procedures that take just a few moments
Calibration and Leakage to perform. The first procedure (CALTEST) verifies the calibration of the
Current Test tester and tests the conductivity of the saline. The second procedure
(TRANSDUCER TEST) tests the impedance of the transducer. Both
procedures should be performed at the end of the disinfecting period.
◆ To perform the calibration and transducer leakage current test:
1. Place the transducer neck through the hole on the cap. Rest the
control housing on the cap.
IMPORTANT: The fluid level should not go beyond the fill line. Doing so can result in
a false reading during the test and damage the transducer.
2. Connect the transducer to the connector on the tester.

3. Press and hold the toggle up toward CALTEST.
4. Look at the indicators and release the toggle.
NOTE: If the green indicator lights up, the system passes the CALTEST.
The saline provides adequate conductivity and the tester is calibrated.
Continue with this test procedure. If the red indicator lights up, the
system fails the CALTEST. Ensure that the electrodes are connected
properly and repeat the test. If repeated attempts fail, the saline may be
contaminated. Replace the solution and repeat the test. If repeated
attempts fail, contact your Acuson Customer Engineer.
5. Press and hold the toggle down toward TRANSDUCER TEST.
6. Look at the indicators and release the toggle.
NOTE: If the green indicator lights up, the transducer passes the
TRANSDUCER TEST. The electrical impedance of the transducer is within
acceptable limits. You can use this transducer for a patient exam. If the
red indicator lights up, the transducer fails the TRANSDUCER TEST.
Ensure that the electrodes are connected properly and repeat the test. If
repeated attempts fail, the test is invalid or the electrical impedance of the
transducer is beyond acceptable limits. DO NOT use this transducer.
Contact your Acuson Customer Engineer.
7. Rinse and dry the transducer as described in “Cleaning, Sterilizing,
and High-Level Disinfecting” on page 201.

Testing the Transducer Leakage Current
IMPORTANT: The laparoscopic transducer should only be handled by personnel

trained in its specific use and limitations.

Preparing the
Transducer
IMPORTANT: It is important to determine and review the techniques and precautions

for preparing and using the intraoperative transducer before the exam.
◆ To prepare the laparoscopic transducer with a sterile cover:

1. Inspect the transducer for any visible signs of damage. DO NOT use
the transducer if the housing is cracked or damaged, or if there are
cuts, holes, or perforations in the cable. Contact your Acuson
Customer Engineer before using.
2. Use approved, operating room sterile-wound technique. Pass a sterile
transducer cover and ultrasound coupling gel into the sterile field.
3. Insert a quantity of sterile water or gel into the tip of the sterile
transducer cover.
4. Hold the sterile transducer cover at the edge of the sterile field to
allow insertion of the transducer.
5. Insert the tip of the disinfected transducer into the transducer cover.
6. Pull the transducer cover down on the transducer neck, stopping at
the transducer handle.
The International Medical Products B.V. transducer cover allows you
to pull the transducer cover the full length of the cable, covering the
cable well beyond the edge of the sterile field. The transducer cover
should completely cover the transducer cable, up to, but not
including, the connector.
7. Remove any air bubbles between the face of the transducer and the
cover. Air bubbles can distort sound wave transmission and should
be removed.
8. Secure the cover around the head of the transducer to maintain
correct position of the gel and sterile cover.
Preparing the ◆ To prepare the Aspen system:

System 1. Connect the transducer to one of the active ports.
2. Freeze the system while you prepare the patient.
3. Unfreeze the system when you are ready to begin scanning.
Adjusting the ◆ To adjust the transducer position:

Transducer Position 1. Hold the transducer with the control levers facing down.
2. Move the right lever forward to move the transducer tip to the left.
Move the right lever backward to move the tip to the right.
3. Move the left lever forward to move the transducer tip down. Move
the left lever backward to move the tip up.

Storing the Transducer
Storing the To reduce the risk of infectious disease transmission, Acuson

Transducer recommends that the L7L Laparoscopic Transducer be disinfected at a
high level before storage.
Store the transducer in a clean, dry location, away from temperature
extremes and direct sunlight. Use of a wall rack that securely holds the
transducer and protects it from impacts by other objects is recommended.
DO NOT store the laparoscopic transducer in a drawer.
For shipping or long-distance transport of the transducer, use the
carrying case provided. For shipping, the case should be properly packed
and placed in a suitable cardboard shipping container. DO NOT regularly
store the transducer in its carrying case, as this may cause contamination
of the case lining material.


CHAPTER 28
INTRAOPERATIVE TRANSDUCERS
Using Transducers You can use transducers during an operation to examine the interior of
for Intraoperative organs and vessels. Acuson provides several transducers appropriate for
Applications intraoperative scanning applications.
Transducers used for intraoperative applications include:
• V7
• L7
• L7T
• L7L
Preparing the
Transducer
IMPORTANT: It is important to determine and review the techniques and precautions

for preparing and using the intraoperative transducer before the exam.
◆ To prepare the intraoperative transducer for an exam:

1. Inspect the transducer for any visible signs of damage. DO NOT use
the transducer if the housing is cracked or damaged, or if there are
cuts, holes, or perforations in the cable. Contact your Acuson
Customer Engineer before using.
2. Use an approved, operating room sterile-wound technique. Pass a
sterile transducer cover kit with elastic bands, retainer clip, and
ultrasound coupling gel into the sterile field.
3. Insert a quantity of sterile gel into the tip of the sterile transducer
cover.
4. Hold the sterile transducer cover at the edge of the sterile field to
allow insertion of the transducer.
5. Insert the tip of the nonsterile transducer into the transducer cover
until the tip of the transducer contacts the tip of the cover, taking care
not to touch the outside of the cover.
6. Pull the transducer cover down the length of the cable, covering the
cable well beyond the edge of the sterile field.
7. The transducer cover should completely cover the transducer cable,
up to, but not including, the connector.
8. Remove any air bubbles between the face of the transducer and the
cover. Air bubbles can distort sound wave transmission and should
be removed.

Chapter 28 - Intraoperative Transducers
9. Apply sterile elastic bands around the head of the transducer to

maintain correct position of the gel and sterile cover.
10. If desired, place retainer clips around the transducer cover and cable
to reduce bulk.
◆ To prepare the system:
1. Connect the transducer to one of the active ports on the front of the
system.
2. Freeze the system while you prepare the patient.
3. Unfreeze the system when you are ready to begin scanning.
Cleaning or Consult with your infection control officer or operating room supervisor
Disinfecting a as to the appropriate level of sanitation or disinfection required after an
Transducer after intraoperative procedure.
Intraoperative
Procedures

PART 8
SYSTEM SETUP
System Setup describes how to customize your system. It includes the
following chapter:
Chapter 29 System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Setup Menu
CHAPTER 29
SYSTEM SETUP
Setup Menu You use the Setup function to modify various set-up parameters and
customize your system. For detailed instructions for system setup, see the
Administrator Manual, available from Acuson.
1. To display the Setup menu, press SETUP.
The Setup menu
contains a list of
the functions
that you can
customize.
2. Select a function you want to customize.

3. Press [SELECT].

Chapter 29 - System Setup
Setup Options
SETUP OPTION USE
2-D Customizes Image Width, B-Color, Freeze,

High-Resolution Freeze functions, and
trackball response speed for 2-D imaging
mode. Also sets operation of DEPTH and
FOCUS knobs. Controls DGC and RES box
settings.
AEGIS: PROGRAM- Allows you to create protocols and customize
SPECIFIC FUNCTIONS clip storage and review parameters. See “Aegis
Software Setup” on page 218.
AEGIS: SYSTEM-WIDE Customizes exam storage, printing, and
FUNCTIONS worklist server. See “Aegis Software Setup” on
page 218.
AUTO MEASURE: Customizes Auto Doppler measurement
DOPPLER configurations. You can specify which
CONFIGURATION measurements to display, and record for live
FUNCTION and frozen strips. You can also specify different
sites, names, and signal types for user-defined
configurations.
CALC SET-UP Customizes calculation packages.
COLOR DOPPLER Customizes the Color Doppler (CD) box
IMAGING behavior. Also allows you to operate the color
and 2-D modes at different imaging
frequencies simultaneously.
FOOT SWITCH Programs the two buttons on the footswitch to
perform frequently used functions.
PERIPHS:EXTERNAL Specifies the external video source.
VIDEO SOURCE
PERIPHS:PRINT Allows you to install or remove printing

CONTROL devices, change the PRINT key functions, or
print manually.
PERIPHS:VCR SIGNAL Adjusts the system’s VCR signal output level.
OUTPUT CONTROL
PERIPHS:VCR/EXT Configures peripheral devices.

VIDEO/PRINTER
CONFIGURATION
PRESETS Customizes Exam and Image Presets. See

Chapter 4.
SCREEN DATA: Allows you to specify cursor appearance.
CURSOR DENSITY
SCREEN DATA: DATA Allows you turn the DGC and data field
displays on or off.

Setup Options
SETUP OPTION USE
SCREEN DATA: DATE/ Changes the date and time on the system clock.
TIME
SCREEN DATA: Selects which output values appear on the

OUTPUT Output Display. See “Output Display” on
page 8.
SCREEN DATA: SCALE Customizes the location and brightness of the
scale markers that indicate image depth in 2-D
and strip modes.
SCREEN DATA:SCREEN Allows you to adjust gray shades, graphics
CONTROL (GRAY brightness, and text brightness on the display.
LEVEL) Also lets you specify the monitor tint.
STRIP MODES Customizes the behavior of the system in strip
modes.
STUDY TYPES Allows you to create and remove Study Types.
SYSTEM LIGHTING Customizes keyboard lighting.

Aegis Software On-board AEGIS software allows you to store and review images and
Setup clips. AEGIS setup features allow you to customize how images and clips
are captured and where they are stored and printed. It also controls how
your ultrasound system is integrated into a DICOM PACS or Acuson
AEGIS network. For more information about using the on-board AEGIS
software, see Chapter 8. For detailed information about setting up the
on-board AEGIS software, see your Administrator’s Manual.
Choose AEGIS: System-Wide Functions from the Setup menu to
customize the on-board AEGIS software. Use the following information
to configure AEGIS system-wide parameters.
PARAMETER DESCRIPTION
Define Printers Displays options for configuring DICOM

network printers. For more information,
see your Administrator Manual.
Define Servers Displays options for configuring the Aspen

system to connect to DICOM network file
servers. For more information, see your
Administrator Manual.
Define Worklist Server Displays options for configuring the Aspen

system to connect to DICOM network
worklist servers. For more information, see
your Administrator Manual.
Top Line Display Selects the information that appears across

the top of the display: patient name, patient
ID, and/or sonographer’s initials. You
enter this information on the patient
demographic page. See Chapter 3.
Active Studies Directory Shows the current active studies directory.

(Can be changed only if on an AEGIS
network.)
Store on Local Print Turn on this option to automatically store

images that you print to the system’s local
printer(s).
Location Name If your Aspen system is moved between

different locations, your Acuson Customer
Engineer can program it with a different
network address for each location. (The
system needs a network address to connect
to network servers and printers.) Select the
location name that corresponds to your
current, actual location.
Your change to this setting takes effect only
after you turn the system off and turn it on
again.
[EXIT] Press to exit the AEGIS setup function.

Aegis Software Setup
Choose AEGIS: Program Specific Functions from the Setup menu to

customize clip capture protocols. Use the following information to
configure AEGIS program-specific functions.
PARAMETER AVAILABLE SETTINGS
Study Type Displays the current Study Type.
Playback Mode Loop Align - Playback synchronized; all

(during review) clips begin and end together.
Free Running - Clips run at own times and
speeds.
Same Start- Clips begin together and run
at actual speeds (so they end at different
times).
Save Clips on Select ON - Clips permanently saved when they

are included in a Select Set.
OFF - Clips not permanently saved by
being included in a Select Set.
Protocol Free Form - Allows a straightforward

review of images.
Staged - Allows shuffling of images by
stage names and view names.
Protocol Capture Types Enter and define a capture type name or

or Protocol Stages1 stage name for each capture type or stage
in the protocol.
View Names Type in a view name and press [ADD] for

each view in the capture type or stage.
1
Depending on the protocol indicated in the Protocol field.

Remote Service The Remote Service capability allows the Acuson Help Desk to access
special diagnostic service and maintenance tools within the Acuson
system.
Included with the Acuson system is a communications device that
enables Acuson personnel to access your system to perform Acuson’s
duties under the Warranty or qualifying Customer Protection Plan. You
are responsible for providing a dedicated analog telephone line suitable
for connection to the communications device. You are also responsible for
replacing communications devices that are lost or damaged. For
additional details, please refer to your Warranty Policy or Customer
Protection Plan Terms and Conditions.
The Acuson Help Desk will coordinate the remote service procedure.
They will be available to answer any questions you might have during
the process.
Requirements To use remote service, you must provide:
• A dedicated, analog telephone line. This phone line must be
connected directly to the telephone utility’s lines without passing
through manual or automatic switchboards, PBX, or any other
nonstandard telephone switching device.
• Adequate space for the communications device. The approximate
size of the device is 31 x 26 x 15 centimeters (12 x 18 x 6 inches).
• Adequate space between the communications device and the patient.
The communications device must be located at least 2 meters (6 feet)
from the Acuson system and from the patient. There may be other
local regulatory requirements regarding the installation of the
communication device.
Remote Service Safety Electrical isolation between the communications device and the Acuson
Precautions system is provided by the isolator and cabling connections. For the
isolation to be effective, IT IS IMPERATIVE that the following
requirements are followed.
WARNING! Do not plug the communications device into the accessory outlets of
the Acuson system. Electrical isolation is provided by the isolator. No
additional electrical path should be allowed between the
communications device and the ultrasound system. The
communications device must be connected to a grounded (protectively
earthed) wall outlet.
Do not set the communications device on the Acuson system. The
communications device equipment must be located at least 2 meters (6
feet) from the system and the patient.
Remote Service Depending on your system’s configuration, you connect one of the
Communications following communications devices to initiate remote service:
Devices
• Network modem which connects using an Ethernet cable to the
system’s Ethernet port. For connection instructions, see “Remote
Service Procedure - Network Modem,” next.
• Serial modem which connects using a special Acuson serial cable to
the system’s Serial port. For connection instructions, see “Remote
Service Procedure - Serial Modem” on page 222.

Remote Service
Remote Service ◆ To begin the remote service procedure using the network
Procedure - Network modem:
Modem
1. Turn off the Acuson system.
2. Move the system to a location near the network modem and the
telephone line (if not already connected).
Your Acuson Customer Engineer sets up the network modem for you
and connects it to the telephone line. It is connected to the Acuson
system’s Ethernet port (located on the back of the system) using a
nonstandard cross-over cable. It may be disconnected from the
Acuson system for portable exams.
3. If you need to connect the Ethernet cable, orient the connector with
the small latch upwards and gently press the connector into the
Ethernet port until it latches into place. Repeat this process to connect
the other end of the cable to the network modem.
4. Turn on the Acuson system.

5. Connect the telephone line to the network modem’s Line port.
Make a note of the telephone number for this telephone line. You will
need to provide it to the Acuson Help Desk.
6. Turn on the network modem.
The Acuson Help Desk will initiate the remote service procedure.
7. When the remote service procedure is complete, turn off the system,
wait for several seconds, and then turn it on again to reset it for
imaging.
If you need to move your system for portable exams, you must first
disconnect it from the modem.
◆ To disconnect the network modem, depress the small latch on
the Ethernet connection cable and gently pull the connector out
of the Ethernet port on the Acuson system.
Leave the cable connected to the network modem.

Remote Service ◆ To begin the remote service procedure using the serial modem:
Procedure - Serial
1. Turn off the Acuson system.
Modem
2. Move the system to a location near the network modem and the
telephone line (if not already connected).
3. Check that the modem adapter is installed on the connector labeled
SERIAL/0 RS232 on the back of the Acuson system as shown in the
illustration on this page.
4. Connect the modem cable to the modem adapter as shown in the
illustration on this page.
If the cable does not easily snap in place, try turning it over.

Remote Service
5. Make sure that the telephone line is connected between the telephone
jack and the LINE connector on the modem, as shown in the following
illustration.
Modem
X Do not connect the cable

here.
Power Cable Telephone Cable
Modem Adapter
Modem cable (connect to Acuson system)
Make a note of the telephone number for this telephone line. You will
need to provide it to the Acuson Help Desk.
6. Verify that the modem power cable is connected to a grounded
(protectively earthed) wall outlet.
7. Turn on the modem.
8. Turn on your Acuson system and immediately press D on the Acuson
system keyboard to display the Diagnostics screen.
9. The Acuson Customer Support Engineer can now access your system
to run diagnostics from the Help Desk.
10. When the remote service procedure is complete, turn off the system,
wait for several seconds, and then turn it on again to reset it for
imaging.
If you need to move your system for portable exams, you must first
disconnect it from the modem.
◆ To disconnect the serial modem, disconnect the serial cable
from the adapter on the back of the Acuson system.
Leave the adapter connected to the Acuson system and the cable
connected to the modem.


PART 9
SUPPLEMENT
Insert any User Manual Supplements that you receive after this page.

Index
INDEX
Symbols A
((())) (double-click icon) 13 acoustic output levels, monitoring
(()) (single-click icon) 13 8
Acuson
Numerics
See also system
2-D calculations, cardiac 144
contacting vii
2-D mode 55-62
manuals, in this set vii
data field 56
Advanced Display Option
image format controls 56 Overview 95
image optimization controls 57 AEGIS software 44-48
measurements options 44
calibrating 125 printing during review 48
caliper 118 reviewing images 47
trace 121
saving images and clips 47
Native Tissue Harmonic setting up 218
Imaging (NTHI) 59
storing clips 46-47
overview 55
AFI. See amniotic fluid index
postprocessing map 57
amniotic fluid index (AFI),
RES Enhanced Resolution measurements and calculations
Imaging 58 134
2-D volume calculations, Animating the 3-D View 110
performing 123
annotating images 27-30
3-D imaging, with
Transesophageal Transducer 162 annotation keys 27
3-D MultiPlanar Reconstruction body markers 29-30
111 pop-up menu 28
Capturing the 3-D Image 111 text function 27
Reviewing the MultiPlanar annotation keys 27
Reconstruction 112 Auto Doppler 127-130
Selecting an Image for configurations 127
Reconstruction 111 entering and exiting 127
3-D Surface Rendering 102 measurements, recording 128
Animating the 3-D View 110 report 130
Reviewing the 3-D Rendering using with Cine 129
105
auxiliary channel 33
Select an Image for
Reconstruction 103 controls 33
Setting the ROI 104 trace 33
4V2 transducer. See transcranial auxiliary triggers 60
transducers

Index
B wall motion scoring 148

biometric measurements, in cardiac scanning. See
obstetrical calculation package Transesophageal Transducers
134 cardiac stress echo. See stress echo
biopsy (endorectal) instruments, studies
sources for 187 CD caliper measurements 118
biplane Transesophageal Cine memory 39-41
Transducer 160
Cine function 39
body markers 29-30
controls 41
available 30
Extended Freeze 41
controls for 29
Extended Freeze function 39
displaying 29
Freeze function 39
C imaging Cine memory 40
calculations Strip Cine memory 40
2-D volume 123 using 41
cardiac. See cardiac calculation Cine, using with Auto Doppler 129
package cleaning transducers
obstetrical. See obstetrical See also disinfecting transducers;
calculation package sterilizing transducers
vascular. See vascular endocavity transducers 187
calculation package
intraoperative transducers 212
calibrating measurement tools 124
laparoscopic transducers 201-
2-D measurements 125 203
strip measurements 125 cleaning agents 201
Calibration pop-up menu options cleaning precautions 202
125 cleaning procedures 202
calipers 117-120 precleaning solutions 203
2-D, CD, and M-mode 118 clips
calipers function, using 120 saving 47
mode requirements 117 storing 46-47
spectral Doppler 119 CODE keys 11
calipers function, using 120 color bar 63
cannulas, specifications for color box. See Color Doppler box
laparoscopic transducers 200 Color Doppler box 63
Capturing an EFOV 96 adjusting, controls for 64, 70
Capturing the 3-D Image 111 Color Doppler Energy (ENE) 68
cardiac calculation package 143- data field 68
150
postprocessing maps 73
2-D calculations 144
Color Doppler mode
entering and exiting 144
Color Doppler Energy
M-mode calculations 146
postprocessing 73
pop-up menus 143
Color Doppler modes 63-66, 67-75
report and worksheet 150
See also Color Doppler Energy;
spectral Doppler measurements Color Doppler Velocity;
147 Convergent Color Doppler

Index
adjusting Color Doppler box, computer, viewing exams from.

controls for 64, 70 See WebPro Package
basic formatting, controls for 65 contacting Acuson vii
caliper measurements 118 CONV. See Convergent Color
Color Doppler Energy (ENE) 68 Doppler
Color Doppler Velocity (VEL) 67 Convergent Color Doppler
(CONV) 69
Convergent Color Doppler
(CONV) 69 data field 69
Doppler Tissue Imaging (DTI) postprocessing maps 74
77-81 covers
data field 77 endocavity transducers 187
postprocessing maps 80-81 intraoperative transducers 211
strip mode 81 laparoscopic transducers 199
Doppler Tissue Pulsed Wave 81 Transesophageal Transducers
entering and exiting 64 155
filters 72 cursors, spectral Doppler 84
image format, controls for 71 curved array imaging format 7
image optimization, controls for cycling annotation keys 28
72
D
options
entering and exiting 70 data display box, moving 15
list of 63 data fields
selecting, controls for 64 2-D mode 56
overview 63, 77 Color Doppler Energy (ENE) 68
postprocessing maps 73 Color Doppler Velocity (VEL) 67
selecting 75 Convergent Color Doppler
Regional Expansion Selection (CONV) 69
(RES) 65 Doppler Tissue Imaging (DTI)
Color Doppler Velocity (VEL) 67 77
data field 67 M-mode 87
postprocessing maps 73 spectral Doppler mode 84
Color M-mode 91-93 data management 43-52
entering 92 AEGIS software 44
from Color Doppler 92 printing images 43
from M-mode 92 recording exams on videotape
43
exiting 92
reviewing images 47
filters 93
saving images and clips 47
strip format controls 92
storing clips 46
strip optimization controls 93
storing images digitally 44
switching the active mode 92
study management 49
velocity scale 93
DC input trace 34
communications devices, for
remote service 220 dialog boxes, using 14
components, system 3 DICOM worklist, retrieving
patient information from 20

Index
DIMAQ workstation 44 text 15

disconnecting transducers 5 text in images. See annotating
disinfecting transducers images
See also cleaning transducers; EF extended frequency imaging
sterilizing transducers transducers 7
endocavity transducers 187 ellipse function, for measurements
121
disinfection products 186
endocavity transducers 185-196
intraoperative transducers 212
See also endorectal transducer;
laparoscopic transducers 201-
endovaginal transducers
203
solutions for 203 cleaning, sterilizing, and
disinfecting 187
Doppler cursors 84
endorectal biopsy instruments,
Doppler measurements, in OB
sources for 187
calculation package 134
kits 186
Doppler Tissue Imaging (DTI) 77-
81 Needle Guides
safety issues 187
data field 77
sterilizing reusable 187
Doppler Tissue Pulsed Wave
(DTPW) 81 storing 188
entering and exiting 78 products for disinfection/

sterilization 186
filters 79
supplies required for use of 186
image optimization controls 79
transducer covers 187
overview 77
using ultrasound coupling gel
postprocessing maps 80-81
with 186
strip mode 81
endorectal transducer 191-196
velocity scale 79
See also endocavity transducers
Doppler Tissue Pulsed Wave
beginning endorectal exams 193
(DTPW) 81
biopsy instruments 187
double-click icon ((())) 13
grid array display practice
DTI. See Doppler Tissue Imaging
procedure 196
DTPW Doppler mode 83
Needle Guides 195-196
DTPW. See Doppler Tissue Pulsed
needle visualization, on grid
Wave
array display 196
E preparing for exams
EC7 transducer. See endovaginal without water path 191
transducers preparing for exams, with water
ECG channel 32 path 192
ECG module 31 selecting a plane 194
auxiliary channel 33 stepper devices 196
ECG channel 32 switching image planes 194
triggered images 60 endovaginal transducers 188-191
ECG trace 32 See also endocavity transducers
ECG triggers 60 Needle Guides 188-191
editing attaching 188
disassembling 191

Index
Needle Guide program 191 full-screen menus 14

procedure for using 188
G
ultrasound coupling gel 186
grid array display practice
precautions 186
procedure (endorectal) 196
ENE. See Color Doppler Energy
growth curves, in OB calculation
entering patient information 19-21 package 135-136
manually 21
H
using DICOM worklist 20
heartsounds filters 34
ER7B transducer. See endorectal
transducer heartsounds trace 34
EV7 transducer. See endovaginal high level disinfection, of
transducers laparoscopic transducers 201
EVC8 transducer. See endovaginal hip angle, measuring 124
transducers
I
Exam Presets 23
icons
changing settings for 24
double-click 13
creating new 24
single-click 13
recalling 24
Image Presets 23
setting default 25
changing settings for 24
stress echo 153
creating new 24
exams
recalling 24
video
images
recording 43
annotating 27-30
taking measurements from 124
viewing from computer. See enhancing 58
WebPro Package printing 43
Extended Freeze function, Cine while reviewing 48
memory 39, 41 reviewing 47
saving 47
F
storing digitally 44
filters
imaging Cine memory 40
Color Doppler mode 72
imaging formats
Color M-mode 93
curved array 7
Doppler Tissue Imaging (DTI)
79 linear array 6
heartsounds, in phono channel NewView enhanced access 7
34 sector array 6
foot switch 10 Vector wide view array 6
Free Form protocol, for storing imaging frequencies, changing 7
clips 46 imaging modes
FreeStyle Extended Imaging 96, See also 2-D mode; spectral
101 Doppler mode; Color
Capturing an EFOV 96 Doppler mode; M-mode;
Reviewing an EFOV 97 Color M-mode
Taking Measurements 99 monitoring acoustic output
levels 8
Freeze function, Cine memory 39

Index
overview 4 cleaning, sterilizing, and

imaging planes disinfecting 201-203
endorectal transducer 194 cleaning agents 201
selecting an imaging plane 194 cleaning procedures 202
switching planes 194 high level disinfecting 201

obtaining solutions for 203
selecting, when using
Transesophageal precautions 202
Transducers 160 sterilization procedure 202
intraoperative transducers 211-212 components of 200
cleaning and disinfecting 212 covers, obtaining 199
preparing for exams 211 inspecting 200
kit and its components 199
K
preparing 208
key conventions, in this manual
viii safety guidelines 197-199
keyboard storing 209
adjusting 9 testing leakage current 205-207
controls 11 leakage current tests, on

laparoscopic transducers 205-207
keys
linear array imaging format 6
annotation 27
Linear Measurement and
CODE keys 11 Extended Image FreeStyle
select keys 13 Accuracy 101
soft keys 12 locking wheels, on system 10
kits
M
endocavity transducer 186
manuals, others in set vii
endorectal biopsy, sources for
187 markers. See body markers
laparoscopic transducer 199 measurement tools 117-126
calibrating 124
L 2-D measurements 125
L7 transducer. See intraoperative strip measurements 125
transducers calipers 117-120
L7L transducer. See intraoperative 2-D, CD, and M-mode 118
transducers
calipers function, using 120
L7L transducers. See laparoscopic
mode requirements 117
transducers
spectral Doppler 119
L7T transducer. See intraoperative
data display box, using 117
transducers
ellipse 121
labeling images. See annotating
images trace function 121
languages, converting system to measurements
other viii 2-D volume calculations 123
laparoscopic transducers 197-209 Auto Doppler 127
adjusting position of 208 biometric, in OB calculation
cannula specifications 200 package 134
cardiac calculations 143-150

Index
Doppler, in OB calculation practice procedure 171

package 134 Quik-Clip 175, 179-181
hip angle 124 Slide-On 182-184
measuring from video exams network modem, for remote
124 service procedures 221
trace 121 NewView enhanced access
vascular calculations 140 imaging format 7
menstrual age, programs for non-ODS transducers 8
calculating 132
menus O
full-screen 14 obstetrical calculation package

131-136
pop-up 13
AFI measurements and
MI acoustic output level 8 calculations 134
M-mode 87-89 biometric measurements 134
See also Color M-mode customizing the USER program
calculations, cardiac 146 133
caliper measurements 118 Doppler measurements 134
data field 87 entering and exiting 131
entering and exiting 88 growth curves 135-136
image format controls 88 programs for calculating
overview 87 menstrual age 132
selecting postprocessing maps selecting a calculation program
89 132
strip optimization controls 89 taking measurements 133
modems twin exams
network, for Remote Service beginning 133
procedures 221 growth curves 135
serial, for Remote Service moving between twins 135
procedures 222 worksheet and report 135
modes, imaging. See imaging on/off procedure, system 5
modes Output Display system 8-9
monitor, adjusting 9 acoustic output levels 8
multiplane Transesophageal setting up 9
Transducer 160
P
N
patient information
Needle Guides
changing during studies 22
endorectal 195-196
entering 19-21
endovaginal 188-191
manually 21
attaching 188
retrieving from DICOM
disassembling 191 worklist 20
Needle Guide program 191 patients
for endocavity transducers locating on Scheduled Studies
reusable, sterilizing 187 page (DICOM) 21
safety issues 187 technically difficult, using NTHI
storing 188 to improve images for 59

Index
PC, viewing exams from. See Color Doppler Velocity (VEL)

WebPro Package 73
Perspective 95-114 Convergent Color Doppler
(CONV) 74
selecting maps 75
111
Capturing the 3-D Image 111 Doppler Tissue Imaging 80-81
Reviewing the MultiPlanar Re- M-mode, selecting maps 89
construction 112 spectral Doppler mode,
Selecting an Image for Recon- selecting maps 86
struction 111 power level, transducer defaults 8
3-D Surface Rendering 102 power on/off procedure 5
Animating the 3-D View 110 practice procedures
Reviewing the 3-D Rendering
grid array display (endorectal)
105
196
Select an Image for Reconstruc-
tion 103 Needle Guide 171
Setting the ROI 104 precleaning solutions, for
laparoscopic transducers 203
Advanced Display Option
Overview 95 Presets 23-25
FreeStyle Extended Imaging 96, changing settings for 24
101 creating new 24
Capturing an EFOV 96 Exam 23
Reviewing an EFOV 97 recalling 24
Taking Measurements During setting default 25
Review 99
Image 23
phono channel 34-35
recalling 24
controls 35
printing 43
Physiologic Module 31
while reviewing images 48
phono channel 34-35
pulse trace 36
controls 35
pulse/respiration channel 36
pulse/respiration channel 36
controls 36
controls 36
physiologic monitoring modules Q
31-36 Quik-Clip Needle Guides 175, 179-
See also ECG module; 181
Physiologic Module
pop-up menus 13 R
for annotation 28 Regional Expansion Selection
(RES)
for cardiac calculation 143
RES Enhanced Resolution
ports
Imaging 58
system 5
using with Color Doppler
transducer, switching 5 modes 65
postprocessing maps Remote Service 220-223
2-D mode 57 communications devices 220
Color Doppler modes 73 procedures, using network
Color Doppler Energy (ENE) modem 221
73

Index
procedures, using serial modem procedures, using network mo-

222 dem 221
requirements 220 procedures, using serial mo-
dem 222
safety precautions 220
requirements 220
reports
safety precautions 220
Auto Doppler 130
Setup menu 215
cardiac calculations 150
single-click icon (()) 13
OB 135
Slide-On Needle Guide 182-184
vascular calculation 142
soft keys 12
RES Enhanced Resolution Imaging
spectral Doppler calipers 119
58
spectral Doppler mode 83-86
respiration trace 36
cardiac measurements 147
Reviewing an EFOV 97
cursors 84
Taking Measurements 99
data field 84
reviewing images 47
DTPW Doppler 83
Reviewing the 3-D Rendering 105
entering and exiting 84
Reviewing the EFOV Image 96
image format controls 85
Reviewing the MultiPlanar
Reconstruction 112 mode types 83
overview 83
S
selecting postprocessing maps
S219 transducer. See transcranial 86
transducers
strip optimization controls 86
safety
trace measurements 121
guidelines for laparoscopic
Staged protocol, for storing clips
transducers 197-199
46
system safety issues 10
stepper devices, using with
Scheduled Studies page (DICOM), endorectal transducer 196
locating patients on 21
sterilizing transducers
sector array imaging format 6
See also cleaning transducers;
Select an Image for Reconstruction disinfecting transducers
103
endocavity transducers 187
select keys 13 sterilization products 186
Select Set images and clips, saving laparoscopic transducers 201-
47 203
Selecting an Image for procedure for 202
Reconstruction 111
solutions for 203
serial modem, for Remote Service
stop watch function 15
procedures 222
stress echo studies 153-154
Setting the ROI 104
customizing 153
Setup menu 215
Exam Presets 153
setup, system 215-223
performing studies 154
AEGIS software 218
wall motion scoring 153
options 216
Strip Cine memory 40
Remote Service 220-223
strip mode
communications devices 220

Index
calibration, of measurement options 216

tools 125 Remote Service 220-223
Doppler Tissue Imaging 81 Setup menu 215
studies 19-22 wheels, locking and unlocking
beginning 19 10
cardiac calculation 143-150 T
changing patient information 22 Taking Measurements 99
definition of 19 TCI exams. See transcranial
ending 22 transducers
entering patient information 19 TCI ORB exams. See transcranial
managing 49 transducers
maintaining study archives 49 technically difficult patients, using
restarting 22 NTHI to improve images for 59
stress echo 153-154 temperature, of Transesophageal
Transducer 156
wall motion scoring 153
text
vascular calculations 139-141
See also annotating images
measurements 140
entering and editing, controls
study archives, maintaining 49
for 15
study utilities function 49
text function, for annotation 27
symbols, in this manual viii
thermal limit messages, for
system Transesophageal Transducers
components 3 157
connecting and disconnecting thermal sensor, for
transducers 5 Transesophageal Transducer 156
controls 11-15 TIB acoustic output level 8
CODE keys 11 TIC acoustic output level 8
data display box 15 timer 15
dialog boxes 14 TIS acoustic output level 8
full-screen menus 14
TISF acoustic output level 8
keyboard 11
tissue movement, using DTI to
pop-up menus 13 show 77
select keys 13
tools, measurement. See
soft keys 12 measurement tools
text editing 15 traces
trackball 12
auxiliary 33
converting to other languages
DC input 34
viii
ECG 32
foot switch 10
heartsounds 34
keyboard, adjusting 9
pulse 36
monitor, adjusting 9
respiration 36
Output Display system 8
trace function, using while
power on/off procedure 5
measuring 121
safety 10
trackball 12
setup 215-223
changing function of 12
AEGIS software 218

Index
select keys on 13 beginning 133

transcranial transducers 165 growth curves 135
initializing 166 moving between twins 135
transducers
U
See also specific transducers:
endocavity; endorectal; ultrasound
endovaginal; intraoperative; in-situ limits, FDA 7
laparoscopic; transcranial; ultrasound coupling gel
Transesophageal precautions for vaginal imaging
changing imaging frequencies 7 186
characteristics of different types using with endocavity
6 transducers 186
connecting and disconnecting 5 using with intraoperative
default power level 8 transducers 211
EF extended frequency imaging using with laparoscopic
7 transducers 208
imaging formats 6 using with Transesophageal
Transducers 155
monitoring acoustic output
levels 8 V
non-ODS 8 V510B transducer. See
switching active ports 5 Transesophageal Transducers
Transesophageal Transducers 155- V5M transducer. See
162 Transesophageal Transducers
3-D imaging 162 V7 transducer. See intraoperative
adjusting transducer tip transducers
position 161 V705B transducer. See
biplane 160 Transesophageal Transducers
covering 158 vascular calculation package 139-
inserting 159 142
inspecting 158 entering and exiting 141
monitoring temperature with report 142
thermal sensor 156 studies 139-141
multiplane 160 study measurements 140
preparing the system 158 worksheet 142
removing 161 VCR controls 43
safety issues 155 Vector wide view array imaging
selecting an imaging plane 160 format 6
thermal limit messages 157 VEL. See Color Doppler Velocity
triggers 60-62 velocity scale
auxiliary 60 Color M-mode 93
ECG 60 Doppler Tissue Imaging (DTI)
79
positioning and using 62
video controls 43
setting up 61
videotaped exams, taking
timed 61 measurements from 124
twin exams videotaping exams 43

Index
viewing exams, from a computer.

See WebPro Package
volume calculations, 2-D 123
W
wall motion scoring
cardiac calculation 148
stress echo studies 153
water path, for endorectal exams
192
WebPro Package 51-52
logging in 52
minimum computer
requirements 51
recommended plug-ins 51
reviewing images and clips 52
using 51
wheels (system), locking and
unlocking 10
worksheets
cardiac calculations 150
OB calculation 135
vascular calculation 142

Aspen User Manual
Document No. 58233
Rev. 4
Language: English

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Acuson Aspen Ultrasound System

Siemens Medical Solutions Acuson, a Siemens Company

Tel: +44 (0) 208 479 7950 www.acuson.com

Document No. 58233

TRADEMARKS ACUSON, MultiHertz, Native, RES, Sequoia, SpaceTime, The Value of

0202 Acuson Aspen Ultrasound System iii

iv Acuson Aspen Ultrasound System 0202

Part 1 System Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Part 2 Basic Exam Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Part 3 Imaging Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Part 4 Measurements and Calculations. . . . . . . . . . . . . . . . . . . . . . 115

Part 5 Cardiovascular Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

0202 Acuson Aspen Ultrasound System v

Part 7 General Imaging Features . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Part 8 System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Part 9 Supplement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

vi Acuson Aspen Ultrasound System 0202

Other Manuals This manual is part of a set that also includes:

0202 Acuson Aspen Ultrasound System vii

◆ A diamond-shaped bullet indicates steps to follow

Acuson provides special alphanumeric keys and annotation terms for

viii Acuson Aspen System 0202

0202 Acuson Aspen Ultrasound System 1

ECG and Physiologic

Aux CW Transducer Port

Foot Switch Connector

0202 Acuson Aspen Ultrasound System 3

Imaging Modes The Aspen™ ultrasound system displays ultrasound information in

2-D MODE The system displays a two-dimensional image of

4 Acuson Aspen Ultrasound System 0202

Switching You can connect up to three transducers simultaneously on the Aspen

0202 Acuson Aspen Ultrasound System 5

Linear A linear transducer has a medium to large footprint that

Vector Vector is Acuson’s trademark for its proprietary

Sector A sector array transducer forms ultrasound scan lines that

6 Acuson Aspen Ultrasound System 0202

NewView NewView enhanced access imaging format is similar to

Curved A high-performance curved array transducer forms

◆ To change the imaging frequency, press MULTIHZ.

0202 Acuson Aspen Ultrasound System 7

ABBREVIATION MEASUREMENT DESCRIPTION

MI Mechanical Index Used for scanning in 2-D

TIC Thermal Index, Recommended for adult or

TIB Thermal Index, Recommended for second

TIS Thermal Index, Recommended for soft-tissue

TISF Thermal Index, Indicates focal region TIS for

8 Acuson Aspen Ultrasound System 0202

[PWR ON/OFF] Controls whether the transducer power value

Monitor/Keyboard ◆ To adjust the monitor position:

Push in handle to Pull out handle

1. Push the monitor handle in to unlock it.

0202 Acuson Aspen Ultrasound System 9

Wheel Unlocked Wheel Locked

To unlock the To lock the

Safety For information on safety issues regarding Acuson Ultrasound systems,

System Requirements Environmental Requirements

System Operation and Turning the System On and Off

Caring for and Cleaning Using Transducer Covers

System Measurement Measurements in Color Doppler