1siemens LVA

ACUSON SC2000
Expert Meeting
Erlangen, Germany
June 1, 2011
Barbara Conwell
PLM SC2000 Product Manager
For
Forinternal
internaluse
use only.
only.
Copyright © 2011 Siemens Medical Solutions USA, Inc. All rights reserved.
H CP US CRM PM
Trademarks
The following are trademarks of Siemens Medical Solutions USA, Inc.

(syngo is a trademark of Siemens AG)
ACUSON SC2000™ volume imaging ultrasound system
eSie LVA™ volume LV analysis
eSieScan™ workflow protocols
syngo ® Dynamics
For internal use only.

Page 2 2011 H CP US CRM PM
ACUSON SC2000 System
eSie LVA
Key Features
eSie LVA: Siemens fully integrated

Knowledge Based Workflow technology:
Volume Contouring and Tracking
Volume Analysis in One Step
Full integration of knowledge based work

flow from Siemens Corporate Research
(SCR) in Princeton, NJ, USA
Volume Contour Detection and Tracking
Added more data sets in Release 1.6 SCR

algorithm
Need Volume Contrast Datasets for 2.0!

eSie LVA
Benefits
Streamlined workflow
Volume to quantification in as little as

15 Seconds for a volume rate of 15
VPS
Higher volume rates will add time for

tracking and calculating
Improved VR display and ACUSON

SC2000 system volume review
navigation tools

eSie LVA
Benefits
Simplified editing
3 point semi-automated volume

contouring
Ability to launch eSie LVA on volumes

with Color Doppler
Ability to access both EF and Volume

Curve data without going into User
Configuration
AHA segmentation for 16 and 17

segments (same as CT, MRI and MI)
Standardization between modalities

eSie LVA
Additional Information
Volume rates > 5 vps and < 100 VPS
Gain and Dynamic range adjustments

available on the keyboard
Replaces Brightness and Contrast in
prior versions
Does not affect the eSie LVA trace
Workplace: Upper Left
X and Y values are now displayed on

the time to minimum volume curves
Customizable measurement display

eSie LVA
Additional Information
Release 1.5 LVA utilized SCR for

Auto RP extraction and initial A4C,
A2C and A3C only
Release 1.6 eSie LVA Knowledge

Based Workflow tracking full R-R
cycle
Removed manual ROI trace on bulls

eye display
No ability to edit worksheet and report

if multiple LV Analyses is done
Existing behavior since Release 1.2
Will be able to edit in 2.0!

eSie LVA
Workflow
eSie LVA supports one R-R Cycle

capture
R-R capture for Time to Maximum

Volume
If Multiple cycle volume acquisition,

eSie LVA will only quantify the last
beat on ECG acquisition
If no ECG, last 100 frames are loaded

to eSie LVA application

eSie LVA
EF Calculation
When there is ECG physio information, algorithm will use R wave information as
a starting point for ED and uses a formula to estimate ES (same as syngo Auto
Left Heart)
EF is computed from maximum (closest to first ED of R-R) and minimum of curve
Without ECG input, algorithm has challenges

eSie LVA
Recommendations
If major changes needed using Non-Contrast datasets, Delete automated

contours, then use 3 point (manual), then use "Track all" method
“Track all” method is re-running algorithm after user edits the ED (and/or ES)
If making minor tweaks in the automated contour using Non-Contrast datasets:
Recommend "Adjacent" frames
Adjacent: Smooths out contours temporally
Contrast Datasets:
For Contrast datasets: Recommend Deleting automated contours, using 3 point
(manual) method and use “Adjacent" frames method
Note: For Contrast datasets, only EDV, ESV, EF, and Stroke Volume are
Valid. Other measurements cannot be used!
Because the current algorithm implementation and model focused on non-
contrast data, "track all" will not work properly on contrast data.
Improvements will be made in 2.0-need datasets! For internal use only.
Release 1.6 Highlights
Think Volume!
The contours you see are the

intersection of the 3D cast (mesh)
with each of the planes

eSie LVA
Recommendations
Manual Method order:

Must Place 3 points in following order:
1st Point: Apex
2nd Point: Base LV/Medial Mitral Annulus
3rd Point: Base LV/Lateral Mitral Annulus

eSie LVA
Parametric Maps
eSie LVA Parametric Maps utilize a much higher spatial resolution in order to define
smaller segments.
The LV mesh surface is triangulated and connects each triangle to the LV surface
within the LV. This results in more than 4500 segments or parametric volumes.

H CP US CRM PM
eSie LVA: Twist
Why do we now see twist in 1.6 eSie LVA?
1.5 and earlier versions of LVA were rudimentary

Twist was not seen in the LV Cast
In 1.6 version of LVA, the learned pattern recognition tracking is combined with a
simplified version of 3D tracking
3D tracking is the underlying reason we see Twist

H CP US CRM PM
eSie LVA: Twist
Demo Tip: Best way to demonstrate Twist:
Sync VR to SAX view
Remove Volume from display to show just cast (mesh)
Rotate VR to show Base up to Apex view
Slow down clip playback
See Twist!

H CP US CRM PM
eSie LVA: Demo
Demo Tip:
Delete all segments except 2 (1 normal, 1 abnormal)
Show delay (in orange) of abnormal segment on Dynamic Map
Show delay of Abnormal curve on graphical display
Slow down clip playback to show mechanical Dyssynchrony

H CP US CRM PM
eSie LVA: Competition
Competition: Philips
Uses semi-automated (3 point method)
Has to place on every view!

Apical 4 Chamber
Apical 3 Chamber
Apical 2 Chamber
On Each View (4, 3, and 2) have to place points for BOTH ED AND ES Frames
Total of 18 points have to place manually!
Time Consuming and not good workflow
End of Life Service field issues

H CP US CRM PM
eSie LVA: Normal Values
All 1.6 eSie LVA Formulas are the same as prior versions of LVA
Normal Values:
Dispersion (DISP ES):

Definition: Time difference between earliest and latest End Systolic
Time segments
Dyssynchrony parameter
Use DISP ES (DISP ED not used that much clinically)

H CP US CRM PM
Normal Values
End Diastolic Sphericity Index (EDSI)

Index to describe the shape of the LV Cast
Used for remodeling assessment
Use ED Sphericity Index (EDSI), not ESSI
Normal Left Ventricle is Conical shaped in Diastole
The more spherical LV gets, the more Abnormal it is
Normal=Closer to 1 the better. Normal: Less than 1.5

H CP US CRM PM
Normal Values
Systolic Dysynchrony Index (SDI)

Measure for Mechanical Dyssynchrony of the LV
Normal < 8.3
Abnormal > 8.3

H CP US CRM PM
eSie LVA: Definitions
Absolute Curves
Displays LV volume and EF with respect to time
Normalized Curves
Displays percent LV volume/EF, as compared to Min and Max LV volume, with
respect to time
Displays results within a standard range (ex. 0-100%) based on the minimum
and maximum volumes/EF

H CP US CRM PM
eSie LVA: Acoustic Capture
Acoustic Captures
In Volume imaging, all frames are captured
When a Volume is captured, all the data is stored
No need to go into CINE
Keep in mind may not want to go use very high frame rates in 2.0
Time consuming workflow in 2.0: High VPS with 3 beat analysis

H CP US CRM PM
eSie LVA: New Parametric Maps
Two Static Maps
Two Dynamic Maps
New Color Display

eSie LVA
Changes to LVA
New Names: Time to Minimum Volume and Time to Minimum Volume
Release 1.5 Contraction Time Mapping Release 1.6 Time to Minimum Volume

Parametric Maps
A Parametric Map is a visual, superimposed segment model
The graph displays either a Global volume curve, a 16 or 17 segment model
Select / de-select
Global
Segment function
is available Volume
Timing
measurements are Segmental
based on 16/17 Volumes
segments

Parametric Maps
There are four types of parametric maps: Two static and two dynamic
Parametric Static Map Parametric Dynamic Map

Minimum Volume Time to Minimum Volume
Parametric Static Map Parametric Dynamic Map

Maximum Volume Time to Maximum Volume

Parametric Maps
The same parametric information is mapped to the LV mesh (LV Cast)
1) Segments 2) TMV static 3) TMV dynamic

Static and Dynamic Maps
• A Static Map looks at 30% of the

complete heart cycle
• Range is compressed within 30% A Dynamic Map looks at a 10% of
•Anything outside of 30% variation is heart cycle time window and moves
displayed as solid Orange or solid Aqua through the heart cycle
All Cycle 10%

Dynamic and Static Maps
In case of Dynamic maps the reference moves with current frame

Segments that reach minimum volume BEFORE the REFERENCE are colored
AQUA, segments that reach minimum AFTER the REFERENCE are colored
ORANGE and if segment reaches its minimum at the REFERENCE then its colored
white. This translates to segments that arrive first have AQUA color, segments that
arrive late have ORANGE color and segments arrive at this moment as white.
In case of Minimum Volume Static map the reference is ES

In case of Maximum Volume Static map the reference is ED
Parametric Maps
SDISDI 25ms
1.0 ms
When all individual segments
reach end-systole at
approximately the same time, the
Parametric Map looks very
homogeneous
SDI=1.0 ms
SDI 49.9
SDI ms
136ms
When individual segments
reach end-systole at quite
different times, the
Parametric Map looks very
heterogeneous
SDI=49.9 ms

Dynamic
Time to Minimum Volume
A Dynamic Time to Minimum Volume Map, visualizes timing information
It represents which smaller segments have reached End Systolic volume at a specific-point-in-time
A specific-point-in-time is a 10% time window of the heart cycle which moves through the heart cycle
The time-window explains why we also have some white, and some light shades of burnt orange and
green and not just orange and aqua green

Dynamic
Time to Minimum Volume
10%
All frames < or > 10% from Minimum Volume are color coded as solid color
< 10% from Minimum Volume are solid Aqua-Green color
> 10% from Minimum Volume are solid Orange color
All mesh volumes casts on either side of minimum volume are color coded as white (center) of color
bar.
Transition from white to solid color starts at 5% from min volume and extends to 10%
This is a qualitative assessment meant to help assess areas that reach minimum volume late in
dynamic review of data
Dynamic
Time to Maximum Volume
A Dynamic time to Maximum Volume Map, visualizes timing information
It represents, which larger segments have reached end-diastole at a specific-point-in-time
A specific-point-in-time is a 10% time window of the heart cycle which moves through the
heart cycle
The time-window explains why we also have some white, and some light shades of burnt
orange and green and not just burnt orange and aqua green
Dynamic
Time to Maximum Volume
All frames < or > 10% from Maximum Volume are color coded as solid color
< 10% from Maximum Volume are solid aqua color
> 10% from Maximum Volume are solid orange color
All mesh volumes casts on either side of maximum volume are color coded as white or center of
color bar. Solid colors start at 10% on each side of maximum volume
Transition from white to solid color starts at 5% from max volume and extends to 10%
This is a qualitative assessment meant to help assess areas that reach maximum volume late in
dynamic review of data
Static Minimum Volume
A qualitative assessment to evaluate at which point in time each point reached its Minimum value
All points have a time volume curve from tracked volume frames
All points whose minimum volume fall within 7.5% each side of average min volume are coded white
All points 7.5% to 15% from average minimum volume have transition color
All points that are < or > 15% from average minimum volume curve are color coded in solid colors
< 15% are solid Aqua-green; > 15% are solid Orange; Range is 30%
Values displayed in units “%” or “ms” minimum volume occurred
Anything outside of 30% variation is displayed as solid Orange or solid Aqua For internal use only.
Static Maximum Volume
A qualitative assessment to evaluate at which point in time each point reached its maximum value
All points have a time volume curve from tracked volume frames
All points whose maximum volume fall within 7.5% each side of average min volume are coded White
All points 7.5% to 15% from average maximum volume have transition color
All points that are < or > 15% from average maximum volume curve are color coded in solid colors
< 15% are solid Aqua-green; > 15% are solid Orange; Range is 30%
Values displayed in units “%” or “ms” maximum volume occurred
eSie LVA
Release 1.5

Page 37 2011 Michael Snyder H CP US CRM PM
eSie LVA
Release 1.6

eSie LVA
Release 1.6

eSie LVA: Field Issues
Do NOT use copied disks to upgrade systems!

Use only ones from AcuTrak

H CP US CRM PM
eSie LVA: FAQ
FAQ question
Q: What happens when editing the LVA package, when you make an adjustment
to the contours, and go immediately to the Analysis page without
selecting "apply to adjacent frames" or "apply to all"?
A: If contours are present on all frames: “Apply to adjacent frames” is used. If

user deleted contours then did manual method (contours not present on all
frames) then “Apply to All” would be triggered

H CP US CRM PM
eSie LVA: 1.6 Release Notes
Release Notes
Clips more than 100 frames: First ED may be chopped off
Will need to Edit ED and ES frames
Both Physio and Non-Physio scenarios

H CP US CRM PM
Release Notes
Measurement values in the LVA and RVA applications are averaged. You
cannot edit LVA and RVA measurements in the worksheet.
Siemens recommends capturing volumes with ECG data for use with the eSie
LVA feature.
In order to display the bulls-eye information corresponding to the graphical

curve displays, press the 4-up display icon.
The Post Contraction 16 (Post Contr 16) segment measurement is truncated

in the LVA worksheet. The report correctly displays the Post Contr 16
measurement.

H CP US CRM PM
Release Notes
Do not use the following types of volumes saved as clips with the eSie LVA feature:
Truncated Clip Capture: Volume clips created in cine (press GAIN FREEZE/CINE,
press CLIP STORE to begin capture, and then press CLIP STORE again to end
capture).
Truncation can also be done by going into different modes during capture
“Clip truncated” message will appear in lower left status area of screen
Retrospective volume clip lengths greater than 6 beats.
Always ensure that the end-diastolic and end-systolic frames are accurate. As in prior
releases, modifying the ED and ES frame must be done in the first step of analysis
(Adjust Reference Planes). This will have a direct impact on the calculated volumes
and EF.

H CP US CRM PM
eSie LVA: Release Notes
Release Notes
In some segments, the 16 and 17 Segment model apical labels are not AHA
convention:
17 Segment Model Siemens LVA Labels AHA Convention

Segment 16 Apical Inferolateral Apical lateral
Segment 14 Apical Anteroseptal Apical septal
16 Segment Model Siemens LVA Labels AHA Convention

Segment 16 Apical Inferolateral Apical lateral
Segment 14 Apical Anteroseptal Apical septal
Results of LVA measurements done in volume stress echo review are now correctly
placed into the report in the order of acquisition in the protocol stages. In prior releases,
LVA measurements were incorrectly placed in the report in the order they were made,
regardless of protocol stage.

H CP US CRM PM
ACUSON SC2000 1.6D release
Changes in 1.6D include:

1) Adding fields specific to use with syngo Dynamics: Custom 1, Custom 2 &
Indications
2) Making the referring physician field modifiable when this field is entered via
MWL
The following bugs were addressed:
Unable to move the CROI (PW, CW M-mode) cursors when user ends the exam
with annotation as active task
Measurements displayed in eSie LVA (milliseconds) are not correctly converted
from % heart cycle.
Incorrect measurements can be displayed when user reviews image then
changes to an image with different scale (region of calibration)
Blood pressure now transfers to syngo Dynamics without the need for secondary
captures For internal use only.
H CP US CRM PM
ACUSON SC2000 1.6 Late Breaking Bugs
Bugs reported from field:

Hang when going into Report issue from live review
Workaround: Instead of entering report from review, go back to imaging first,
them hit report.
First static image store of study is not being saved
User hears a Beep but first static of study not stored
Train users to look at status message lower left of screen
Workaround: Take clip capture before static
Volume fails to load to LVA application when user creates a MWL worklist study
with patient name having five carets or more (ex. MORSELL^DARRYL^^^^)
Workaround: Use up to 4 carets. Do NOT use 5 carets or more

H CP US CRM PM
ACUSON SC2000
QUESTIONS?

H CP US CRM PM
ACUSON SC2000
System, Release 1.6
Other Improvements
For
Forinternal
internaluse
use only.
only.
Copyright © 2011 Siemens Medical Solutions USA, Inc. All rights reserved.
H CP US CRM PM
Other Improvements
ACUSON SC2000 System and syngo Dynamics

Addressed in Release 1.6
Underscore in Study Type
ACUSON SC2000 system uses the sDx Common Reporting Component
(CRC) to create worksheets and reports on the ACUSON SC2000 system
The CRC creates a study “bolus” of data that is read only by sDx
The bolus currently changes the study type and adds an underscore such
that Adult Echo becomes Adult_Echo_1
ACUSON SC2000 system Study Linked to sDx Report Template

Studies from ACUSON SC2000 system would not link to and open sDx
report template
These issues are corrected in Release 1.6

Note: ACUSON SC2000 system report is now read only – edits can only be
done from the worksheets
Other Improvements
Addressed in Release 1.6:
Fix for the TEE lock-up during angle change and color box movement
Color flash reduction
All transducers
Default Color preset modification

4Z1c Changes
General: Priority from 1 to 0
Low Flow: Persistence from 2 to 1, Filter from 1 to 2, set color scale to .55
High Flow: Priority from 1 to 0
Frame Rate: Priority from 1 to 0, S/T from S1 to T1
4V1c Changes
General: Persistence from 2 to 1, Priority from 2 to 0
Low Flow: Persistence from 3 to 1, Priority from 2 to 1, Filter from 1 to 2, set scale to .55
High Flow: Priority from 2 to 0, Persistence from 2 to 1
Frame Rate: Persistence from 2 to 1, Priority from 2 to 0, S/T from S1 to T1
eSie LVA: Ventricular Segmentation
Cerqueira, M. D. et al. Circulation 2002;105:539-542


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ACUSON SC2000

The following are trademarks of Siemens Medical Solutions USA, Inc.

For internal use only.

eSie LVA: Siemens fully integrated

Volume Analysis in One Step

Full integration of knowledge based work

Volume Contour Detection and Tracking

Added more data sets in Release 1.6 SCR

Need Volume Contrast Datasets for 2.0!

For internal use only.

Volume to quantification in as little as

Higher volume rates will add time for

Improved VR display and ACUSON

For internal use only.

3 point semi-automated volume

Ability to launch eSie LVA on volumes

Ability to access both EF and Volume

AHA segmentation for 16 and 17

For internal use only.

Volume rates > 5 vps and < 100 VPS

Gain and Dynamic range adjustments

X and Y values are now displayed on

Customizable measurement display

For internal use only.

Release 1.5 LVA utilized SCR for

Release 1.6 eSie LVA Knowledge

Removed manual ROI trace on bulls

No ability to edit worksheet and report

For internal use only.

eSie LVA supports one R-R Cycle

R-R capture for Time to Maximum

If Multiple cycle volume acquisition,

If no ECG, last 100 frames are loaded

For internal use only.

EF is computed from maximum (closest to first ED of R-R) and minimum of curve

Without ECG input, algorithm has challenges

For internal use only.

If major changes needed using Non-Contrast datasets, Delete automated

The contours you see are the

For internal use only.

Manual Method order:

For internal use only.

For internal use only.

Why do we now see twist in 1.6 eSie LVA?

1.5 and earlier versions of LVA were rudimentary

3D tracking is the underlying reason we see Twist

For internal use only.

Demo Tip: Best way to demonstrate Twist:

Sync VR to SAX view

Remove Volume from display to show just cast (mesh)

Rotate VR to show Base up to Apex view

Slow down clip playback

For internal use only.

Show delay (in orange) of abnormal segment on Dynamic Map

Show delay of Abnormal curve on graphical display

Slow down clip playback to show mechanical Dyssynchrony

For internal use only.

Uses semi-automated (3 point method)

Has to place on every view!

Total of 18 points have to place manually!

Time Consuming and not good workflow

End of Life Service field issues

For internal use only.

Dispersion (DISP ES):