Ultrasound-Guided Attenuation

Parameter(UGAP)
Measurement Tips

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Steps for UGAP measurement Quality
Patient:
• Fasting 4-6 hours
• Utilize supine position
• If the patient is large, turn them in a slight lateral
decubitus to reduce the distance from the skin to
the liver capsule
• Elevate right arm above head
• Have the patient tilt their shoulders toward the left
• Use Intercostal window, similar to Liver Biopsy

VII VIII

VI V

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Steps for UGAP measurement Quality
Basic measurement steps

• Select C1-6-D probe and the Abdomen, Abdomen Detail or Abdomen Pen Model
• Scan intercostal on the right side along the mid-axillary line
• Scan right side of the liver, where there are few large vessels VII VIII
• Activate UGAP from assigned button on the operator panel
• Place ROI near the same location of the liver as SWE avoiding large vessels
• The ROI is fixed in size and depth, it can be moved in the lateral direction
• Select Single or Multi on the touch panel
• Have patient suspend breathing VI V

• Push the “ Set or Start” button on the right trackball key

• Freeze and the measurement will display
• Acquire 10 measurements

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Steps for UGAP measurement Quality
1. Display B-Mode image with good quality
2. Probe placement parallel to the ribs (turn the probe slightly to go between ribs)
3. Probe to skin contact (No air gap at the skin, Push when needed)
4. Avoid artifacts, shadowing and vessels
5. Measure at the position with high quality on quality map, keep measurement ROI as
close to the center of the field of view as possible

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Multiple Shadows

• There are Rib shadows near the measurement ROI • Probe is turned parallel to the ribs to reduce rib
• Numbers are higher than expected shadows
• Numbers are as expected
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Multiple Shadows

• There are some shadows in liver parenchyma • Remeasured with avoiding the shadow
• The measurement ROI is placed on the shadow • Watch for artifacts in the liver

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Effects of Vessels

• There is a vessel in the measurement ROI • Remeasured with avoiding the vessel
• 0.61 dB/cm/MHz lower than expected • 0.72 dB/cm/MHz, as expected

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Effects of Vessels

• There is a vessel in the measurement ROI • Remeasured with avoiding the vessel
• 0.74 dB/cm/MHz, higher than expected • 0.67 dB/cm/MHz, as expected

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Image noise

GOOD CONFIDENCE

*Note the shadow across the liver

tissue

• Half of B-Mode is noisy, the visibility of liver • Remeasured in B-Mode with good visibility of liver
parenchyma is bad parenchyma
• 0.79 dB/cm/MHz, higher than expected • 0.65 dB/cm/MHz, as expected

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Probe-Skin contact

• There is a loss of probe contact on the lateral side • Probe is turned parallel to the ribs and good contact
• Numbers are higher than expected is seen across the whole FOV
• Numbers are as expected
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Probe-Skin contact

Segment 5 Segment 8

• Segment 5 or 6 may be measured • Segment 7 or 8 may be measured

• Look for the best location with fewest vessels • Look for the best location with fewest vessels
• Avoid rib shadows • Avoid rib shadows
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UGAP measurement with Good Quality

1. Display B-Mode image with good quality (without artifact or rib shadows)
• No artifact from rib bones?
• Not too much reverberation, haze and noise in liver surface?
• Good liver parenchyma visibility?
2. Avoid artifacts, shadowing and vessels
3. Measure at the position with high quality on quality map
4. Place probe parallel to the ribs to help reduce the shadows
5. Keep good Probe-skin contact across the whole transducer
6. Segments 5, 6, 7 or 8 may be measured

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