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BBG 012. Description of Study -Echocardiography. CONTENTS. page Patient Data Entry (SonoVue) /Erase Buffer 17 Preparation SonoVue 18 Loop 9 (a 4 CV SonoVue) 19 Loop 10-12 (a2CV, a3CV, SAX SonoVue) 20

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Bbg 012

BBG 012

Description of Study -Echocardiography


Contents
CONTENTS

page

Patient Data Entry (SonoVue) /Erase Buffer 17

Preparation SonoVue 18

Loop 9 (a 4 CV SonoVue)19

Loop 10-12 (a2CV, a3CV, SAX SonoVue)20

Contrast AQ Optimisation 21

AQ (a4CV-SonoVue)22

Loop 13 (CK - a 4CV SonoVue)23

Loop 14-16 (CK a2CV, a3CV, SAX SonoVue)24

MCE 25

-Flash 26

Reentry Hospital Name 27

page

Overview 1

Preparations 2

Patient Data Entry (native) 3

Erase Hospital Name 4

Checklist 5

M-Mode-Measurements 6

Annotation Cursor 7

Loop 1 (a 4 CV unenhanced) 8

Loop 2-4 (a2CV, a3CV, SAX unenhanced)9

AQ (a4CV-unenhanced)10

- Selection of ROI (a4CV) 11

- Waveform Analysis 12

Loop 5 (CK - a 4CV unenhanced) 13

Loop 6-8 (CK a2CV, a3CV, SAX unenhanced)14

-Selection of ROI (a2CV, a3CV, SAX) 15

Loop Review 16


Overview

Proceed with MCE-Real Time Perfusion: Image MCE in three apical projections and acquire

at least two flash-replenishment cycles in a 4CV (digital storage not mandatory).

1


Step 1 preparations
Step 1 - Preparations

ECG

MOD

(Initialistation of MODs:

Touch Disk on left touch panel and afterwards touch Init Disk)

SVHS-Video-Tape

S

S

2


Step 2 patient data entry
Step 2 - Patient Data Entry

Press Patient ID

1

Select Manual Entry(necessary only if IDI-Box

is installed and activated –

otherwise go to step 3 directely

2

3

Press ENTER (New Patient)

  • Entry Patient Data:

  • Last Name Field: Insert BBG-Pat.No and add „-N“ to label the loops as „native“First Name Field: Insert Patient Initials

4

S

-N

BBG090101

JRE

If IDI is activated, the MRN-Field a has

to be filled in; please repeat the last name

field (i.e. BBG-Pat.No-N)

Press Patient ID

5

3


Step 2 patient data entry erase hospital name
Step 2 - Patient Data Entry: Erase Hospital Name

PressSetup

1

Touch System on

right Touch Panel

2

Press Institute Name:

a field with your

Institute Name will now appear:

Notice the Institute name for

Post-Study Reinsertion.

3

PressErase

Institute Name is now erased;

Go to OK and confirm with Enter

4

Finalize withSetup

5

4


Step 3 checklist
Step 3 - Checklist

ECG: Are R-Waves positive and clearly distinctable ?

1

Storage: Is the respective SVHS Videotape inserted ?

2

Storage: Is the respective MOD inserted and intialised?

3

Patient No.: Is patient number inserted as described ?

4

Hospital Name: Is hospital name erased ?

5

5


Step 4 m mode measurements

SVHS

Step 4 - M-Mode-Measurements

Touch PRESET

1

Select BBG012-Nativ

2

3

Perform M-Mode-Meaurements from parasternal LAX or parastermal SAX and document size in mm of:

LA, IVSd, LVDD, LVSD, LWPd

(insert results into CRF page 15)

6


Step 5 preparation of annotation cursor for consecutive numbering of digitally stored loops
Step 5 - Preparation of Annotation Cursor(for consecutive numbering of digitally stored loops)

Touch ANNOTATE

1

Position Cursor at Top Right

2

Touch HOME SET

The Annotation Cursor will reappear

automatically at the same position

any time ANNOTATEis pressed

3

1

Annotate 1 for Loop No 1

4

Press ENTER

5

7


Step 6 capture loop 1 apical 4 cv unenhanced

DIGITAL

Step 6 - Capture LOOP 1(apical 4 CV unenhanced)

Image apical 4 CV

1

Press ACQUIRE

5 consecutive cycles will

be prospectively captured

and displayed as loop

2

Press ENTER to accept Loop

for definite storage

OR

Press Acquire again to redo Loop

3

If IDI is activated, a Message will appear on screen

regarding the storage location:

Choose OPTICAL DISC (by moving Track Ball)as your Target Disk

Selection. Go to OKAY and confirm with ENTER

4

Subsequent Loops will be automatically transferred to MOD after step 3 (Acquire + Enter)

8


Step 7 to 9 capture loop 2 4 unenhanced apical 2 cv apical 3cv parasternal sax

DIGITAL

Step 7 to 9 - Capture LOOP 2 - 4(unenhanced apical 2 CV, apical 3CV, parasternal SAX)

Touch ANNOTATE and change Annotation to 2 (3,4)

1

Take care to update the Annotation

BEFORE CAPTURE

of the RESPECTIVE LOOPS

Acquire Loops

Loop 2: apical 2 CV

Loop 3: apical 3 CV

Loop 4: parasternal SAX

2

9


Step 10 aq in apical 4 cv unenhanced

SVHS

Step 10 - AQ in apical 4 CV (unenhanced)

Clear Annotation ->Touch ANNOTATE  CLEAR ALL

1

Touch AQ and Image ABD

afterwards optimise border

detection by adaption of

Gain (i.e. reduce gain),

TGC and LGC

2

Touch ROIto select Region of Interest

3

10


Aq in apical 4 cv selection of roi

SVHS

AQ in apical 4 CV – Selection of ROI

1

Position Cursor in the RV just beside the basal septum at mitral valve level and press Caliper

Now move the cursor just outside the basal lateral wall and there- fore define the base line of the LV and press Caliper

2

Draw the ROI towards the apex

by using the Trackball and

therefore setup the ROI and Press ENTER TWICE

3

To change size or position of the

defined ROI use the Sizeand/or

Positionbuttons above the Trackball.

Press ENTER after each manipulation

4

11


Aq in apical 4 cv waveform analysis

SVHS

AQ in apical 4 CV – Waveform Analysis

Touch WAVEFORM

1

2

The composite Waveform should

be green, indicating low

beat to beat variability

Press Freezeand touch

Global Function

3

Insert the LV-Volumes and EF displayed into the CRF-Page 15: ABD a4CV

4

12


Step 11 capture loop 5 apical 4 cv colour kinesis unenhanced

DIGITAL

Step 11 - Capture LOOP 5 (apical 4 CV Colour Kinesis unenhanced)

Touch 2 D

1

Touch Annotate and set

Annotation to 5

2

3

Image apical 4 CV

4

Touch AQ and Change from

Image ABD to Image Systole

by turning the respective knob

on the right panel

Define ROI (as described for AQ)

5

6

Optimise Image for CK by Gain,

TGC and LGC

Capture Loop

7

13


Step 12 to 14 capture loop 6 8 apical 2 cv 3 cv and parasternal sax colour kinesis unenhanced

DIGITAL

Step 12 to 14 - Capture LOOP 6-8 (apical 2 CV, 3 CV and parasternal SAX Colour Kinesis unenhanced)

Touch 2 D

1

2

Touch Annotate and

change Annotation to 6 (7,8)

Take care to update the Annotation

BEFORE CAPTURE

of the RESPECTIVE LOOPS

3

Image respective view

Touch AQ and Change from

Image ABD to Image Systole

by turning the respective knob

on the right panel

4

Loop 6: apical 2 CV

Loop 7: apical 3 CV

Loop 8: parasternal SAX

Define ROI (see page 14)

5

a2CV & a 3CV & parasternal SAX

Optimise Image for CK by Gain,

TGC and LGC

6

Capture respective Loop

7

14


Ck in a2 cv a3cv and sax selection of roi

DIGITAL

CK in a2 CV, a3CV and SAX – Selection of ROI

Cursor Position a2CV ->Inferior – Anterior at MVL

1

Cursor Position a3CV ->Posterior – Anteroseptal at MVL

2

Cursor Position SAX ->Position Cursor in the middle of RV

at the RV-EBD of IVS;

Press CALIPER ONCE

Move the circle-shaped ROI

to its correct position and press ENTER

twice

3

15


Review of captured loops
Review of captured Loops

DeFreeze

1

Touch Loop on

left Touch Panel

2

Press Display

3

Toggle through the loops by

turning thepage knob

4

16


DIGITAL

Step 15 - Erase Storage Buffer (please erase storage buffer now and apply new patient name as described)

Perform loop review

(8 loops should be in storage buffer)

1

If IDI is activated, the MRN-Field a has to be filled in; please repeat the last name field (i.e. BBG-Pat.No-S)

2

Touch 2 D

7

Press Patient ID

3

Press Patient ID

Select Manual Entry(necessary only if IDI-Box is installed and

activated –otherwise go to step 3 directely

4

-S

BBG090101

JRE

5

Press ENTER (New Patient)

  • Entry Patient Data:

  • Last Name Field: Insert BBG-Pat.Noand add „-S“ to label the loops as „SonoVue“First Name Field: Insert Pat. Initials

6

17


Preparation of sonovue

SonoVue

Preparation of SonoVue

Preparation

SonoVue

18


Step 16 capture loop 9 sonovue enhanced apical 4 cv

DIGITAL

Step 16 - Capture LOOP 9(SonoVue enhanced apical 4 CV)

Select

Preset BBG012 - SonoVue

1

Annotate via Homeset;

set Annotation to 9

2

Start SonoVue Infusion at an

infusion rate of 1 ml/min

and adjust dose

3

Image apical 4 CV

4

Capture Loop 9

5

19


Step 17 to 19 capture loop 10 12 sonovue enhanced apical 2 cv apical 3cv parasternal sax

DIGITAL

Step 17 to 19 - Capture LOOP 10 - 12(SonoVue enhanced apical 2 CV, apical 3CV, parasternal SAX)

Touch ANNOTATE and change Annotation to 10,(11,12)

1

Take care to update the Annotation

BEFORE CAPTURE

of the RESPECTIVE LOOPS

Acquire Loops

Loop 10: apical 2 CV

Loop 11: apical 3 CV

Loop 12: parasternal SAX

2

20


Step 20 optimisation of aq ck with sonovue

SVHS

Step 20 - Optimisation of AQ / CK with SonoVue

  • Provide sufficient contrast concentration (infusion rate; use bolus if necessary) in LV chamber and homogenous contrast

  • Optimisation of Gain Settings(inverted to unenhanced AQ)Adjust Overall Gain (normally increase !)Adjust Lateral Gain Comp. (LGC)

  • If dose optimisation is problematic -> increase MI,especially if shadowing appearsAdjustment of Compression may improve visual image quality, but has no influence on extent of automatic border tracking

21


Step 21 aq in apical 4 cv sonovue

SVHS

Step 21 - AQ in apical 4 CV (SonoVue)

Clear Annotation ->Touch ANNOTATE  CLEAR ALL

1

2

Touch AQ and Image ABD

afterwards optimise border

detection by adaption of

Gain (increase Gain),

TGC and LGC

Touch ROIto select Region of Interest

3

Perform Waveform analysis and document on CRF Page 18

4

22


Step 22 capture loop 13 sonovue enhanced apical 4 cv colour kinesis

DIGITAL

Step 22 - Capture LOOP 13 (SonoVue enhanced apical 4 CV Colour Kinesis)

Touch 2 D

1

2

Touch Annotate and set

Annotation to 13

3

Image apical 4 CV

4

Touch AQ and Change from

Image ABD to Image Systole

by turning the respective knob

on the right panel

5

Define ROI (as described for AQ)

6

Optimise Image for CK by Gain,

TGC and LGC

Capture Loop

7

23


Step 23 capture loop 14 16 sonovue enhanced apical 2 cv 3 cv and parasternal sax colour kinesis

DIGITAL

Step 23 - Capture LOOP 14-16 (SonoVue enhanced apical 2 CV, 3 CV and parasternal SAX Colour Kinesis)

Touch 2 D

1

Touch Annotate and

change Annotation to 14 (15,16)

2

Take care to update the Annotation

BEFORE CAPTURE

of the RESPECTIVE LOOPS

3

Image respective view

Touch AQ and Change from

Image ABD to Image Systole

by turning the respective knob

on the right panel

4

Loop 14: apical 2 CV

Loop 15: apical 3 CV

Loop 16: parasternal SAX

5

Define ROI (see page 14)

a2CV & a 3CV & parasternal SAX

Optimise Image for CK by Gain,

TGC and LGC

6

Capture respective Loop

7

24


Step 24 mce real time perfusion

SVHS

Step 24 - MCE-Real Time Perfusion

Touch Tools  TCE 3

1

2

Touch Angio (on the right Touch Panel)

3

Image a4CV, a3CV and a2CV

(storage on SVHS)

Apply Destruction Flashs

and image at least two flash replenishmant cycles

in a 4CV

4

Flash

Adjust Focus Position

to verify perfusion defects,

i.e. move focus to apex in case of

apical defect to exclude artifacts

5

25


Setting of flash in mce real time perfusion

SVHS

Setting of Flash in MCE-Real Time Perfusion

Touch Impulse

1

Adjust number of destruction frames if necess.:

Touch IFrames and turn

respective knob

2

To adjust Flash MI go toSecondary Controls and then to

Ipower in the right touchpanel.

Default Setting is 0.0 dB = maximum(MI ~ 1.5)

3

Impulse / FlashAngio-MODE

Frames per FlashMI

26


Step 25 reentry hospital name
Step 25 - ReEntry Hospital Name

PressSetup

1

Touch System on

right Touch Panel

2

Press Institute Name,

an empty field will now appear:

Insert the Institute Name

3

Go to OK and Confirm with Enter

4

Finalize withSetup

5

27


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