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ACUSON Cypress™ Operator’s Manual

8-1

CHAPTER 8

Stress Echo

8

Stress echo studies are based on the serial collection of image loops for specific
cardiac views. The Cypress system provides several different stress echo proto-
cols to choose from. Information in this chapter includes:

Connecting the

ECG

signal

How to achieve the best

signal quality during stress echo exams

artifacts

Using the stress setup controls

The stress protocols

Conducting the stress exam — including Rest Stage, Immediate Post and
Peak, and Pharmacological Stress

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Summary of Contents for ACUSON Cypress

Page 1: ...SA Inc MANUFACTURER S ADDRESS 1230 Shorebird Way Mountain View CA 94043 Phone 650 969 9112 800 422 8766 EUROPEAN REPRESENTATIVE Siemens Aktiengesellschaft Medical Engineering Group Henkestraße 127 D 91052 Erlangen Germany Phone 49 9131 84 2524 Document No 10034330 Rev 01 Language English ...

Page 2: ...Solutions USA Inc welcomes customer input on cor rections and suggestions for improvements to this manual Although Siemens Medical Solutions USA Inc has attempted to ensure accu racy throughout this manual Siemens Medical Solutions USA Inc assumes no liability for any errors or omissions nor for any damages resulting from the application or use of this information ACR NEMA v3 TCP IP Ethernet Inter...

Page 3: ...hatsoever Buyer may not reverse assemble reverse compile or otherwise reverse engi neer 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 compute...

Page 4: ...onnel DANGER Possible explosion hazard if used in the presence of flammable anesthetics WARNING Risk of fire Replace fuse as marked WARNING The Cypress System is not intended for use as an ECG monitor or for diagnostic ECG CAUTION Total system chassis leakage current should not exceed 100µA ATTENTION Before using the system carefully read the Safety Technical Description and Accuracy section IMPOR...

Page 5: ... System OFF 1 4 Logging On and Off of the Cypress System 1 5 Logging On 1 5 Logging Off 1 6 Setting Up User Accounts 1 7 Adding Users 1 7 Editing or Removing Users 1 8 Connecting and Using Transducers 1 9 Magneto Optical MO Disk Drive 1 10 External Devices and Connections 1 11 Transporting the System 1 12 Proper Viewing Angle 1 13 System Security 1 14 Location of Fan and Vents 1 15 Contents ...

Page 6: ...o Specify a Setup Option 3 3 About User Accounts 3 3 Explanation of Setup Menu Fields 3 4 The Presets Menu 3 12 Storing a User Defined Preset 3 13 Recalling a Saved Preset 3 13 Recalling a Saved Preset on the New Patient Screen 3 14 Renaming a User Defined Preset 3 14 Removing a User Defined Preset 3 14 Making Changes to the Current User Defined Preset 3 15 Reload Preset with New Patient 3 15 The ...

Page 7: ... the Display Format 4 19 Removing a Study or Patient from the System 4 20 Batch Removal 4 21 Patient Reports 4 22 Adding a Text Comment to a Patient Report 4 23 CHAPTER 5 Scanning Overview of the Scanning Process 5 2 General Information 5 2 Basic Steps to Complete a Scanning Session 5 2 Using Soft Windows 5 3 Using Tools 5 4 Saving Image Data 5 5 Viewing Saved Loops 5 6 Flagging Images 5 7 When to...

Page 8: ...Activate the PW Display 5 44 Main Knob Controls PW Gain and Volume 5 44 PW Soft Windows 5 45 PW Tools 5 48 M Mode Scanning 5 50 Activate the M Mode Display 5 51 Main Knob Controls Gain and Compress 5 51 M Mode Soft Windows 5 52 M Mode Tools 5 53 CHAPTER 6 Cardiac Calculations Overview of Cardiac Measurements 6 2 Types of General Cardiac Measurements 6 2 Types of Specific Cardiac Calculations 6 3 C...

Page 9: ...Calculation References 6 24 CHAPTER 7 Vascular Calculations Overview of Vascular Measurements 7 2 Types of General Vascular Measurements 7 2 Types of Specific Vascular Calculations 7 3 Vascular Calculations Setup 7 4 Setting Parameters 7 4 About Construction Methods 7 4 Selecting a Report Format 7 5 Selecting a Report Background 7 5 About Default Sites for Vascular 7 5 Adding Default Sites for Vas...

Page 10: ... 19 IMT Formulas 7 20 IMT References 7 20 CHAPTER 8 Stress Echo Connecting and Using ECG 8 2 Stress Echo ECG Cables and Connectors 8 3 ECG Signal Quality During Stress Echo Exam 8 6 Reducing ECG Artifacts 8 6 About the Stress Protocols 8 7 Important Stress Controls 8 9 Using the Protocol Soft Window Knob 8 10 Deleting Unlabeled Loops from a Study 8 11 Transferring Studies in a DICOM Format 8 11 St...

Page 11: ...ICOM Setup for Network Transfers 9 8 DICOM Storage Commitment 9 10 Setting the Network Speed 9 10 DICOM Setup For Modality Worklist 9 11 DICOM Setup For Storage Commitment 9 12 Connecting the Cypress System to a Network 9 13 Transferring Studies 9 14 Selecting Studies 9 14 Sending the Studies 9 17 Removing Patient Name and ID from Multimedia and DICOM Images 9 20 Troubleshooting a Network DICOM Tr...

Page 12: ... Acoustic Exposure on the Cypress System Implementing ALARA 10 10 Electrical Warnings 10 11 Infection Control 10 11 Sterilization 10 12 Infection Control Reference 10 13 Patient Contact Materials 10 13 U S Food and Drug Administration Medical Alert 10 14 Peripheral Device Connections 10 15 Ultrasound Contrast Agents 10 16 Operator Safety Issues 10 17 Electrical Safety 10 17 Explosion Hazards 10 17...

Page 13: ...rge Protection 11 6 Troubleshooting 11 7 No Power 11 7 LCD Screen 11 7 Fuse Replacement 11 8 Trackball Maintenance 11 9 Cleaning the Cypress Trackball 11 9 APPENDIX A Connecting External Devices Connecting a Video Printer A 3 Connecting a SVHS VCR A 5 Connecting a VCR and Video Printer A 7 Connecting an External Monitor A 9 Connecting an External Keyboard A 10 APPENDIX B Printing Reports Connectin...

Page 14: ...ames are in bold italics BUTTON Buttons that appear on the screen are in capital let ters and enclosed in square brackets KEY Keys are in capital letters and enclosed in angle brackets system output System output e g messages are in courier font Click In this manual click means n Move the cursor to the desired location using the Trackball n and then press one of the ENTER keys located next to the ...

Page 15: ...ess ultrasound system It includes the following information Overview drawings of the system How to turn the power ON and OFF How to log on and off of the system How to connect transducers Using removable media in the optical disk drive Connections to external devices How to transport the Cypress system System security ...

Page 16: ...erator s Manual Overview of the Cypress System FIGURE 1 Overview of the Cypress System KEYBOARD TRANSDUCER CONNECTOR TILT MONITOR KEYBOARD TILT MECHANISM ON OFF SWITCH ON BACK ECG CONNECTOR ON BACK MAGNETO OPTICAL DRIVE EXTERNAL CONNECTORS ...

Page 17: ...ated above the power cord receptacle Press the side of the rocker switch The system goes through its boot up sequence If User Accounts are enabled the Login window opens see Logging On and Off of the Cypress System on page 1 5 and Setting Up User Accounts on page 1 7 for more information If User Accounts are not enabled the 2D screen appears and the system is ready for use WARNING Never turn the s...

Page 18: ...the disk Wait until the system displays this mes sage It is now safe to turn off your computer NOTE Using Shutdown insures that any open Patient Studies or images are properly saved Failure to use the Shutdown command can result in boot up delays the next time the system is turned on 5 Switch the power OFF Press the o side of the rocker switch FIGURE 3 The Shutdown Menu Screen THEN CLICK THE SHUTD...

Page 19: ...ge 1 7 for information about enabling the logon feature and creating User names and Passwords When the system is set up to require User Accounts and the system is booted the following things happen On the Shutdown screen the RESTART button is replaced by the LOGOFF button Every user must have a valid User Name and Password The logon screen opens when the system is started Logging On To logon to th...

Page 20: ...and the system will not respond until a valid user name and password are entered Automatic Logoff An automatic logoff occurs when the system Administrator has Enabled the Automatic Logoff option and there is no system activity i e nothing on the key board is pressed or touched for the specified time The time choices for automatic logoff are 15 30 45 and 60 minutes If the imaging system is active a...

Page 21: ...ion 3 On the right side of the screen click the Require User Logon box to enable User Accounts 4 If desired type in a Logon Message The Logon Message will appear at the top of the Logon box For example it can be a welcoming message like Hello please Log on or it can specify an emergency logon For Emer gency Logon enter User Hospital Password Echo 5 Type in a User Name for the user Note that User N...

Page 22: ...s To edit or remove User Account follow these steps 1 Press the SETUP key 2 Highlight the User Accounts option 3 Specify the User Account by selecting the account from the dropdown menu 4 Make any changes and click EDIT or click REMOVE to delete the user from the Cypress system ...

Page 23: ... to scan if a message that no transducer is connected appears on the screen the transducer connector may not be securely attached Remove the connector and try again When the Cypress is powered up and a transducer is inserted an audio signal indicates that the transducer has been inserted cor rectly When the transducer is not in use store it in the holder on the back of the sys tem When transportin...

Page 24: ...ystem uses a 3 5 inch magneto optical disk for removable stor age Disks may need to be formatted prior to use Transferring Studies Using the MO Drive on page 9 22 FIGURE 5 Using the MO Disk Drive To insert a disk into the system load the disk as shown in Figure 5 To remove a disk press the button located next to the disk bay NOTE The system must have power to eject the disk when using the eject bu...

Page 25: ...ing equipment and IEC 601 1 for medical equipment Fur thermore all configurations shall comply with the system standard IEC 601 1 1 Any party who connects additional equipment to the signal input part or signal output part is considered to be configuring a medical system and is therefore responsible for ensuring that the system com plies with the requirements of the system standard IEC 601 1 1 If ...

Page 26: ...en transporting the unit Always put the hinged keyboard in the up position FIGURE 7 How to Move the Cypress System Transporting the Cypress System in a Vehicle Disconnect the transducers and store them in a separate packing case Place the system itself securely in a packing case or carrying case Secure the case within the vehicle to prevent it from moving or shifting Moving the Cypress System with...

Page 27: ...Angle Proper Viewing Angle The images on the Cypress system appear most clearly when the user is look ing down at the screen at a 15 angle Tilt the monitor to achieve the best view ing angle The monitor tilts from 5 to 30 FIGURE 8 Proper Viewing Angle 15 ...

Page 28: ...to use with the Cypress system security lock Siemens does not sell this cable These cables are most commonly used to secure laptop computers To install the security cable follow these steps 1 Insert the cable into the security slot provided 2 Wrap and secure the cable around an adjacent fixture To prevent theft the fixture should be immovable or extremely difficult to move FIGURE 9 Cypress System ...

Page 29: ... Cypress system fan and vents in Figure 10 Make sure that the fan and vents are never covered Air should always be able to flow freely around the Cypress system FIGURE 10 Location of Fan and Vents THE FAN IS LOCATED ON THE RIGHT SIDE OF THE CYPRESS SYSTEM VENTS ARE LOCATED ON THE TOP AND BACK OF THE CYPRESS SYSTEM ...

Page 30: ...System Overview 1 16 ACUSON Cypress Operator s Manual ...

Page 31: ...the type of scanning Using the Trackball and ENTER keys Using the time gain compensation TGC slide pots to adjust the depth related gain of the 2D image How the function of the Main knob depends on the active mode of the system Using the Soft Window knobs to control the soft windows options located on the bottom of the screen Using the Function keys Using the Alphanumeric keys to enter text data ...

Page 32: ...me gain compensation TGC slide pots The Main knob Four Soft Window knobs Six Function keys An alphanumeric keypad PATIENT CALC 2D M C CW PW qSAVE Caps Lock A S D F G H J K L Return Z X C V B N M Shift W E R T Y U I O P Q Tab 2 3 4 5 6 7 8 9 0 1 Esc TRACKBALL MODE KEYS TGC SLIDE POTS ALPHANUMERIC KEYPAD MAIN KNOB SOFT WINDOW KNOBS FUNCTION KEYS TOOLS SAVE SETUP VIEW Ctrl Fn Alt Shift ENTER KEYS Bac...

Page 33: ...vates the time motion sweep The M key then toggles from time motion sweep to the real time image To exit M Mode press 2D COLOR Color Flow Mapping Pressing the COLOR key activates color flow mapping mode within the 2D image The location of the color may be adjusted by moving the Trackball The COLOR key toggles ON OFF to turn color flow OFF press the COLOR key again Note that Color can only be turne...

Page 34: ...Doppler or M Mode pressing Q SAVE saves a single sweep screen In Freeze mode Q SAVE saves the frozen image displayed on the screen It also saves loops stored in temporary memory by pressing Q SAVE while the loop is playing While images are being saved an icon of a camera is displayed in the upper right hand corner of the screen For more information see Sav ing Image Data on page 5 5 FREEZE The FRE...

Page 35: ... be used to move frame by frame through a loop The Main knob also controls one or two separate parameters per mode Press the knob down to activate the different parameters For example in PW mode the knob controls PW gain and volume Buttons on the bottom center of the screen display the two choices with Gain highlighted as the active default control Press the knob to select Volume press the knob ag...

Page 36: ...ck speed turn the Main knob counterclockwise to select SLOW and clock wise to select FAST This function is available in all full screen View and Freeze modes when PLAY is displayed in the Soft Window controlled by the Main knob M Mode 2D Active Compress 2D Gain Search Play M Mode T M Active Compress Gain Scroll Color 2D Gain Color Gain Search Play CW 2D Active Compress 2D Gain Search Play CW Spect...

Page 37: ... through the functions press the corresponding knob The label name changes as the knob is pressed For example in PW active mode the fourth Soft Window knob controls both Fil ter and Scale Press the corresponding soft window knob to switch between the two options The label that is displayed on the screen determines which function is active See the list of the Cardiac and Vascular Soft Window contro...

Page 38: ...le when the PLAY LOOP PLAY SERIES function is activated the area will be blank when PLAY ALL is activated BEATS FRAMES TIME MS APEX INVERT FINE POWER DEPTH ZOOM FREQUENCY FLAG PLAY ALL PLAY SERIES PLAY LOOP SWEEP FREQUENCY FLAG FILTER SCALE APEX INVERT FINE POWER DEPTH ZOOM FRAME RATE HEIGHT FLAG PLAY ALL PLAY SERIES PLAY LOOP FILTER SCALE BASELINE SWEEP FLAG FILTER SCALE RANGE GATE BASELINE SWEEP...

Page 39: ...lank when PLAY ALL is activated 2D STEER APEX INVERT FINE POWER DEPTH ZOOM FREQUENCY FLAG PLAY ALL PLAY SERIES PLAY LOOP PW STEER 2D STEER ANGLE SWEEP RANGE GATE APEX INVERT FINE POWER ZOOM DEPTH FREQUENCY FLAG SWEEP FREQUENCY FLAG C STEER FILTER SCALE APEX INVERT FINE POWER DEPTH ZOOM INVERT HEIGHT WIDTH FLAG PLAY ALL PLAY SERIES PLAY LOOP PW STEER ANGLE FILTER SCALE RANGE GATE BASELINE SWEEP INV...

Page 40: ...OR CALC Calculations Activates the measurement and analysis function If CALC is pressed during real time scanning the system will freeze the image first then open the Calculations menu Pressing CALC a second time removes the calculations menu from the screen Which Calculations menu is activated is determined by the active scanning mode or what is being reviewed For exam ple if 2D is active the 2D ...

Page 41: ...exit View press any scanning Mode key except COLOR TOOLS Used to access infrequently used image adjustment con trols Pressing TOOLS opens a list of controls on the right side of the screen Use the Trackball and ENTER key to activate a specific choice Once a choice has been activated make adjustments in the settings using the Trackball and ENTER key To leave Tools press the TOOLS key again SAVE Sav...

Page 42: ...r left section of the numeric keys For all capital letters press the CAPS LOCK key to disable all capital let ters press CAPS LOCK again To select multiple items that are in consectutive order use the SHIFT key Press and hold down the SHIFT key while using the Cypress Trackball and the ENTER key to highlight items To select multiple items that are not in consecutive order for example a number of s...

Page 43: ...s the corresponding key shown below To create uppercase characters with diacritical marks Hold down the ALT key and the SHIFT key and press the corresponding key shown below Caps Lock á ß ð ø Return æ ç ñ µ å é þ ü ú í ó ö ä Tab Esc Shift Shift Backspace Ctrl Fn Alt Caps Lock Á Ð Ø Return Æ Ç Ñ Å É Þ Ü Ú Í Ó Ö Ä Tab Esc Shift Shift Backspace Ctrl Fn Alt ...

Page 44: ...ters They are highlighted below To add a diacritical mark to certain alphabetic characters Hold down the ALT key and the SHIFT key and press the key with the corresponding diacritical mark shown below Type the alphabetic character key Caps Lock A S D F G H J K L Return Z X C V B N M W E R T Y U I O P Q Tab Esc Shift Shift Backspace Ctrl Fn Alt ...

Page 45: ...l 3 1 CHAPTER 3 Basic Setup 3 This chapter describes how to use the SETUP Function key to configure the Cypress system It includes information on User Accounts Setting parameters for system operation The user defined Preset settings ...

Page 46: ...on page 3 4 for an explanation of the fields FIGURE 13 The Setup Menu Screen Shutdown Reports Setup Patient CLICK THE SIGN TO DISPLAY THE FULL LIST OF OPTIONS WHEN YOU SELECT AN OPTION THE SELECTION INFORMATION WILL BE DISPLAYED HERE Setup Presets User Accounts Calculations DICOM Network Identification Multimedia Connection System ...

Page 47: ...cify a Setup Option 1 Press the SETUP key 2 To display the list of subtitles click the sign next to Setup or double click the Setup heading 3 Use the Trackball and ENTER key to highlight a subtitle A selection menu will appear on the right side of the display 4 Use the Trackball and ENTER key to specify a setting About User Accounts The Cypress system can be configured with User Accounts When this...

Page 48: ...e default is 1 When 1 is selected the loop or series will play one time Using Loop Repeats While in Play Loop mode turn the PLAY ALL knob and each loop will play X times before advancing to the next loop Quad Review specifies whether the system uses Loop Align When this box is checked the loops displayed in the quad format while in a stress protocol will start and end at the same time For example ...

Page 49: ... more frames with measurements present these frames will not have the measure ment graphics present in the loop when exported in DICOM or multimedia format The frames contain ing measurements will be transferred as single frame images with the measurement graphics visi ble These images will follow the loop in which the measurements originally appeared Using this fea ture the frames containing meas...

Page 50: ...TER key while mov ing the Trackball to set the speed Or use the Track ball to position the cursor at a point within the range scale and then press the ENTER key the speed marker will move towards the cursor To slow down the Trackball slide the bar to the left for a faster Trackball slide the bar to the right Double Click Speed Sets the speed of the double click used throughout the system for examp...

Page 51: ...his manual Options Soft Tissue s Bone b or Cephalic c There are three Thermal Indices Soft Tissue TI TIs for use in Cardiac first tri mester fetal vascular and abdominal Cranial Bone TI TIc for use in Transcranial Bone near surface Bone TI TIb Second and third trimester fetal Bone near focus Institution Name Sets the current Institution name Type a new name or select one from the drop down list A ...

Page 52: ...selected and M PW or CW are pressed a split screen appears with a small image Use the Trackball to position the cur sor Press the mode key again to display the Time Motion or Spectral Display Press the mode key to switch between the 2D image and the Time Motion or Spectral display Press 2D to exit Duplex 2D Update Use the radio buttons to select the rate of update for the 2D image while in duplex ...

Page 53: ...rk in the box tells the system to display military time 2 00 PM is displayed as 14 00 00 To enable the 24 hour clock click the checkbox To disable the 24 hour clock click the checkbox again to remove the check AM and PM time are displayed when the box is not checked Video Out Mode Sets the video out mode Use VGA when connecting a monitor or overhead projector Use NTSC when con necting a video prin...

Page 54: ...ral display in the Doppler modes Lock Studies Sets the status of a study once it is deactivated Options include Never Changes can be made to the studies at any time After Hours Use the trackball to place the cursor in the box and type the number of hours after which the study will automatically lock Once Deactivated Studies are locked as soon as they are deactivated Stress Echo When Enabled the ca...

Page 55: ... box to enable Quick Text See Quick Text on page 5 17 for more information 3D Acquisition This is available with the separate 3D option The 3D options are R Trigger R Trigger Signal Out Go Signal In Step Size in degrees from 1 to 6 degrees TABLE 4 Setup Menu Fields Field Description ...

Page 56: ...r the 3V2c and 7V3c transducers User defined Presets These presets can be defined edited and deleted by users NOTE The Cypress system saves the last loaded preset which is loaded at the next power up This is the list of functions that can be stored in a user defined preset 1 Depth 22 Sweep Speed 2 Frequency 23 PW Range Gate Size 3 Left Right Invert 24 PW Gain 4 2D Gain 25 PW Baseline 5 Apex Invert...

Page 57: ...ings Contrast etc 6 Click OK 7 Click UPDATE NOTE A maximum of 16 user defined presets can be stored NOTE Changes can be made to the Presets at any time by changing the system parameters and then clicking the UPDATE button in the Setup Presets menu Recalling a Saved Preset To recall a saved Preset follow these steps 1 Press the SETUP key 2 Highlight the Presets heading 3 Use the pull down menu to s...

Page 58: ...tory default Preset will be loaded Renaming a User Defined Preset To change the name of an existing Preset follow these steps 1 Press the SETUP key 2 Highlight the Presets heading 3 Use the pull down menu to select the Preset option to be renamed 4 Click RENAME 5 Use the Trackball to place the cursor in the Presets text field and type a new name 6 Click OK Removing a User Defined Preset To remove ...

Page 59: ...ess the SETUP key 2 Highlight the Presets heading 3 Click UPDATE Reload Preset with New Patient Presets can be reloaded each time new patient data is entered To enable this feature follow these steps 1 Press SETUP and double click the Presets heading 2 Highlight the Reload with New Patient option 3 Place a checkmark in the Enabled box The Preset is loaded when live imaging begins NOTE If a Preset ...

Page 60: ...stem or double click the System heading 3 Use the Trackball and ENTER key to highlight a subtitle A selection menu will appear on the right side of the display 4 Use the Trackball and ENTER key to specify a setting or view the current setting See Table 5 for an explanation of the System fields Explanation of System Menu Fields When System is highlighted the following information is displayed Syste...

Page 61: ... a transducer for example AcuNav and select a default protocol from the pull down menu at the right of the screen 3 Continue until each transducer has been assigned a default protocol Options Highlight Options to display the following informa tion Enable Password Modification Click the check box to enter a new password Password Passwords are issued by Siemens Passwords are unique to each Cypress s...

Page 62: ...r 2D Trace Defines a portion of the 2D image Specify the Construction and Resolution Doppler Trace Defines the flow patterns on the Doppler Spectral Display Specify the Construc tion and Resolution Construction The Construction option speci fies whether the trace is built in a continuous motion or using points that are then connected To change the construction use the Construc tion radio buttons t...

Page 63: ...port displays only the sections where data has been entered Vascular Format Specifies a report format for Vascular studies Only the Configured format is available the report displays only the sections where data has been entered Menu Position The default menu position for the Calcs menu is in the upper right corner Using this option you can move it to one of the other corners of the screen by sele...

Page 64: ...mber is different from that of the DICOM Server configuration See DICOM Storage Commitment on page 9 10 for more information Modality Worklist Server Information If a DICOM Worklist Server which is part of a hospi tal information system is on the imaging network it can be queried by the ultrasound system for a list of patients scheduled for exams Patient and study demographics can then be auto mat...

Page 65: ...specifies the color of the calculation report when it is converted into DICOM It does not affect the calculation report displayed on the Cypress system To set the DICOM calculation report color click the radio button to specify the color selection either dark text on a light background or light text on a dark background Single Frame Images Place a checkmark in the Always Send Lossless box to send ...

Page 66: ...ems and a PC running the CypressViewer soft ware Transferring images in Cypress format over a network using CypressLink requires the Networking option for the Cypress ultrasound system CypressLink is enabled when the Enabled box is checked Specify the Port Multicast IP address and Multicast TTL here To Allow Receiving Stud ies put a check mark in the box Multimedia Connec tion Setup The Multimedia...

Page 67: ...bes how to use the PATIENT Function key to create view and maintain a patient directory in the Cypress system It includes information on Setting up a patient directory Entering patient information Adding new patients to the directory Creating editing and viewing patient studies ...

Page 68: ...dit Remove Study 0 Shutdown Reports Setup Patient New Study Study List New Patient Storage Free 3535 Send Cypress DOE A 04 22 2000 09 27 None 04 22 2000 08 54 None DOE B 04 21 2000 14 59 3 Stage Exercise 04 21 2000 13 27 None DOE C 05 21 2000 13 18 Pharmacological DOE J 06 21 2000 11 01 2 Stage Exercise DOE P 12 10 1999 10 40 MO Disk 63 Mbytes free DOE E ALPHABETICAL LIST OF PATIENTS AND ALL OF TH...

Page 69: ... DOE WE 36038 10 30 1999 None 1 DOE WR 36517 04 04 2000 None 1 Storage MBytes Free 3535 Si Patient Name Patient Id Protocol Date Arc THIS DISPLAY SHOWS EACH STUDY AS A SEPARATE ITEM WHERE THE LISTS CAN BE SORTED TO SORT A COLUMN CLICK THE LABEL AT THE TOP FOR EXAMPLE TO SORT BY PATIENT CLICK THE PATIENT NAME LABEL ONCE TO SORT FROM A TO Z CLICK AGAIN TO SORT FROM Z TO A SWITCH BETWEEN THE PATIENT ...

Page 70: ...studies stored in DICOM for mat This icon only appears in front of studies listed in the MO Disk sub directory Studies listed in the MO Disk sub directory can have either the Cypress format icon or the DICOM format icon in front of them depending on which format was used to save the study to the MO Disk Note that studies saved to the MO Disk in DICOM format cannot be read on the Cypress system you...

Page 71: ...s Icon Name Explanation Study 0 Shutdown Reports Setup Patient Storage MBytes Free 3535 Cypress DOE A 04 22 2000 09 27 None 04 22 2000 08 54 None DOE B 04 21 2000 14 59 3 Stage Exercise 04 21 2000 13 27 None DOE C 05 21 2000 13 18 Pharmacological DOE J 06 21 2000 11 01 2 Stage Exercise DOE P 12 10 1999 10 40 01 24 2000 11 10 MO Disk 63 Mbytes free DOE E CYPRESS SYSTEM HARD DRIVE PATIENT FILE TURNS...

Page 72: ...for the selected patient or study to edit existing data see Editing Patient and Study Information on page 4 16 REMOVE Removes the highlighted patient or study from the list and the system see Removing a Study or Patient from the System on page 4 20 There are three options Remove all data removes all traces of the studies and all patient information and reports Remove all images removes images but ...

Page 73: ...s displayed when a compatible ink jet printer is connected to the Cypress system via the USB port WORKLIST Requires optional DICOM Network ing Feature Use the Worklist feature to query the Hospital Informa tion System for Patient Demographic Information This information is automatically entered into the New Patient screen eliminating the need to manually enter the data Systems with the DICOM Netwo...

Page 74: ...ed by this icon Multimedia Study data can be sent to an MO disk or a computer in a Multi media format Images are converted to AVI files and the patient report is con verted to RTF Rich Text Format files that are compatible with most major word processing programs Represented by this icon Expanding Patient Folders Patient folders have either a plus or minus sign next to them A plus sign means that ...

Page 75: ...ame 4 Use the Trackball or TAB key to move the cursor to the First Name field and type in the patient s first name 5 If desired type an ID number up to 64 characters The ID number should be unique e g the patient s date of birth or social security number Note that the combination of the patient s last name first name and the ID num ber must be unique Shutdown Reports Setup Patient OK Cancel Last N...

Page 76: ...irst time an image is saved for this study the date and time are automatically put in The default is a checked box If you are adding a group of patients before actually conducting the studies for example you may want to add all the patients that you will see on the following day un check the box When you save an image for these patients the system will add the date and time of the actual study NOT...

Page 77: ...dy To deactivate averaging click the box to remove the checkmark Note that this checkbox overrides the system wide selection in the Setup menu 13 Select a Preset for this study Click the PRESETS button to display a pull down menu Select a Preset and click LOAD 14 To save the new entry and stay in the patient study directory click OK To exit without saving click CANCEL To save the new entry and go ...

Page 78: ...x is displayed with a CANCEL button to cancel the search click CANCEL 9 When the search is complete the results are displayed in table form at the bottom of the Worklist Query screen The displayed fields are Patient Sex Birth Date Patient Id Accession Number Study Date and Modality Each field can be sorted alphabetically by clicking on the column header 10 Select the desired patient by double clic...

Page 79: ...he first name Christopher you can enter Chris or pher Accession The Identification code indicating the sequence of the current study as related to other studies for this patient Used for billing purposes Typically generated by a HIS RIS worklist server Note that searching for the acces sion number requires an exact match Procedure ID Requested Procedure ID Note that searching for the requested pro...

Page 80: ...ouble clicking its row or by selecting high lighting it and clicking CREATE 4 The Modality Worklist Details screen will be displayed listing all available information on this patient received from the Worklist Server Use this infor mation to verify that the selected patient is the patient that is about to be scanned 5 To create a new Patient and Study for the selected patient click OK on the Modal...

Page 81: ...hen you have found the appropriate patient use the Trackball and ENTER key to highlight the patient name 4 Click the NEW STUDY button to start a separate and new study for this patient 5 If desired enter a new Height Weight Blood Pressure Study Indication or Accession and select the Protocol by clicking on the arrow to display the drop down menu and highlighting the protocol 6 Click OK 7 To save t...

Page 82: ... information for an existing patient follow these steps 1 Press the PATIENT function key to display the Patient list or Study list 2 Highlight the patient s name in the Patient list 3 Click the EDIT button 4 Use the Trackball or TAB key to move the cursor to the field you want to edit and type in the new information 5 Click OK to save the changes 6 To exit press 2D or any Mode key except COLOR FIG...

Page 83: ...field you want to edit and type in the new information 5 Click OK to save the changes 6 To exit press 2D or any Mode key except COLOR FIGURE 18 Editing Study Information HIGHLIGHT THE STUDY DATE AND TIME THESE FIELDS CANNOT BE CHANGED TO CHANGE THE INFORMATION IN THESE FIELDS USE THE TRACKBALL AND KEYPAD Shutdown Reports Setup Patient OK Cancel Last Name First Name ID Birth Date Sex Height Weight ...

Page 84: ...Use the Trackball or TAB key to move the cursor to the patient information fields and type the new information 5 Click OK to save the changes 6 To exit press 2D Using Existing Studies Adding Data to an Existing Study To add additional loops to an existing study follow these steps 1 Press the PATIENT function key to display the Patient Study list 2 Scroll through the directory by positioning the Tr...

Page 85: ...ACTIVATE button 5 Press the VIEW function key to display the study 6 To exit View and return to the patient directory press PATIENT To exit and continue scanning press 2D NOTE An alternate method of activating a study is to double click the study in the Patient List If a patient folder contains more than one study double click the specific study date and time How to Change the Display Format Studi...

Page 86: ... patient or study you want to remove use the Trackball and ENTER key to highlight the patient name or the date of the study 4 Click the REMOVE button to delete the patient or study from the system 5 A system message prompts you to specify what data should be removed by clicking the corresponding radio button All Data deletes all information per taining to the patient All Images deletes all loops a...

Page 87: ...he corresponding radio button All Data deletes all information per taining to the patient All Images deletes all loops and frames the patient name and patient information remain in the Patient Study List or Unflagged Images all image data not flagged will be deleted 6 Click YES TO ALL to remove all of the highlighted studies or click YES to confirm deletion of each study one at a time 7 To exit pr...

Page 88: ...s 1 Press the PATIENT function key to display the patient directory 2 Use the Trackball to highlight the desired study and press ENTER 3 Click the ACTIVATE button 4 Click the Reports tab to display the information 5 Scroll through the report by positioning the cursor on the up or down arrow and pressing ENTER or by turning the Main knob FIGURE 19 The Patient Report Shutdown Reports Setup Patient P...

Page 89: ...e patient directory 2 Use the Trackball to highlight the desired study and press ENTER 3 Click the ACTIVATE button 4 Click the Reports tab to display the information 5 Click the TEXT COMMENTS button to open a text box 6 Use the Cypress system keypad or an external keyboard to type in the text box and then click OK The text entered in the text box will appear in the Comments section of the Patient ...

Page 90: ...Patients 4 24 ACUSON Cypress Operator s Manual ...

Page 91: ...ols for each of the following scanning states 2D Color Flow Continuous Wave Doppler CW Pulsed Wave Doppler PW M Mode Controls used to complete scans and save images include The time gain compensation TGC controls The Main knob changes for each scan mode Soft windows change for each scan mode The Tools buttons how they work for each scan mode ...

Page 92: ...he boot up sequence Never turn the Cypress system OFF until boot up is complete 5 Press the PATIENT function key to add a new patient or select a patient with a previous study from the patient directory 6 Scan the patient and use the system controls to optimize the image 7 Use the Mode keys to activate the scanning modes 8 Use the FREEZE key to freeze the image and activate the scrolling memory 9 ...

Page 93: ...ions are listed by mode on page 2 8 and page 2 9 Some Soft Windows are assigned two or more functions these are indicated by a triangular icon in the upper right corner of the Soft Window Press the corresponding Soft Window knob to display the additional function s FIGURE 20 Soft Windows are Controlled by the Soft Window Knobs PATIENT CALC 2D M C CW PW qSAVE TOOLS SAVE SETUP VIEW EACH SOFT WINDOW ...

Page 94: ... select a control button A menu opens Select a function from the menu See the descriptions of each scanning mode on the following pages for informa tion about specific tools FIGURE 21 The TOOLS Function Key Displays the Tools Buttons Apex Invert Depth Frequency 2D Gain Compress Image 3V2c Pwr M MI 1 0 TIs 0 1 Comp 2 Pproc 3 GN 5 45fps 16 2cm Harmonic Text THE TOOLS BUTTONS ARE LOCATED IN THE TOP R...

Page 95: ...loops in a seamless dis play Press SAVE or Q SAVE to capture the series of loops Each loop in a series of loops can be viewed separately by pressing the PLAY SERIES knob to display PLAY LOOP in the soft window The SAVE key can be programmed to save 4 8 16 or 32 seconds of data The Q SAVE key can be programmed to save 1 2 or 3 cardiac cycles when the patient s ECG is properly displayed on the scree...

Page 96: ...series turn the knob clockwise To return to the previous loop series turn the knob counter clockwise Delete The Delete function is available in both the Play Loop and Play Series modes When PLAY LOOP is displayed pressing or turn ing the DELETE Soft Window knob deletes the currently dis played image data When PLAY SERIES is displayed pressing or turning the DELETE Soft Window knob deletes the curr...

Page 97: ... Soft Window the currently displayed single loop or frame is flagged If PLAY SERIES is displayed the entire series of loops is flagged NOTE In Freeze mode flagging does not save the data you must also press either SAVE or Q SAVE to save the data as part of the patient s study TABLE 13 Main Knob Controls When Viewing Loops Control Function Description Search In Search mode turning the knob allows a...

Page 98: ...w and Stage are flagged automati cally you can easily remove all the unflagged loops from the study 1 Press PATIENT and highlight the Date and Time of the study 2 Click REMOVE 3 An option box opens Click the Unflagged Images radio box and then click YES ALL frames loops and series not flagged are deleted Note that deleted data cannot be retrieved Transferring a Study in Multimedia Format To transf...

Page 99: ...lds Not all fields appear all the time When a field has a set range of values that range is noted See the individual descriptions of scanning modes in this chapter for specific information on changing settings Most of the fields are controlled by the Soft Windows and their options When a field includes a variable number or letter it is shown in the Setting column of the Table as the pound sign The...

Page 100: ...ver neither MI 1 0 nor any other level indicates that a bioeffect is actually occurring Do not be alarmed by the reading but use it to implement the ALARA As Low As Rea sonably Achievable principle TIx Thermal Index TI is a relative indicator of temperature increase The selections are Soft Tissue s Bone b or Cephalic c TI monitors conditions that may lead to a temperature rise whether at the surfa...

Page 101: ... 26 9 cm HPF Hz High Pass Filter Doppler Mode only Use the FILTER Soft Window knob to adjust the filter The range is from 200 Hz through 1400 Hz for CW and from 25 Hz through 1400 Hz for PW F Filter Color mode only indicates the velocity filter applied to the Color Doppler The range is F1 through F6 Harmonic Harmonic If your transducer has harmonic mode the word Harmonic will appear Use the FREQUE...

Page 102: ...e is turned on and adjusted with the corre sponding Soft Window knob The angle symbol appears in the System Data field when an angle equal to or greater than 1 is selected The current angle correction setting appears to the right of the symbol TABLE 14 Explanation of the System Data Fields Setting Function Description xx ...

Page 103: ...te that the Advanced Triggering option must be installed for this Soft Window to have multiple functions FIGURE 23 The Trigger Modes Table 15 describes the trigger modes TABLE 15 Explanation of the Trigger Mode Fields Setting Function Description Beat s Beat Shows the number of beats selected for intermittent imaging mode The range is from 1 through 16 ms Time Increases the trigger time in millise...

Page 104: ...rst line displays the number assigned to the currently displayed loop 1 in the example The second number displays the total number of loops in memory 5 in the example The second line displays the time the current loop was captured The third line displays the date the current loop was captured FIGURE 24 Loop Information LOOP INFORMATION IS DISPLAYED 1 IN VIEW MODE 2 WHEN THE FREEZE KEY IS PRESSED A...

Page 105: ... added to images while in Freeze or Active mode i e any time except when doing calculations There are two types of text that can be placed on images Existing standard labels for example Aorta or Left Ventricle New text or annotations that are added using the alphanumeric keypad for example Check after 6 months FIGURE 25 Adding Text Annotations THE ANNOTATION WINDOW OPENS WHEN YOU CLICK THE TEXT BU...

Page 106: ...emoving Text Annotations from an Image There are two methods of removing text annotations from an image To remove one or more text annotations from an image using the TOOLS menu 1 While scanning press the TOOLS function key 2 Click the TEXT button 3 Remove the text To delete a single annotation In the annotation list highlight the annota tion to be erased from the screen and click ERASE If the ann...

Page 107: ...until it is deleted from the menu Deleting Text Annotations from the Text Menu Text annotation that have been added to the menu using the New Annotation option can be deleted To delete a text annotation from the menu follow these steps 1 While scanning press the TOOLS function key 2 Click the TEXT button 3 Highlight the user defined annotation and click BACKSPACE Note that multiple contiguous anno...

Page 108: ...d Quick Text labels to images while scanning follow these steps 1 Make sure that Quick Text has been activated using the Setup menu 2 To open the Quick Text function press any alphanumeric key on the Cypress keypad or external keyboard 3 Type your text until the annotation is displayed and highlighted in the Text box To backspace and erase a single letter use the BACKSPACE key 4 Press ENTER and us...

Page 109: ...een 2 Use the Trackball to move and position the arrow 3 Press RETURN to rotate the arrow in a clockwise direction in 45 incre ments 4 When the arrow is correctly positioned press the ENTER keys located beside the Trackball to anchor the arrow Adding an Arrow when Quick Text is Not Enabled 1 Press the TOOLS key and click TEXT to open the Annotations window 2 Click the arrow button to display the o...

Page 110: ...he 1 5X Zoom box will open To select the 2 0X Zoom box turn the Soft Window knob clockwise To return to the 1 5X Zoom box turn the knob counterclockwise 3 Once the desired Zoom box is selected use the Trackball to position the box and press ENTER to activate the zoom function 4 To exit and return to a full screen display press the ZOOM knob Zoom Notes The ZOOM function can be activated deactivated...

Page 111: ... controls related to 2D operation are described on the following pages FIGURE 26 The 2D Scanning Screen SYSTEM DATA See Cypress System Data on page 5 9 2D SOFT WINDOW MENU OPTIONS See Table 16 2D Scanning Soft Win dows Options on page 5 23 Depth Frequency 2D Gain Compress 3V2c Pwr M MI 9 9 TIs 1 0 Comp 2 PProc 3 GN 5 45fps 16 2cm Harmonic 60 bpm PRESS THE MAIN KNOB TO SWITCH BETWEEN COMPRESS AND 2...

Page 112: ... depth Slide pots at the top of the slide pot console control near field amplification Slide pots at the bottom of the slide pot console control far field amplification Main Knob Controls Compress and Gain When you press the 2D mode key two options appear Compress and 2D Gain They are controlled by the Main knob Press the Main knob to toggle between the options The current setting is shown in the ...

Page 113: ...l either Rest for 2 Stage and 3 Stage or Base for Pharmacological is highlighted Depth Adjusts the scanning field of view Scanning depth is measured in centimeters and varies according to the transducer frequency Press the corresponding Soft Window knob to select DEPTH For a shallower depth turn the knob counter clockwise For a deeper depth turn the knob clockwise The current selection is displaye...

Page 114: ...gh center frequency of 7 MHz Harmonic is ON when Harmonic is displayed with the System Data in the top left corner of the screen Frequency can be adjusted when Frequency is displayed with the System Data See Cypress Sys tem Data on page 5 9 and Table 14 on page 5 10 Apex Invert Moves the orientation of the image so that the apex switches from the top to the bottom of the screen Press the correspon...

Page 115: ...s and then turn the knob to adjust the setting NOTE As with any echocardiographic technique that uses ECG triggering for this process to func tion properly a stable and reliable waveform or trig ger must be detected by the system Artifacts or other irregularities such as arrhythmias may cause problems in the detection of trigger points such as the R wave NOTE To resume normal scanning when you are...

Page 116: ...ight of QRS turn the knob clockwise The current selection is displayed under the System Data for example 40 0 ms Frames Selects the number of frames that are pro duced in intermittent mode Press the corresponding Soft Window knob to select FRAMES Turn the knob to select a number The range is from 1 to 16 The current selection is displayed under the System Data for example 3 Frames TABLE 16 2D Scan...

Page 117: ...is a sub menu for the selected option another window opens Highlight the desired option and press ENTER to activate the change Press TOOLS to exit the menu To exit the menu without activating the change highlight Cancel and press ENTER Click TEXT to add text to an image in either Freeze or Active mode Click ROI to capture a selected area of the image using the ROI Region of Interest box Click TIME...

Page 118: ...e 3 provides the most lateral gain Post Processing Select from seven post processing or grayscale compression curves The number 2 selection is a linear setting Colorize Applies a variety of colorized maps overlaying the grayshade image Colorize is useful in certain situations to optimize contrast resolution Structure Persistence Turns image persistence to Low Medium or High The default setting dep...

Page 119: ... the box to the desired area Timer Procedure Timer A timer is available for all exams To access the timer follow these steps 1 Press TOOLS and click the TIMER button 2 Select START to display the timer Start Starts the timer clock Restart Starts the timer clock once it has been stopped Stop Stops the timer clock Off Stops the timer clock and removes it from the screen Cancel Closes the menu withou...

Page 120: ... DISPLAYED HERE USE THE SOFT WINDOW KNOBS TO ADJUST THE SETTING SEE Table 18 on page 5 32 SYSTEM DATA See Cypress System Data on page 5 9 COLOR SOFT WINDOW MENU OPTIONS See Table 18 Color Flow Scanning Soft Windows Options on page 5 32 Depth Frame Rate Color Gain 2D Gain Scale 3V2c Pwr M MI 0 9 TIs 0 1 Comp 2 PProc 3 GN 05 17 FR3 45fps 16 2cm Harmonic 52 cm s 52 PRESS THE MAIN KNOB TO SWITCH BETWE...

Page 121: ... if a scanning depth of 16 2 cm is selected the shallowest 1 6 cm is not displayed Main Knob Controls 2D and Color Gain When you press the COLOR mode key two options appear 2D Gain and Color Gain They are controlled by the Main knob Press the Main knob to toggle between the options 2D Gain Turn the knob clockwise to increase the overall amplification of the 2D image data Turn counterclockwise to d...

Page 122: ...g depth is measured in centimeters and is displayed on the top left corner of the screen see Cypress System Data on page 5 9 Scanning depth varies with transducer frequency The maxi mum scanning depth of the system is 24 4 cm For a shallower depth turn the knob counter clockwise For a deeper depth turn the knob clockwise Zoom Available only in active scanning Allows you to select and enlarge a por...

Page 123: ...To decrease the color flow frame rate turn the knob counterclockwise Width Changes the width of the color box The width of the color box can be increased or decreased within the 2D image Press the corre sponding knob to select WIDTH To increase the width turn the knob clockwise To decrease the width turn the knob counter clockwise Height Changes the height of the color box The height of the color ...

Page 124: ...the corresponding knob to select SCALE To increase the velocity setting turn the knob clockwise To decrease the velocity setting turn the knob counterclockwise Filter Applies a velocity filter to Color Doppler The settings are 1 6 A setting of 6 applies the maximum velocity filter Press the corresponding knob to select FILTER To increase the velocity filter turn the knob clock wise To decrease the...

Page 125: ...ted option another window opens Highlight the desired option and press ENTER to activate the change Press TOOLS to exit the menu To exit the menu without activating the change highlight Cancel and press ENTER Click TEXT to add text to an image in either Freeze or Active mode Click ROI to capture a selected area of the image using the ROI Region of Interest box Click TIMER to start the time counter...

Page 126: ... A Higher setting allows the combined 2D and Color Flow data to be dis played with the emphasis placed on the color flow data a Lower setting reduces the color flow data overlay of the 2D image data Transmit Power Controls the maximum acoustic output of the transducer Settings range from 5 to 100 of maximum Use the lowest setting consistent with diagnostic quality The current mechanical index MI a...

Page 127: ...s available for all exams To access the timer follow these steps 1 Press TOOLS and click the TIMER button 2 Select START to display the timer Start Starts the timer clock Restart Starts the timer clock once it has been stopped Stop Stops the timer clock Off Stops the timer clock and removes it from the screen Cancel Closes the menu without changing the timer clock TABLE 19 Color Flow Tools Functio...

Page 128: ...S FILTER SETTING CW MODE SOFT WINDOW MENU OPTIONS See Table 20 CW Scanning Soft Windows Options on page 5 40 CW DOPPLER SPECTRAL DISPLAY APPEARS HERE SYSTEM DATA See Cypress System Data on page 5 9 Baseline Sweep CW Gain Volume Scale 3V2c Pwr M MI 0 9 TIs 0 1 Comp 2 GN 05 13 HPF 700Hz Harmonic 2 0 1 0 0 0 1 0 2 0 PRESS THE MAIN KNOB TO SWITCH BETWEEN VOLUME AND CW GAIN THE BASELINE SOFT WINDOW KNO...

Page 129: ... sector image You can also reposition the CW sample while the 2D image is frozen The cursor in the 2D image will move but the 2D image will remain frozen Main Knob Controls Volume and CW Gain When you press the CW mode key two options appear Volume and CW Gain They are controlled by the Main knob Press the Main knob to toggle between the options Volume Increases or decreases the amplification of t...

Page 130: ... For example Sweep 1 is a 1 second sweep Sweep 2 is a 2 second sweep etc Filter Applies a high pass filter to the Doppler spectrum The filter setting is displayed in the upper left portion of the screen in Hertz Hz see Cypress System Data on page 5 9 The range is from 200 Hz to 1400 Hz Press the corresponding knob to select FILTER To increase the filter setting turn the knob clockwise To decrease ...

Page 131: ... you are in Active mode or Freeze mode Use the Trackball to highlight the desired option and press ENTER If there is a sub menu for the selected option another window opens Highlight the desired option and press ENTER to activate the change Press TOOLS to exit the menu To exit the menu without activating the change highlight Cancel and press ENTER Click TEXT to add text to an image in either Freez...

Page 132: ...tput setting are displayed with the System Data NOTE Refer to the Safety Standards and Accuracy section of this manual and the AIUM document provided with your system Medi cal Ultrasound Safety for important information about Acoustic Out put Colorize Applies a variety of colorized maps overlaying the CW grayshade image This may be useful in certain situations to optimize contrast resolution Text ...

Page 133: ...Y THE HIGH PASS FILTER SETTING PW MODE SOFT WINDOW MENU OPTIONS See Table 22 PW Scanning Soft Windows Options on page 5 45 PW DOPPLER SPECTRAL DISPLAY SYSTEM DATA See Cypress System Data on page 5 9 Baseline Sweep PW Gain Volume Scale 3V2c Pwr M MI 0 9 TIs 0 1 Comp 2 GN 05 13 HPF 700Hz Harmonic 2 0 1 0 0 0 1 0 2 0 PRESS THE MAIN KNOB TO SWITCH BETWEEN VOLUME AND PW GAIN THE BASELINE SOFT WINDOW KN...

Page 134: ... also reposition the PW sample while the 2D image is frozen The cursor line in the 2D image will move but the 2D image remains frozen Main Knob Controls PW Gain and Volume When you press the PW mode key two options appear Volume and PW Gain They are controlled by the Main knob Press the Main knob to toggle between the options Volume Increases or decreases the amplification of the audio signal sent...

Page 135: ...vated only PW Steer will be available in the multifunctional Soft Window Steer ing PW will also steer the Color Box When 2D and Color are both active the multifunctional Soft Win dow will toggle between 2D Steer and C Steer Angle Angle Correction Adjusts the flow direc tion angle Press the corresponding Soft Window knob to select and display the angle correction cursor Turn the knob to adjust the ...

Page 136: ...ert the display Turn the knob again to return to the non inverted display An on screen indicator INVERT is displayed in the System Data Field when the Doppler is inverted Sweep Adjusts the sweep speed of the spectral display Press the corresponding knob to select Sweep Select a sweep number from 1 to 4 where the selection is the number of seconds For example Sweep 1 is a 1 second sweep Sweep 2 is ...

Page 137: ... select Range Gate For the 3V2c transducer the sizes are 5 0 mm 6 0 mm 7 0 mm 8 5 mm 10 0 mm 15 0 mm 20 0 mm For the 7V3c transducer the sizes are 2 0 mm 2 4 mm 3 9 mm 4 9 mm 5 9 mm 8 0 mm 10 0 mm For the 7L3 transducer the sizes are 1 0 mm 2 0 mm 3 0 mm 4 0 mm 6 0 mm 8 0 mm 10 0 mm For the Acunav 10F and 8F transducers the sizes are 1 7 mm 2 1 mm 3 3 mm 4 3 mm 5 3 mm 8 0 mm 10 0 mm For the 4C1 tr...

Page 138: ...eze mode Use the Trackball to highlight the desired option and press ENTER If there is a sub menu for the selected option another window opens Highlight the desired option and press ENTER to activate the change Press TOOLS to exit the menu To exit the menu without activating the change highlight Cancel and press ENTER Click TEXT to add text to an image in either Freeze or Active mode Click TIMER t...

Page 139: ...acoustic output setting are displayed with the System Data NOTE Refer to the Safety Standards and Accuracy section of this manual and the AIUM document provided with your system Medi cal Ultrasound Safety for important information about Acoustic Out put Colorize Applies a variety of colorized maps overlaying the PW grayshade image This may be useful in certain situations to optimize contrast resol...

Page 140: ...DE TRACE OR 2D IMAGE TIME MOTION DISPLAY M MODE SOFT WINDOW MENU OPTIONS See Table 24 M Mode Scan ning Soft Windows Options on page 5 52 SYSTEM DATA See Cypress System Data on page 5 9 Frequency Gain Compress Sweep 3V2c Pwr M MI 0 9 TIs 0 1 Comp 2 PProc 3 GN 05 15 8cm Harmonic PRESS THE MAIN KNOB TO SWITCH BETWEEN COMPRESS AND 2D GAIN THIS MARKER REPRESENTS TIME THIS SCREEN SHOWS A 2 SECOND SWEEP ...

Page 141: ... shallowest 1 6 cm is not displayed Main Knob Controls Gain and Compress When you press the M mode key two options appear Compress and 2D Gain If you press M again the spectral display becomes active and the two options are Compress and Gain Press M again to make 2D active again The options are controlled by the Main knob Press the Main knob to toggle between the two active options Compress Adjust...

Page 142: ...can improve image quality and edge defini tion for difficult studies To turn Harmonic ON or OFF press the FREQUENCY knob The default state is ON To adjust the Frequency press the FREQUENCY knob Harmonic is ON when Harmonic is displayed with the Sys tem Data in the top left corner of the screen Frequency can be adjusted when Frequency is displayed with the System Data See Cypress System Data on pag...

Page 143: ...in Active mode or Freeze mode Use the Trackball to highlight the desired option and press ENTER If there is a sub menu for the selected option another window opens Highlight the desired option and press ENTER to activate the change Press TOOLS to exit the menu To exit the menu without activating the change highlight Cancel and press ENTER Click TEXT to add text to an image in either Freeze or Acti...

Page 144: ...em Medi cal Ultrasound Safety for important information about Acoustic Out put Post Processing Selects from four post processing or gray scale compression curves The number 2 selection is a linear setting Colorize Applies a variety of colorized maps overlaying M Mode grayshade image This may be useful in certain situa tions to optimize contrast resolution Text Adds text labels to an image See Addi...

Page 145: ... measure ments and calculations This chapter includes information about How to make cardiac measurements Formulas 2D M Mode and Doppler References for the calculations NOTE Review the information regarding measurement and calculations accuracy in Chapter 10 Safety Technical Description and Accu racy before starting any calculations ...

Page 146: ...iple measurements and the calculation of a clinical index such as Ejection Fraction These calculations are saved in the Patient Report Table 27 on page 6 3 lists the specific calculations by each mode type NOTE General measurements are designed to be a quick way to perform calculations that you do not assign to a report Types of General Cardiac Measurements Table 26 shows the general measurements ...

Page 147: ...ning Ejection Fraction Cubed Ejection Fraction Teichholz Stroke Volume Cubed Stroke Volume Teichholz Cardiac Output Cubed Cardiac Index Cubed Cardiac Output Teichholz Cardiac Index Teichholz LV Mass LV Mass Index EPSS E Point to Septal Separation Doppler See Table 31 on page 6 20 Peak Pressure Gradient Mean Velocity Mean Pressure Gradient Time Velocity Integral Stroke Volume Cardiac Output Mitral ...

Page 148: ...pattern or 2D image with a continuous motion When the Point to Point method is selected the Trackball is used to place points along the flow pattern or 2D image Press ENTER after each point is positioned and the points will automatically connect Double click the last point to complete the outline NOTE The direction of the trace cannot be reversed once started when tracing from left to right the tr...

Page 149: ...e entire report including sec tions with open data fields The Configured format displays only the sections where data has been entered Selecting a Report Background Color 1 Press the SETUP key and click the Calculations heading 2 Click Reports 3 Select a color Using the Averaging Function When averaging is turned ON measurements that are part of the patient report will automatically display the av...

Page 150: ...t Menu 2 Use the Trackball to place the cursor over the averaged result The list of individual measurements will open To edit the list click BACKSPACE to open the Averaging Edit box A checkmark next to a measurement indicates that the number is a part of the averaged result 3 Use the Trackball and ENTER key to remove and add checkmarks A checkmark in the Select All box places a checkmark in each b...

Page 151: ... choice of general and specific measurements Performing General Measurements General measurements are not entered into the Patient Report The measure ment result is displayed on the Selection Menu and the screen along with the image To perform a general measurement follow these steps 1 Press 2D to activate the scanning mode 2 Press the CALC key to freeze the image and open the Selection Menu 3 Use...

Page 152: ...n This index is stored with the frame when the frame is saved for review at a later time TABLE 28 Measurement Index Table Measurement Index Description Single Upper Case Letter A A general measurement Results are displayed in the Selection Menu Single Lower Case Letter a A specific measurement Results are displayed in the Selection Menu Report Menu and Patient Report MEASUREMENT INDEX IN SELECTION...

Page 153: ... order is for ease of use and does not affect the results To override this and go to a component out of sequence move the Trackball to highlight the desired item in the Report Menu NOTE While the Report Menu is on the screen turn the Main knob to search for the correct frame on which to perform the measurement and then press ENTER 4 Use the Trackball to position the cursor and press ENTER 5 Use th...

Page 154: ...gain To keep the menu open but clear all the results currently displayed click CLEAR To cancel the currently calculation and close the menu click CANCEL When you have completed all your calculations and are satisfied with the results to save the measurements and close the Report Menu click OK Results can be viewed at any time by activating the patient study and then click ing the Report tab To Del...

Page 155: ...he keypad Click the SET button above the new heart rate to confirm the entry To clear the heart rate from a Report Menu place the cursor over the HR but ton and press the BACKSPACE key or click the CLEAR button to clear the heart rate as well as any measurements and calculations NOTE For more information regarding the method used to display the heart rate read the Heart Rate Information section lo...

Page 156: ...y using the Main knob to search for the frame Deleting a General Measurement To delete a general measurement follow these steps 1 Display the frame containing the measurement graphic 2 Press CALC to display the Selection Menu 3 Use the Trackball to highlight the measurement you want to delete 4 Press the BACKSPACE key Deleting a Specific Measurement To delete a specific measurement follow these st...

Page 157: ...p a measurement or sequence of measurements and exit the Calcula tion package press the CALC key before completing the measurement Setting the Trace Resolution The Resolution feature defines the spacing of the dots used to form the trace outlines To change the resolution follow these steps 1 Press SETUP double click the Calculations heading and highlight Mea surements 2 Specify resolution settings...

Page 158: ...n of the menu to any corner using the method described in Changing the Position of a CALC Menu on page 6 14 If you change the position of a menu or menus during an exam reset the menus to the user defined default position by clicking the RESET button The menus will also return to the user defined default position when the Cypress system is powered down To set the default position of the CALC menus...

Page 159: ...s the number of disk segments into which the ventricle is divided ml LV Volume Method of Disks Single Plane adi is the ith disk diameter of LV apical 2 or 4 chamber cm L is the chamber length of the cavity cm ml Ejection Fraction V is LV volume ml s is systole d is diastole Stroke Volume V is LV volume ml s is systole d is diastole ml Cardiac Output SV is stroke volume ml HR is heart rate bpm l mi...

Page 160: ...Surface Area BSA W is weight kg range 0 5 160 0 kg H is height cm range 15 0 204 0 cm m2 Fractional Area Change FAC LVd is LV diastolic area cm2 LVs is LV systolic area cm2 Flow Area d is diameter cm cm2 Fractional Shortening FS LVd is diastolic dimension cm LVs is systolic dimension cm TABLE 29 2D Formulas Cardiac Type Formula Units LV Mass 1 05 5 6 A1 L t 5 6 A2 L t A1 π A2 π LVMI LV Mass BSA BS...

Page 161: ...erventricular Septum in systole IVSd is Interventricular Septum in diastole Fractional Thickening Left Ventricular Posterior Wall FT LVPWs is Left Ventricular Posterior Wall in systole LVPWd is Left Ventricular Posterior Wall in diastole TABLE 29 2D Formulas Cardiac Type Formula Units FT IVSs IVSd IVSd 100 FT LVPWs LVPWd LVPWd 100 ...

Page 162: ...ricular Posterior Wall in diastole Volume Cubed LVID is left ventricular internal diameter cm ml Volume Teichholz LVID is left ventricular internal diameter cm ml Ejection Fraction Cubed Vd is diastolic volume cubed ml Vs is systolic volume cubed ml Ejection Fraction Teichholz Vd is diastolic volume Teichholz ml Vs is systolic volume Teichholz ml Stroke Volume Cubed Vd is diastolic volume cubed ml...

Page 163: ...Teichholz l min BSA is Body Surface Area m2 l min m2 LV Mass IVSd is interventricular septum diastole cm LVIDd is left ventricular internal diameter diastole cm LVPWd is left ventricular posterior wall diastole cm g LV Mass Index LVMI LV Mass g BSA is Body Surface Area m2 g m2 Body Surface Area BSA W is weight kg range 0 5 160 0 kg H is height cm range 15 0 204 0 cm m2 TABLE 30 M Mode Formulas Car...

Page 164: ...r of velocity trace points is the time increment between two successive velocity trace points seconds m s Mean Pressure Gradient V is the average velocity between two successive velocity trace points m s N is the number of velocity trace points is the time increment between two successive velocity trace points seconds mmHg Time Velocity Integral m Pressure Gradient 4V 2 Vmean Vi Δti i 1 N 1 Δti i ...

Page 165: ...is body surface area m2 l min m2 Pressure Half Time PHT Vmax is Maximum Velocity m s Deceleration Slope m s2 ms Valve Area by PHT PHT is Pressure Half Time msec cm2 Aortic Valve Area by the Continuity Equation using Vmax AVA is Aortic Valve Area cm2 CSALVOT is Cross sectional Area of LVOT cm2 VmaxLVOT is the maximum velocity in the LVOT m s VmaxAoV is the maximum velocity across the aortic valve m...

Page 166: ...VOT is Left Ventricle Outflow Tract cm2 Mitral Valve Area by the Continuity Equation using Pulmonary Artery MVA is mitral valve Area cm2 CSAPA is cross sectional Area of pulmonary artery cm2 TVIPA is the Time Velocity Integral of pulmonary artery m TVIMV is the Time Velocity Integral of mitral valve m cm2 Right Ventricu lar Systolic Pressure from Tricuspid Regurgitation PRA is estimated Right Atri...

Page 167: ...Shunt Ratio COQp is pulmonic Cardiac Output l min COQs is systemic Cardiac Output l min Shunt Difference COQp is pulmonic Cardiac Output l min COQs is systemic Cardiac Output l min l min TABLE 31 Doppler Formulas Cardiac Type Formula Units Qp Qs COQp COQs Qp Qs COQp COQs ...

Page 168: ... Weight be Known Nutrition Sept Oct 1989 Vol 5 No 5 pp 303 313 6 Hatle L Angelsen B Doppler Ultrasound in Cardiology Second Edition Lea Febiger 1985 Philadelphia 7 Hatle L et al Noninvasive Assessment of Atrioventricular Pressure Halftime by Doppler Ultrasound Circulation 1979 60 1096 1104 8 Oh JK et al Prediction of the Severity of Aortic Stenosis by Doppler Aortic Valve Area Determination Prospe...

Page 169: ...easurements and cal culations This chapter includes information about How to make vascular measurements Formulas 2D and Doppler References for the calculations NOTE Review the information regarding measurement and calculations accuracy in Chapter 10 Safety Technical Description and Accu racy before starting any calculations ...

Page 170: ...ulsatility Index These calculations are saved in the Patient Report Table 33 on page 7 3 lists the specific calculations by each mode type NOTE General measurements are designed to be a quick way to perform calculations that you do not need to assign to a site for a report Specific measurements are assigned to a site and generate a Report Types of General Vascular Measurements Table 32 shows the g...

Page 171: ...5 and Table 36 NOTE There are no specific vascular calculations for M Mode TABLE 33 Specific Vascular Calculations by Mode 2D Mode See Table 35 on page 7 14 Stenosis Area and Diameter Volume Flow HWL volume Doppler See Table 36 on page 7 15 Right Carotid CCA ICA ECA Bulb Vert Subclav ICA CCA PSV EDV Left Carotid CCA ICA ECA Bulb Vert Subclav ICA CCA PSV EDV Arterial Vel PI RI Accel Venous Time Rat...

Page 172: ...inuous method is selected the Trackball is used to define the flow pattern or 2D image with a continuous motion When the Point to Point method is selected the Trackball is used to place points along the flow pattern or 2D image Press ENTER after each point is positioned and the points will automatically connect Double click the last point to complete the outline NOTE When tracing a Doppler flow en...

Page 173: ...lar To add vascular sites to specific exam types follow these steps 1 Press SETUP double click Calculations and highlight Vascular Sites 2 Select the specific Exam Type for example Carotid from the pull down menu 3 Select a calculation type for example Stenosis This opens a factory defined list 4 To add sites to the list click ADD 5 Either scroll through the list or start typing for example verteb...

Page 174: ...ype for example Stenosis and double click to open a list of vascular sites 4 To change a specific site highlight the site and click REMOVE Restoring Factory Defaults to Vascular Sites To restore the factory defined site defaults to a calculation type follow these steps 1 Press SETUP double click Calculations and highlight Vascular Sites 2 Select an Exam Type from the pull down menu for example Car...

Page 175: ... a choice of general and specific measurements Performing General Vascular Measurements General measurements are not entered into the Patient Report The measure ment result is displayed on the Selection Menu and the screen along with the image To perform a general measurement follow these steps 1 Press PW to activate the scanning mode 2 Press the CALC key to freeze the image and open the Selection...

Page 176: ... for review at a later time TABLE 34 Measurement Index Table Measurement Index Description Single Upper Case Letter A A general measurement Results are displayed in the Selection Menu Single Lower Case Letter a A specific measurement Results are displayed in the Selection Menu Report Menu and Patient Report MEASUREMENT INDEX IN SELECTION MENU Velocity A 1 25 m s PI RI Acceleration Right Carotid Le...

Page 177: ...an order to this sequence and automatically steps you through the components of a calculation The order is for ease of use and does not affect the results To override this and go to a component out of sequence move the Trackball to highlight the desired item in the Report Menu NOTE While the Report Menu is on the screen turn the Main knob to search for the correct frame on which to perform the mea...

Page 178: ...rt tab To Delete a Single Measurement from a Report Menu 1 Highlight the measurement with the cursor 2 Press the BACKSPACE key to remove that measurement and any associ ated measurements Saving Frames Containing Measurement Graphics After each measurement or sequence of measurements is completed the frame used to perform the measurement can be saved along with the graphics While the frame and grap...

Page 179: ...rt Menu containing the spe cific measurement you want to delete and press ENTER NOTE Specific measurements cannot be deleted from the Selection Menu 4 To delete a single measurement use the Trackball to highlight the measure ment you want to delete and press BACKSPACE To delete all of the mea surements click CLEAR NOTE If the deleted measurement is part of a formula all the formula results that us...

Page 180: ...Report There are two ways of viewing the Patient Report While in the calculation package select Report from the calculation Selection Menu At any time press the PATIENT function key and click the Reports tab Changing the Position of a CALC Menu To change the position of a CALC menu follow these steps 1 Place the cursor on a border of the CALC menu and press ENTER 2 To move the menu downwards place...

Page 181: ...ned default position by clicking the RESET button The menus will also return to the user defined default position when the Cypress system is powered down To set the default position of the CALC menus follow these steps 1 Press the SETUP key 2 Double click the Calculations entry on the Setup listing 3 Highlight Menu Position A menu opens on the right side of the screen It shows arrows pointing in f...

Page 182: ...ea 1 and area 2 cm2 Percent Stenosis Diameter D is the greater of diameter 1 and diameter 2 cm d is the lesser of diameter 1 and diameter 2 cm Volume Flow TAVMax is the time averaged maximum velocity m s CSA is Cross Sectional Area cm2 Factor 60 converts to ml min l min liters minute HWL Volume L is the longitudinal axis W is the transverse axis H is the anteroposterior axis ml A a A 100 D d D 100...

Page 183: ...Doppler shift frequency Volume Flow TAVMax is the time averaged maximum velocity m s Time Averaged Velocity Maximum is the averaged mean value of the maximum Doppler shift frequency CSA is Cross Sectional Area cm2 Factor 60 converts to ml min l min liters minute Ratio Systolic Diastolic S D Internal Carotid Common Carotid Ratio IC CC ICA velocity is the highest Internal Carotid Artery Peak Sys tol...

Page 184: ...chniques in Noninvasive Vascular Diagnosis second edition Summer Publishing 2002 Littleton CO 6 Chervenak F Isaacson G Campbell S Ultrasound in Obstetrics and Gynecology Volume 1 First Edition Little Brown 1993 Boston Peak Systolic End Diastolic PSV is the highest Peak Systolic Velocity of the Internal Carotid artery EDV is the mid End Diastolic Velocity of the Common Carotid artery The highest Pe...

Page 185: ...tup heading to display the Setup options 3 Highlight the IMT Protocol option The IMT options are displayed on the right 4 Specify the grid setting for exported images when Enabled the grid is dis played on exported IMT images To display the grid click the Enabled box to hide the grid click Disabled 5 Specify the AVI Compression Type for IMT images There are two options Click the box for MS RLE los...

Page 186: ... activate the scanning mode The IMT positioning grid will overlay the image 5 Press the CALC key to freeze the image and open the Calc Selection menu or press Freeze and then CALC 6 Use the Trackball to highlight IMT and press ENTER to open the Site Selection menu 7 Select the site by using the Trackball to highlight a site for example R CCA and press ENTER to display the Sub Report menu Distance ...

Page 187: ...Sites for Vascular on page 7 5 for information on how to customize the sites under IMT Turning the IMT Grid ON and OFF The IMT grid is used as an anatomical marker and overlays the image During an IMT exam the grid can be turned ON or OFF To change the grid setting fol low these steps 1 Press TOOLS 2 Click GRID Repeat steps 1 and 2 to toggle the grid ON or OFF Using the IMT On screen Labels On scr...

Page 188: ...l of the American Society of Echocardiography 2005 18 3 244 251 3 Riley W A Evans G W Sharrett A R Burke G L Barnes R W Variation of common carotid artery elasticity with intimal medial thickness the ARIC Study Ath erosclerosis Risk in Communities Ultrasound Med Biol 1997 23 2 157 164 4 Howard G Sharrett A R Heiss G Evans G W Chambless L E Riley W A Burke G L Carotid artery intimal medial thicknes...

Page 189: ...m provides several different stress echo proto cols to choose from Information in this chapter includes Connecting the ECG signal How to achieve the best ECG signal quality during stress echo exams How to reduce ECG artifacts Using the stress setup controls The stress protocols Conducting the stress exam including Rest Stage Immediate Post and Peak and Pharmacological Stress ...

Page 190: ...ectrocution could result if these pins are plugged into AC power To connect the Cypress system to a stress system follow these steps 1 Assemble the supplied ECG to BNC connector cable and BNC to Stress System plug as shown in Figure 36 ECG to BNC Connector and BNC to Stress System Plugs on page 8 4 and Figure 37 Stress Echo ECG Cable on page 8 5 2 Insert the ECG to BNC connector into the port on t...

Page 191: ...time scan ning the ECG waveform will be displayed It is normal for the system to take a few moments to automatically adjust gain levels before displaying the ECG waveform The triggers will automatically appear on the R wave or each car diac cycle They can be turned off only by turning off the ECG Stress Echo ECG Cables and Connectors All of the adapters described in this section are included in th...

Page 192: ...rchase another stress system that needs a different adapter FIGURE 36 ECG to BNC Connector and BNC to Stress System Plugs ATTACH TO ONE END OF BNC CABLE CONNECT TO ECG PORT ON BACK OF CYPRESS SYSTEM ATTACH TO OTHER END OF BNC CABLE CONNECT TO STRESS SYSTEM USE THE PLUG THAT FITS YOUR SYSTEM ...

Page 193: ...ACUSON Cypress Operator s Manual 8 5 Connecting and Using ECG Stress Echo ECG Cable FIGURE 37 Stress Echo ECG Cable CABLE WITH BNC CONNECTOR AT EACH END ATTACH CONNECTORS TO EACH END OF THE CABLE AS ...

Page 194: ...ess studies During pharmacological stress studies there may be increased respiratory artifacts though muscle motion artifacts typically are not an issue If artifacts are present and detected as a heart beat the heart rate displayed by the system may become inaccurate Reducing ECG Artifacts Recommended techniques to reduce ECG artifacts during stress echo include Use a 12 lead electrocardiograph Th...

Page 195: ...LAX SAX AP4 AP2 VIEW5 VIEW6 AP4 AP2 LAX SAX VIEW5 VIEW6 Exercise 3 Stage four views Stage 1 Stage 2 Stage 3 Rest Peak Post LAX SAX AP4 AP2 AP4 AP2 LAX SAX LAX SAX AP4 AP2 Exercise 3 Stage six views Stage 1 Stage 2 Stage 3 Rest Peak Post LAX SAX AP4 AP2 VIEW5 VIEW6 AP4 AP2 LAX SAX VIEW5 VIEW6 LAX SAX AP4 AP2 VIEW5 VIEW6 Pharmacological 4 Stage four views Stage 1 Stage 2 Stage 3 Stage 4 Base Low Pea...

Page 196: ...ressing the SAVE key during the Impost and Peak stages will capture loops for two consecutive minutes or until the SAVE key is pressed a second time Pharmacological 7 Stage four views Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Base Low Stage 3 Stage 4 Stage 5 Peak Post LAX SAX AP4 AP2 LAX SAX AP4 AP2 LAX SAX AP4 AP2 LAX SAX AP4 AP2 LAX SAX AP4 AP2 LAX SAX AP4 AP2 LAX SAX AP4 AP2 Pharm...

Page 197: ...dual loops Label the loop and then press SAVE or Q SAVE to save the loop to the hard drive Q SAVE Quick Save Saves a cardiac cycle and at the same time lets you label the loop Q SAVE also automatically advances the view label to the next view in the sequence SAVE Save All Turns image saving ON and OFF as in non stress exams During Impost when SAVE is activated Make sure that the camera icon appear...

Page 198: ...time counter in seconds of the elapsed time from the start of Immediate Post stages and from the start of a Pharmacological Study s initial injection In the Impost stage the timer starts automatically when you press SAVE or Q SAVE In Pharmacological stages you start the timer manually To start the timer manually press the TOOLS function key and click TIMER then select Start To reset the timer to z...

Page 199: ...ransferring Studies in a DICOM Format Stress studies can be transferred to a DICOM compatible viewer so that the images can be displayed in either a full screen format or a region of interest ROI format The full screen format displays the entire image The ROI format displays only the data within the ROI To setup the DICOM stress image size follow these steps 1 Press the SETUP key 2 Double click th...

Page 200: ...ble 17 on page 5 28 for an explanation of these buttons The TIMER button has the following functions Start Starts the timer clock Restart Starts the timer clock once it has been stopped Stop Stops the timer clock Off Stops the timer clock and removes it from the screen Cancel Closes the menu without changing the timer clock Image Start Restart Stop Off Cancel 3V2c PA Pwr M MI 1 0 TIs 0 1 Compress ...

Page 201: ...t and the QSAVE Cycle Limit See Table 4 on page 3 4 for more infor mation 2 Press the PATIENT function key to open the patient directory and click the NEW PATIENT button to display the following screen CLICK THE DOWN ARROW TO DISPLAY THE LIST OF PROTOCOLS HIGHLIGHT THE PROTOCOL NAME Shutdown Reports Setup Patient OK Cancel Add Study Averaging Metric Doe Edgar QTR3942 19 01 1944 Male Last Name Firs...

Page 202: ...Continue turning the knob until either Rest for 2 Stage and 3 Stage or Base for Pharmacological is highlighted The following yellow text will appear in the lower left portion of the screen just above the PROTOCOL soft window MAKE SURE THAT THE CORRECT PROTOCOL NAME IS DISPLAYED AT THE TOP OF THE 2D SECTOR Depth Frequency Protocol Gain Compress Apex Invert 3V2c PA Pwr M MI 0 9 TIs 0 1 Compress 2 GN...

Page 203: ...n the upper right portion of the screen displays the number of loops in temporary memory The number varies depending on the patient s heart rate and the amount of time between system parameter changes Turn the PLAY LOOP Soft Window knob counterclockwise to display the loops Stop when you see a loop that contains the greatest amount of diagnostic information If you are not happy with any of the loo...

Page 204: ...gin scanning the patient starting with the LAX view Once the image has been opti mized press Q SAVE If you set the QSAVE Time Limit to 1 Cycle the Cypress system stores one loop that is automatically labeled LAX The view counter registers a 1 next to LAX and then automatically advances to the SAX view label To view the captured loops press the VIEW function key and turn the PLAY LOOP Soft Window k...

Page 205: ...reen Press SAVE to start capturing the Impost loops Loops are captured for two minutes The camera icon remains in the upper right corner of the screen to indicate that Impost loops are being captured To start the Save function press the SAVE key When all four views have been captured press SAVE again to stop the Save function Note You can change the 2D GAIN and adjust the TGCs while the system is ...

Page 206: ...lockwise until the first Peak view is displayed Continue turning the knob until the best loop is playing AP4 is the first view for the Peak stage but loops can be labeled in any order Turn the PROTOCOL knob to display PeakAP4 A 1 appears next to the AP4 view counter Continue turning the PLAY LOOP knob to select and label the remaining three views Press 2D to exit View mode B4 Turn the PROTOCOL kno...

Page 207: ...e SEL QUAD knob to highlight i e select a quad View Stage View and Stage share the same Soft Window Press the corresponding Small Window knob to display and activate the function When VIEW is selected the quad screen displays the same view captured during the protocol Use VIEW to shuffle the loops for a side by side compari son If the stress protocol has more than four views turn the knob to displ...

Page 208: ...ey Deleting Loops NOTE Deleted loops cannot be recovered To delete loops follow these steps 1 Turn the SEL QUAD Soft Window knob to move the box to the desired quad 2 To display the loop in full screen press the VIEW key 3 Turn the DELETE Soft Window knob to display the confirmation window Use the Trackball to highlight NO if you do not want to delete the loop To delete the loop press ENTER 4 To r...

Page 209: ... immediate post exercise stage when images must be captured within a defined period of time the Save the Loop and then Assign a Label method is the most commonly used Using this method lets you quickly capture the loops and then choose the ROI and view label When performing a stress echo exam all loops should be saved with the Stage label Rest Peak etc assigned A View label LAX SAX AP4 AP2 can be ...

Page 210: ...region of interest To display the loops press VIEW To view each loop turn the PLAY LOOP knob While the best loop is playing position the ROI box Turn the PROTO COL Soft Window knob to display the corresponding label Continue until all four views have been assigned labels Numerous loops can be assigned to each view If you are having difficulty deciding which loop displays the most useful diagnostic...

Page 211: ...the number of loops saved and the currently dis played loop in the upper left corner of each quad For example 2 4 indi cates that the second of four saved loops is currently displayed 4 To change the playing speed of the loop turn the Main knob to select from Normal Slow and Slower The Loop Length Bar The Loop Length bar the yellow bar located in the upper right corner of each quad represents the ...

Page 212: ...HE MAIN KNOB TO SWITCH BETWEEN PAUSE AND THE SPEED 2D SOFT WINDOW MENU OPTIONS RestAP4 55 BPM 10 ImpostAP4 123 BPM RestAP2 55 BPM 13 ImpostAP2 120 BPM LOOP 2 5 LOOP 2 2 LOOP 1 1 LOOP 3 10 THE YELLOW BAR REPRESENTS THE LENGTH IN FRAMES OF THE CURRENTLY DISPLAYED LOOP THIS IS A MULTIFUNCTIONAL SOFT WINDOW PRESS THE KNOB TO CYCLE THROUGH THE FUNCTIONS START AND END AND THEN TURN THE KNOB TO ADJUST TH...

Page 213: ...reeze Mode To save and label loops from Freeze mode follow these steps 1 Press the PATIENT function key 2 Click NEW PATIENT Select the stress protocol from the drop down menu 3 Press the 2D mode key to save the patient information and exit the Setup screen 4 Press the TOOLS function key and click ROI to display the region of interest 5 Turn the PROTOCOL knob to display the Stage and View label of ...

Page 214: ...d Label the Loop Simultaneously To save and label the loop at the same time follow these steps 1 Press the PATIENT function key 2 Click NEW PATIENT Select the stress protocol from the drop down menu 3 Press the 2D mode key to save the information and exit the Setup screen 4 Press the TOOLS function key and click ROI to display the region of interest box 5 Turn the PROTOCOL knob to display the View...

Page 215: ...ng studies to the Network Connecting the Cypress system to a Network The DICOM Storage Commitment Option DICOM Setup For Modality Worklist Formatting an MO disk Transferring studies to and from an MO disk Reading studies on the Cypress system Reading studies on a DICOM compatible viewer Troubleshooting file transfers NOTE The Cypress system is not meant to be used for long term storage of patient ...

Page 216: ...udies and their images can be exported in DICOM Digital Imaging and Com munications in Medicine format to the MO drive The images can be stored uncompressed or compressed in Run Length Encoded RLE or JPEG com pressed formats To review the images stored on the MO disk the images must be opened on a DICOM review station that accepts 3 5 inch MO disks of the same capacity Restrictions Studies stored ...

Page 217: ...DICOM format or sent to a DICOM server over a network if the network option is installed Setting an IP Address To set an IP address follow these steps 1 Press the SETUP key and click the Network Identification heading 2 Click the ADD EDIT REMOVE or RENAME button NOTE The Cypress system can store a maximum of four network identifications 3 Complete the Cypress Network Identification settings descri...

Page 218: ...is installed images can be sent in DICOM format to a net worked DICOM server The images can be transferred uncompressed or com pressed in Run Length Encoded RLE or JPEG compressed formats Studies saved on the server can be opened for review on a networked DICOM review station Restrictions It is up to the user to determine compatibility between the Cypress system s DICOM images and the DICOM server...

Page 219: ... follow these steps 1 Press the SETUP key 2 Click the Multimedia Connection listing on the directory 3 Click the ADD button 4 Complete the text fields on the right side of the screen Name Enter a name for the connection e g Multimedia AVI RTF Remote Share Enter a directory on your computer e g JDOE MyDocs User Name Enter the user name for your computer Password Enter the password used to access yo...

Page 220: ...actly match including case the application entity name assigned to the server appli cation Server IP Address The server IP address of the DICOM server where images will be sent Port Number The remote port on the server that is to receive the con nection request and the image data The default setting is 104 Test Result Lets you know if the connection has been made success fully After changing any o...

Page 221: ...ress that receives commands and data from the server The number must match the port number of the server that sends commands and data The default setting is 104 PDU Length in bytes The Protocol Data Unit Length can be set by changing this field The minimum size setting is 4096 The default setting is also 4096 Network Time out 1 Defines the number of seconds allowed between succes sive data blocks ...

Page 222: ...ou want to rename and then click the RENAME button Type the new name in the Network Name field DICOM Setup for Network Transfers If the optional network package is installed the DICOM Server and Cypress sys tem information fields must be completely defined before sending images over a network If the network package is not installed the DICOM Server and Cypress system information fields will not be...

Page 223: ...server or abort the transfer These response codes are server dependent Consult the server documen tation for an explanation of the codes 11 Choose your Storage Commitment server using the Storage Commitment drop down menu If your network does not support Storage Commitment select None If your DICOM server supports Storage Commitment using the same IP Address Application Entity Title and Port Numbe...

Page 224: ...tus column increases When all the images have been verified the Storage Commitment entry is removed from the screen NOTE It may take several minutes for the Storage Commitment Server to respond to a Storage Commitment request During that time any other transfers that have been queued will continue If the Storage Commitment Server has not validated all images in the study the Storage Commitment ent...

Page 225: ...e IP Address This is the IP address of the Modality Worklist Server where the query will be made 8 Set the Port Number This is the remote port on the server that is to receive the connection request The default setting is 104 9 The Test Result field lets you know the test result of the connection to the Modality Worklist server This field is used in conjunction with the PING and VERIFY buttons Bef...

Page 226: ... This is the IP address of the Storage Commitment where the query will be made 8 Set the Port Number This is the remote port on the server that is to receive the connection request The default setting is 104 9 The Test Result field lets you know the test result of the connection to the Storage Commitment server This field is used in conjunction with the PING and VERIFY buttons Before using these b...

Page 227: ...e port on the right side of the system FIGURE 40 Connecting Cypress System to a Network Once the Cypress system is connected complete the DICOM setup as described in DICOM Setup for Network Transfers on page 9 8 Any time that you make changes click PING and then VERIFY to confirm the connection to the network using the new settings The Cypress system will respond with a status message in the Test ...

Page 228: ...ent in alphabetical order every patient has a sub list of studies The Study List displays each individual study sort the list by clicking the col umn headings Patient Name Date Size Location A button toggles between PATIENT LIST and STUDY LIST When the Study List is displayed the button is labeled PATIENT LIST When the Patient List is dis played the button is labeled STUDY LIST The list last displ...

Page 229: ...he Study List FIGURE 41 The Patient List Shutdown Reports Setup Patient Cypress DOE A 04 22 2000 09 27 None 04 22 2000 08 54 None DOE B 04 21 2000 14 59 3 Stage Exercise 04 21 2000 13 27 None DOE C 05 21 2000 13 18 Pharmacological DOE J 06 21 2000 11 01 2 Stage Exercise DOE P 12 10 1999 10 40 MO Disk 63 Mbytes free DOE E CLICK HERE TO SWITCH BACK AND FORTH BETWEEN THE PATIENT LIST AND THE STUDY LI...

Page 230: ...highlight any number of studies FIGURE 42 The Study List CLICK HERE TO SWITCH BACK AND FORTH BETWEEN THE PATIENT LIST AND THE STUDY LIST Shutdown Reports Setup Patient DOE AB 36517 04 22 2000 None 1 DOE C 36285 10 26 1999 None 1 DOE C 36486 08 04 1999 2 Stage E 1 DOE D 369387 09 02 1999 None 1 DOE E 2345686 05 25 2000 Y None 1 DOE MM 36286 06 17 2000 Pharmacolo 1 DOE P 36790 07 23 1999 3 Stage E 1...

Page 231: ...ession and to automatically delete the study from the Cypress system hard drive upon completion of the transfer Multiple formats and destinations can be selected at the same time The three type of formats are Cypress DICOM and Multimedia NOTE To remove the check marks from the destination area click the All or Destinations radio button and then click CLEAR FIGURE 43 The Send Screen Cancel Shutdown...

Page 232: ...Name ID from Images checkbox If you want to keep the name and ID with the images leave the box unchecked To permanently delete the studies after they have been transferred click the Remove Study After Transfer check box If you want to keep them on your Cypress system leave the box unchecked 8 Click OK A green light in the upper right corner of the screen indicates the transfer is in progress An ar...

Page 233: ...nd Screen DICOM Compression Fields Field Description DICOM Compression Sets the DICOM compression settings The selected com pression is applied to studies saved in DICOM format that are saved to the MO disk or saved over a network to a DICOM server if the Network option is installed None Use when a server or viewer does not support JPEG or RLE Lossless compression The largest image files are produ...

Page 234: ...PATIENT button and highlight a patient study 2 Click the SEND button 3 Put a checkmark in the Remove name ID from Images box NOTE When studies are displayed on DICOM readers such as KinetDx the name and ID will be displayed in the study list The Patient Name and Patient ID DICOM elements 0010 0010 and 0010 0020 respectively will still contain the valid patient identifying information for the image...

Page 235: ...ion most likely due to an image format incompatibility Check DICOM compatibility by refer ring to the Cypress system and DICOM server s DICOM Conform ance Statements DICOM Error C STORE response xxxx do you wish to continue The server sent back an error code on the save Consult your server s error code information for more details If you want to continue the save click YES To abort the save click ...

Page 236: ...Use this slot to insert the MO disk cartridge Eject Button and Busy LED Display Lamp Press the push button to eject the MO disk from the drive The button is also the green LED display lamp that lights when the drive is busy during seeking erasing writing or reading of data Note that the MO disk cannot be ejected while the LED is lit Manual Ejection Hole Use this hole to eject the MO disk manually ...

Page 237: ...the Shutdown tab and follow the instruction at the bottom of the screen 2 To format the MO disk click YES 3 Click START on the dialogue box A warning appears to let you know that all data will be erased from the disk if you want to continue 4 To continue click YES or to cancel the formatting click NO 5 When formatting is complete click OK and then click CLOSE NOTE If a transfer is attempted to an ...

Page 238: ... box If you do not close the dialogue box the format will fail To format multiple disks at one time repeat the steps as outlined above 10 When finished formatting click CLOSE on the Utilities menu and the system returns to the 2D screen Reading Native Cypress System Format Studies from the MO Disk To read a study from an MO disk follow these steps 1 Insert the MO disk into the MO drive The Cypress...

Page 239: ...n be restored to the Cypress system hard drive DICOM and Multimedia studies can not be restored to the Cypress system To return a group of studies from the MO disk to the Cypress system hard drive follow these steps 1 Insert the MO disk into the MO drive 2 Press PATIENT 3 If you want to restore everything from the MO disk click the PATIENT LIST and highlight the MO disk icon To restore only select...

Page 240: ...k that is not write pro tected Insufficient space on the disk for the study Insert a disk with more available space or delete studies from this disk A disk with an unknown format is detected Format this disk or insert a properly formatted disk An unformatted disk is in the drive Format this disk or insert a properly formatted disk An MO disk containing studies from a source other than a Cypress ha...

Page 241: ... information about Important Warnings and Notices Intended Use of the Cypress system Information about specific types of studies including Cardiac Intraoperative Pediatric Neonatal Cephalic Peripheral Vascular Fetal and Abdominal Patient Safety Operator Safety Issues Standards Compliance and Other Safety Information ...

Page 242: ...mable anesthetics Safety Information and Other Warnings Before using this system carefully read this chapter Display Monitor Radiation The display monitor used in this product complies with the United States Food and Drug Administration regulations that were applicable as of the date of man ufacture 21 CFR Subchapter J Prescription Device Statement For product usage in the United States of America...

Page 243: ...s Intended Use of the Cypress System Ultrasound Imaging System Diagnostic ultrasound is useful for diagnosing several different disease states The Cypress ultrasound system is intended for cardiac abdominal peripheral vascular fetal neonatal cephalic pediatric and intraoperative cardiac applica tions as defined in FDA guidance documents The patients who may be imaged with the system include adults...

Page 244: ...rameters of the heart and associated vessels Intraoperative Cardiac Studies Intraoperative cardiac studies obtain images that can be used to Detect abnormalities in heart anatomy and blood flow during cardiac surgery Monitor cardiac function during cardiac surgery TABLE 47 Cardiac Studies Table Target Approach Patients Heart and Vessels Transthoracic Adult pediatric neonatal TABLE 48 Intraoperativ...

Page 245: ...lic studies obtain images of brain structures that can be used to Detect abnormalities such as abnormal ventricle size or a shift in the midline or flow abnormalities NOTE The 5 MHz external transducer is the only transducer intended for neonatal cephalic studies TABLE 49 Pediatric Studies Table Target Approach Patients Heart and Vessels Transthoracic Pediatric Organsand Structures Abdomen Arms Le...

Page 246: ...Characterize obstructions Determine blood flow patterns and velocities Image and measure anatomic and physiologic parameters of vessels TABLE 51 Peripheral Vascular Studies Table Target Approach Patients Cerebrovascular arteries and veins Neck Adult pediatric and neonatal Upper extremity arteries and veins Arms Adult pediatric and neonatal Lower extremity arteries and veins Legs Adult pediatric an...

Page 247: ...ary 1984 Health Consensus Development Conference on the use of diagnostic ultrasound in pregnancy the National Institutes of Health developed a consensus statement recommending Ultrasound examination in pregnancy should be performed for a spe cific medical indication The data on clinical efficacy and safety do not allow a recommendation for routine screening at this time Ultrasound examinations pe...

Page 248: ...ac and great vessel anatomy and physiology or other devices in the heart as well as measurement of blood flow The AcuNav diagnostic ultrasound catheter is a disposable single use ultrasound tipped catheter device that is used directly within the venous vasculature and or right heart for intravascular or intracardiac ultrasound imaging WARNING If you intend to use the Cypress system with the AcuNav...

Page 249: ...ansmit setting consistent with obtaining diagnostically useful images Reduce exposure time even with lower acoustic transmit settings using techniques that produce diagnostic data as rapidly as possible Use the appropriate transducer for the type of exam being performed The maximum output levels provided by the Cypress system are described in Reducing Acoustic Exposure on the Cypress System Implem...

Page 250: ...e set tings applied to 2D and M Mode image data but does not affect the acoustic output of the system In some circumstances the controls may be adjusted to improve an image and minimize the need to increase the transmit level Adjusting this control should be attempted first before increasing the Trans mit setting 5 The depth setting in all modes has an indirect effect upon the acoustic out put The...

Page 251: ...transducer is used WARNING Operators must take steps to prevent the transfer of infections between persons WARNING Special infection control precautions must be implemented when scanning patients with open wounds WARNING Only transducers properly enclosed in a sterile sheath are to be used for intraoperative cardiac studies WARNING To minimize risks of cross contamination and infectious diseases h...

Page 252: ...ultraviolet gamma radiation gas or dry heat methods Semicritical Device Applications If an external transducer is used in a situation where it may come into contact with a source of infection such as broken skin lesions or post operative wounds then use a sterile sheath Transducers used in a surgically invasive or intraoperative cardiac application for scanning a surgical site are to be used only ...

Page 253: ...ew of infection control considerations Block S S Disinfection Sterilization and Preservation Chemical Disinfection of Medical and Surgical Materials Chapter 35 Lea Febiger Philadelphia 1991 Patient Contact Materials Materials used in ACUSON transducers have been tested for biocompatibility and have been widely used for many years in similar products and applications without reports of negative rea...

Page 254: ...oth in medical devices and in other consumer prod ucts may be part of the reason that the prevalence of latex sensitivity appears to be increasing For example it has been reported that 6 to 7 of surgical personnel and 18 to 40 of spina bifida patients are latex sensitive Proteins in the latex itself appear to be the primary source of allergic reactions Although it is not now known how much protein...

Page 255: ...number 800 638 6725 In Maryland call collect 301 881 0256 For further information on the clinical aspects of latex sensitivity call Claudia Gaffey MD FDA Office of Health Affairs Center for Devices and Radiological Health at 301 427 1060 For a single copy of a reference list on latex sensitivity write to LATEX FDA HFZ 220 Rockville MD 20857 Peripheral Device Connections WARNING Do not use a periph...

Page 256: ...sed with legally marketed ultrasound contrast agents Siemens makes no claims regarding the safety or efficacy of ultrasound contrast agents It is important that you carefully follow the indications instruc tions for use warnings and cautions that are provided by ultrasound contrast agent manufacturers as a part of the product labeling ...

Page 257: ...ed that can help prevent CTS Do not grasp the transducer with excessive force Interrupt scanning frequently using these breaks to rest and give soft tissue a chance to recuperate from the strained positions and repetitive movements of examinations Try to maintain a comfortable and balanced body position with minimal stress on your joints References Vanderpool et al Prevalence of carpal tunnel synd...

Page 258: ...ptable protection against glutaraldehyde an OSHA requirement be at least 11 inches long be of medical grade to protect against blood borne pathogens and be made of butyl or nitrile rubber or polyethelene Nitrile rubber gloves can protect against glut araldehyde for approximately eight hours or more References Notarianni G Do your gloves really protect you from glutaraldehyd Association of Occupati...

Page 259: ...ce such as a table or cart that the system is securely placed and not subject to acci dental bumping which might cause it to fall The Cypress system is a compact and highly portable ultrasound system Take care when transporting and placing the unit to avoid potential injury to the operator or patient Use the built in handle to carry or move the system short distances When carrying the unit take ca...

Page 260: ... against electrical shock 2 For continuous mode of operation 3 Equipment not suitable for use in the presence of flammable anesthetic mixture with air or oxygen or nitrous oxide 4 Ordinary equipment without protection against ingress of water The Cypress system has two applied parts 1 The transducer is classified as a type BF applied part 2 The ECG cable is classified as a defibrillation proof typ...

Page 261: ...ormation to assist the user s appropriately qualified technical personnel to repair those parts of equipment which are designated by Siemens as repairable NOTICE See the System Overview section and the beginning of this section for information on the safe installation and operation of the Cypress system The equipment shall be connected to a cen ter tapped single phase supply circuit when users in ...

Page 262: ... ference to other devices which can be determined by turning the equipment off and on the user is encouraged to try to correct the interference by one or more of the following measures Reorient or relocate the receiving device Increase the separation between the equipment Connect the equipment to an outlet on a circuit different from that to which the other device s are connected Consult the manuf...

Page 263: ...pe of input voltage Type BF Degree of protection from electrical shock particularly regarding allow able leakage currents having an F Type isolated Floating applied part Type CF Degree of protection from electrical shock particularly regarding allow able leakage currents having an F Type isolated Floating applied part Defibrillation Proof Type CF Degree of protection from electrical shock with add...

Page 264: ... devices System Power On Turns the system on System Power Off Turns the system off Security Lock A security cable can be purchased for added protection against theft Insert the cable into the opening Disposal Do not dispose of by dumping in gar bage Use a separate collection for electrical and electronic equipment TABLE 54 Labeling Icons Icon Meaning Explanation ...

Page 265: ...e patient Many of these variables are not associated with the Cypress system This limits the ability to fully specify the clinical accuracy of the mea surements and calculations provided by the Cypress system Accuracy by Transducer Type All transducers types have been verified for measurement accuracy in the modes appropriate to each measurement type Because of the moderate transducer frequency ra...

Page 266: ... an AIUM standard phantom with a fluid having an acoustic speed of approximately 1540 meters per second at room temperature The accuracy of this measurement is 5 The maximum range of this measurement is 24 cm Velocity The velocity measurement is calibrated using a Doppler string phantom where multiple measured velocities are checked against actual velocities over the range of velocity values provi...

Page 267: ... that accuracy is valid is pro vided in the table below for standard derived calculations TABLE 56 Accuracy of Standard Derived Calculations Measurement Type Maximum Range of Accuracy Accuracy Area 200 cm2 10 Slope 5000 mm sec 10 Velocity 12 m sec 7 Acceleration 100 m sec 12 Pressure Half Time 4 sec 12 Velocity Time Integral 900 cm 12 Mean Pressure Gradient 550 mm Hg 7 ...

Page 268: ...tissue there is approximately a 2 error this may be as high as 5 especially if fatty tissue is present in the area of the image being measured Doppler Alignment When performing Doppler scans try to align the beam as close to parallel to flow as possible Misalignment errors are typically approximately 5 Most cardiac clinical references assume that the angle is under 20 Clinical References Numerous ...

Page 269: ...interval Suc cessively older R R intervals are assigned successively lower weights For the purposes of characterizing this filter function it can be considered an average of the last 5 heart cycles For the 6th and older R R intervals a 20 variation in that interval will result in a 1 or less variation in the heart rate display with each successively older interval contributing successively less to...

Page 270: ...linical Sonography A Practical Guide Second Edition Little Brown and Company 1991 Sahn D DeMaria A Kisslo J The Committee on M Mode Standardization of the American Society of Echocardiography Recommendations regarding quantitation in M Mode Echocardiography Results of a survey on echocardiographic measurements Circulation 58 6 1072 1083 1978 Schiller N B et al The American Society of Echocardiogra...

Page 271: ...e of your Cypress system will help provide proper and safe operation Carefully follow the steps described in this section This chapter includes information about Cleaning the system Maintaining the system Electrostatic discharge protection Fuse replacement If you need additional help call the Help Desk at 1 800 888 SIEM ...

Page 272: ... the display screen with a soft lint free cloth and a mild glass cleaner Do not spray the glass cleaner or any fluid directly onto the screen Carefully remove any solid matter around vents controls or connectors with a cotton swab or toothpick to prevent the matter from entering the inside of the system Refer to the Safety Technical Description and Accuracy section for instruc tions on cleaning tr...

Page 273: ...g period is usually once every six months depending on environmental condi tions Use the Fujitsu MO disk drive head cleaner to clean the lens actuator Part Name Head Cleaner Part Number 0240470 Order Number CA90002 C980 Always check the condition of the cleaning brush by opening the shutter of the head cleaner If the tip of the brush is open use a new head cleaner FIGURE 46 Cleaning the MO Disk Dr...

Page 274: ...s operating properly Do not block the fan or vents Allow space for the transducer and external connectors so there is not a forced bend on any of the cables Check the ECG cable for cuts or breaks Replace the cable if there are prob lems New cables can be ordered from Siemens Transducer Maintenance Regularly check transducers for signs of wear or damage Routinely inspect your transducers for the fo...

Page 275: ...face NOTE Always remove the MO disk from the MO drive when transporting the Cypress system Hard Drive Maintenance The Cypress system s internal hard drive should not be used for long term stor age of studies and patient information Remove data from the internal hard drive on a regular basis daily or weekly Storage information is displayed on the Patient page in the bottom right corner A Low Storag...

Page 276: ...mage or deterioration of sensitive electronic components A full description of these safeguards is beyond the scope of this manual but the following basic steps include Wear a properly grounded wrist grounding strap Do not work in a carpeted area When working on a sensitive area use a grounding mat TABLE 58 Frequency of Maintenance Area Frequency Maintenance Transducers 6 months Check for cracks o...

Page 277: ...terfere with normal operation of the system but could cause confusion if a stuck pixel occurs inside an alphanumeric display For example a pixel stuck in the ON state might be confused for a decimal point in a measurement and a pixel stuck in the OFF state might obscure the display of a decimal point in a measurement The system creates a space around the decimal point separating the whole number f...

Page 278: ...pen the module door by inserting the screw driver at the top of the module and pulling down 3 Use a screwdriver to pull the red fuse module out 4 Remove the old fuses from the sides of the module 5 Insert the new fuses in the sides of the module 6 Hold the fuses in place with your hand and push the module back in the Cypress system until it snaps into place 7 Close the module door If the door does...

Page 279: ...44 1001 or 44 1094 anti static lint less swabs or equivalent Lint free cloth cotton or T shirt type material Paper clip WARNING Before cleaning the Trackball and internal ball cage make sure the Cypress system power is OFF To clean the Trackball and ball cage follow these steps 1 Shutdown the Cypress system and turn the power OFF 2 Press and turn the black retaining ring surrounding the Trackball ...

Page 280: ...reduce the amount of alcohol on the swab by applying it to the lint free cloth or by squeezing the swab tip with tweezers You may use any method for reducing the amount of alcohol on the swab as long as the swab and alcohol are not contaminated 7 Once the proper amount of alcohol is on the swab lightly rub the swab on the inside surface of the ball cage to remove any contaminants Look for a build ...

Page 281: ...n cable must be con nected to the 15 pin connector port on the Cypress system The cable separates the composite video S video and audio signals needed for VCR and printer operation to standard connector types used by these devices NOTE When the screen is recorded on videotape and played back portions of the screen at the bottom and right side are not displayed There is nothing wrong with your disp...

Page 282: ...EC 601 1 for medi cal equipment Furthermore all configurations shall comply with the system standard IEC 601 1 1 Any party who connects addi tional equipment to the signal input part or signal output part is considered to be configuring a medical system and is therefore responsible for ensuring that the system complies with the requirements of the system standard IEC 601 1 1 If you have additional...

Page 283: ...connect a video printer to the Cypress system follow these steps 1 Make sure both the Cypress system and the printer are turned OFF 2 Attach the RCA to BNC adapter to the yellow Video RCA plug on the Video Distribution cable see Figure 48 FIGURE 48 Video Printer Connectors and Cables 15 PIN CONNECTOR TO CYPRESS NOT USED FOR VIDEO PRINTER YELLOW VIDEO RCA PLUG RCA TO BNC ADAPTER YELLOW VIDEO PLUG O...

Page 284: ...he Cypress system and then the printer 7 On the Cypress system press the SETUP function key to display the Setup tab 8 Use the Video Out Mode drop down menu to select NTSC 9 Press SETUP to return to 2D mode or press 2D to begin imaging 10 Press the PRINT key on the printer to print images from the Cypress system FIGURE 49 Connecting a Video Printer 15 PIN CONNECTOR ON CYPRESS PRINTER VIDEO DISTRIB...

Page 285: ... SVHS recorder and SVHS videotapes To connect a SVHS VCR to the Cypress system follow these steps 1 Make sure both the Cypress system and the VCR are turned OFF FIGURE 50 Cypress System SVHS VCR Connectors and Cables 2 Connect the gray SVHS cable to the SVIDEO INPUT connector on the back of the VCR see Figure 51 3 Connect the red and white cables to the two AUDIO IN connectors on the back of the V...

Page 286: ...C 9 Press SETUP to return to 2D mode or press 2D to begin imaging 10 Insert a video tape and press the RECORD button on the VCR to record images NOTE When images are recorded on videotape the playback on the moni tor will look slightly different than the display on the Cypress system parts of the bottom and right sides of the screen will not be shown Nothing is wrong with your playback All the ima...

Page 287: ...the Video Distribution cable as shown in Figure 48 on page A 3 3 Connect the RCA to BNC adapter end of the cable to the VIDEO IN connector on the back of the VCR see Figure 53 on page A 8 4 Connect the red and white cables to the two AUDIO IN connectors on the back of the VCR see Figure 53 5 Connect the gray SVHS cable to the SVIDEO input connector on the back of the VCR see Figure 53 6 Connect th...

Page 288: ...wn menu to select NTSC 11 Press SETUP to return to 2D mode or press 2D to begin imaging 12 Insert a video tape and press the RECORD button on the VCR to copy images 13 Press the PRINT key on the printer to print images from the Cypress system FIGURE 53 Connecting a VCR and Video Printer VIDEO IN SVIDEO AUDIO IN VCR VIDEO OUT 15 PIN CONNECTOR ON CYPRESS SYSTEM CABLE WITH BNC CONNECTOR ON EACH END V...

Page 289: ...VGA monitor through a standard VGA cable To connect an external monitor to the Cypress system follow these steps 1 Make sure Cypress system and monitor are turned OFF 2 Connect the monitor cable to the 15 pin connector on the Cypress system see Figure 54 3 Connect the power cord on the monitor and plug it in 4 Turn the Cypress system ON and then turn the monitor ON 5 On the Cypress system press th...

Page 290: ...o a PS 2 compatible keyboard To connect an external keyboard to the Cypress system follow these steps 1 Make sure Cypress system is OFF 2 Connect the keyboard cable to the external keyboard connection on the Cypress system see Figure 55 3 Turn the Cypress system ON FIGURE 55 Connecting an External Keyboard EXTERNAL KEYBOARD CONNECTION ...

Page 291: ...inting Reports BB This appendix describes printing Reports It includes information about Connecting an inkjet printer to the Cypress system Selecting studies and printing reports Printing the active study Printing reports using the Calculations package ...

Page 292: ...on screen 5 Click the NEW PRINTER button 6 Click the New Drivers pull down menu to display the list of compatible print ers and select your printer 7 Click the INSTALL PRINTER button 8 To complete the printer installation the system must be restarted Click OK to restart the Cypress system 9 Connect the printer to the Cypress system via the USB port located on the right side of the Cypress system S...

Page 293: ...o print the patient s demographic information highlight a patient name on the Patient List Cypress DOE A 04 22 2000 09 27 Routine 04 22 2000 08 54 Routine DOE B 04 21 2000 14 59 3 Stage Exercise 04 21 2000 13 27 Routine Activate Edit Remove Shutdown Reports Setup Patient Print Send Cypress DOE A 04 22 2000 09 27 Routine 04 22 2000 08 54 Routine DOE B 04 21 2000 14 59 3 Stage Exercise 04 21 2000 13...

Page 294: ...side of the screen 4 To exit Reports press 2D DOE AB 36517 04 22 2000 Routine 1 DOE C 36285 10 26 1999 Routine 1 DOE C 36486 08 04 1999 2 Stage E 1 DOE D 369387 09 02 1999 Routine 1 DOE E 2345686 05 25 2000 Y Routine 1 DOE MM 36286 06 17 2000 Pharmacolo 1 DOE P 36790 07 23 1999 3 Stage E 1 Si Patient Name Patient Id Protocol Date Arc Activate Edit Remove Shutdown Reports Setup Patient Print Send ...

Page 295: ...s 1 Press either the PATIENT or SETUP key 2 Click the Reports tab 3 Click the PRINT button located at the bottom of the display screen 4 To exit Reports press 2D Shutdown Reports Setup Patient PATIENT REPORT Information Institution Name ID Accession Sex Birth Date Study Date Indication Miscellaneous Info Comment PB Height Weight BSA Text Comments Print ...

Page 296: ...1 Press the CALC key while in any of the imaging modes 2 When the Calculations Selection menu opens click Report 3 Click the PRINT button located at the bottom of the display screen 4 To exit the patient report click CLOSE or press any mode key except Color CLICK REPORT ON THE CALCULATIONS SELECTION MENU Distance Area Volume Left Ventricle Volumes Left Ventricle Mass Ventricles LVOT Valves Atria Q...

Page 297: ...Users 1 7 Advanced Triggering 5 25 ALARA 10 10 Aliasing Reducing see Scale Allow Receiving Studies Checkbox 3 22 Alphanumeric Keys 2 12 ALT Key 2 12 Always Send Lossless Checkbox 3 21 Angle 5 12 Increase Sector Angle 5 28 PW 5 45 Reduce Sector Angle 5 28 Angle Correction 3 8 5 12 5 45 Aortic Valve Area by the Continuity Equation using TVI Cardiac Doppler Formula 6 22 Aortic Valve Area by the Conti...

Page 298: ...2 External Surfaces 11 2 MO Disk Drive 11 3 Screen 11 2 Vents 11 2 Click 2 5 Clinically Referenced Calculations 10 28 Color Bar 5 30 Color Display Improving Definition 5 33 Color Flow Combining 2D and Color Flow 5 36 Reducing see Priority Scanning 5 30 Tools 5 35 Color Flow Mode Key 2 3 Color Gain 5 31 Color Height Adjustment 5 33 Color Invert Adjustment 5 33 Color Maps 5 36 Color Mode Key 2 3 Col...

Page 299: ...las 7 15 Doppler Scanning 5 38 5 43 Doppler Steering 5 45 Doppler Trace Measurements 3 18 Double Click Speed 3 6 Duplex 2D Update Display Option 3 8 Dynamic Range 5 10 Dynamic Range see Spectral Compression E ECG Artifacts 8 6 Cable 8 2 Cables and Connectors 8 3 Connecting 8 2 Display 3 4 Setup 3 4 Signal Quality 8 6 ECG gated scanning techniques 5 25 Editing Patient Information 4 15 Patient Studi...

Page 300: ...6 16 Fractional Shortening Cardiac 2D Formula 6 16 Cardiac M Mode Formula 6 18 Fractional Thickening Interventricular Septum Cardiac 2D Formula 6 17 Cardiac M Mode Formula 6 18 Fractional Thickening Left Ventricular Posterior Wall Cardiac 2D Formula 6 17 Cardiac M Mode Formula 6 18 Frame Rate 5 28 Color Flow 5 33 Displayed with System Data 5 11 Frames 5 13 5 25 Frames Per Second 5 11 Displayed wit...

Page 301: ...J JPEG Compression 9 19 Lossless 9 19 Lossy 9 19 Quality 9 19 K Keyboard External Connector 1 11 Connecting External A 10 Overview Drawing 2 2 Keypad 2 2 2 12 L Labeling Icons on Cypress System 10 23 Labels Changing 8 19 8 20 Loops 8 21 Turning Off 8 21 Viewing 8 20 Language displayed on screen 3 7 Lateral Gain 2D 5 28 LAX 8 7 Left Right Invert 2D Mode 5 28 Color Flow 5 36 Lock Studies Option 3 10...

Page 302: ...anning 5 50 Tools 5 53 M Mode Display Doppler Display 3 8 MO Disk Reading Studies 9 24 Troubleshooting 9 26 MO Disk Drive 9 22 Cleaning 11 3 Maintenance 11 5 Write Protect Tab 9 23 Modality Worklist Downloading Demographics 3 20 Server Information 3 20 Setup 9 11 9 12 Mode Keys 2 2 2 3 Monitor Connecting External A 9 Moving Cypress 1 12 Multimedia Connection Setup 3 22 Multimedia Format 9 5 Removi...

Page 303: ...t Screen 3 14 Recalling a Saved 3 13 Reload with New Patient 3 15 Reloading with New Patient 3 15 Removing 3 14 Renaming 3 14 Storing 3 13 User defined 3 12 Presets Menu 3 12 Pressure Gradient Cardiac Doppler Formula 6 20 Pressure Half Time PHT Cardiac Doppler Formula 6 21 Preventive Maintenance 11 4 Printer designating the current printer 3 10 Printing Active Study B 5 Patient Reports B 3 Reports...

Page 304: ... 2 Overview 10 3 Patients 10 9 Save Stress Exam 8 9 Save All Function Key 2 11 Save Frames 6 12 7 10 Save Options 3 10 Save Time Limit 3 4 3 10 Saved Loops 5 6 5 14 SAX 8 7 Scale Color Flow 5 33 CW 5 40 5 47 Scanning Basic Steps 5 2 Depth 5 23 Overview 5 2 Screen Brightness 3 4 3 5 Security Lock Slot 1 14 System 1 14 Select Quad Soft Window 8 19 Selected Transfer Syntax Only Checkbox 3 21 Selectio...

Page 305: ... 8 10 Suspend Labeling 8 21 SVHS VCR Connecting A 5 Sweep CW 5 40 M Mode 5 52 Sweep Speed CW 5 42 M Mode 5 54 PW 5 49 Switch Display Button 4 3 System Data Explanation of Fields 5 9 Location on Display 5 9 System Menu 3 16 Fields 3 16 System Tab 3 16 System Utilities 9 24 Systolic Diastolic S D Vascular Doppler Formula 7 15 T Tabular Format Cardiac 9 18 Technical Description 10 20 Temperature Incr...

Page 306: ... 7 2 7 7 Patient Reports 7 2 Point to Point 7 12 References 7 16 Saving 7 12 Specific 7 2 Vascular Sites 3 19 VCR Connector 1 11 Velocity Decreasing 5 33 Increasing 5 33 Limits 5 33 Velocity Setting 5 40 5 47 VGA Compatible Monitor A 9 Video Out Mode 3 4 3 9 Video Printer Connecting A 3 Connector 1 11 View Function Key 2 11 View Images After Study Activation Checkbox 3 4 View Key Stress Exam 8 10 ...

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