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BBG 012

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

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BBG 012

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  1. BBG 012 Description of Study -Echocardiography

  2. CONTENTS page Patient Data Entry (SonoVue) /Erase Buffer 17 Preparation SonoVue 18 Loop 9 (a 4 CV SonoVue)19 Loop 10-12 (a2CV, a3CV, SAX SonoVue)20 Contrast AQ Optimisation 21 AQ (a4CV-SonoVue)22 Loop 13 (CK - a 4CV SonoVue)23 Loop 14-16 (CK a2CV, a3CV, SAX SonoVue)24 MCE 25 -Flash 26 Reentry Hospital Name 27 page Overview 1 Preparations 2 Patient Data Entry (native) 3 Erase Hospital Name 4 Checklist 5 M-Mode-Measurements 6 Annotation Cursor 7 Loop 1 (a 4 CV unenhanced) 8 Loop 2-4 (a2CV, a3CV, SAX unenhanced)9 AQ (a4CV-unenhanced)10 - Selection of ROI (a4CV) 11 - Waveform Analysis 12 Loop 5 (CK - a 4CV unenhanced) 13 Loop 6-8 (CK a2CV, a3CV, SAX unenhanced)14 -Selection of ROI (a2CV, a3CV, SAX) 15 Loop Review 16

  3. Overview Proceed with MCE-Real Time Perfusion: Image MCE in three apical projections and acquire at least two flash-replenishment cycles in a 4CV (digital storage not mandatory). 1

  4. Step 1 - Preparations ECG MOD (Initialistation of MODs: Touch Disk on left touch panel and afterwards touch Init Disk) SVHS-Video-Tape S S 2

  5. Step 2 - Patient Data Entry Press Patient ID 1 Select Manual Entry(necessary only if IDI-Box is installed and activated – otherwise go to step 3 directely 2 3 Press ENTER (New Patient) • Entry Patient Data: • Last Name Field: Insert BBG-Pat.No and add „-N“ to label the loops as „native“First Name Field: Insert Patient Initials 4 S -N BBG090101 JRE If IDI is activated, the MRN-Field a has to be filled in; please repeat the last name field (i.e. BBG-Pat.No-N) Press Patient ID 5 3

  6. Step 2 - Patient Data Entry: Erase Hospital Name PressSetup 1 Touch System on right Touch Panel 2 Press Institute Name: a field with your Institute Name will now appear: Notice the Institute name for Post-Study Reinsertion. 3 PressErase Institute Name is now erased; Go to OK and confirm with Enter 4 Finalize withSetup 5 4

  7. Step 3 - Checklist ECG: Are R-Waves positive and clearly distinctable ? 1 Storage: Is the respective SVHS Videotape inserted ? 2 Storage: Is the respective MOD inserted and intialised? 3 Patient No.: Is patient number inserted as described ? 4 Hospital Name: Is hospital name erased ? 5 5

  8. SVHS Step 4 - M-Mode-Measurements Touch PRESET 1 Select BBG012-Nativ 2 3 Perform M-Mode-Meaurements from parasternal LAX or parastermal SAX and document size in mm of: LA, IVSd, LVDD, LVSD, LWPd (insert results into CRF page 15) 6

  9. Step 5 - Preparation of Annotation Cursor(for consecutive numbering of digitally stored loops) Touch ANNOTATE 1 Position Cursor at Top Right 2 Touch HOME SET The Annotation Cursor will reappear automatically at the same position any time ANNOTATEis pressed 3 1 Annotate 1 for Loop No 1 4 Press ENTER 5 7

  10. DIGITAL Step 6 - Capture LOOP 1(apical 4 CV unenhanced) Image apical 4 CV 1 Press ACQUIRE 5 consecutive cycles will be prospectively captured and displayed as loop 2 Press ENTER to accept Loop for definite storage OR Press Acquire again to redo Loop 3 If IDI is activated, a Message will appear on screen regarding the storage location: Choose OPTICAL DISC (by moving Track Ball)as your Target Disk Selection. Go to OKAY and confirm with ENTER 4 Subsequent Loops will be automatically transferred to MOD after step 3 (Acquire + Enter) 8

  11. DIGITAL Step 7 to 9 - Capture LOOP 2 - 4(unenhanced apical 2 CV, apical 3CV, parasternal SAX) Touch ANNOTATE and change Annotation to 2 (3,4) 1 Take care to update the Annotation BEFORE CAPTURE of the RESPECTIVE LOOPS Acquire Loops Loop 2: apical 2 CV Loop 3: apical 3 CV Loop 4: parasternal SAX 2 9

  12. SVHS Step 10 - AQ in apical 4 CV (unenhanced) Clear Annotation ->Touch ANNOTATE  CLEAR ALL 1 Touch AQ and Image ABD afterwards optimise border detection by adaption of Gain (i.e. reduce gain), TGC and LGC 2 Touch ROIto select Region of Interest 3 10

  13. SVHS AQ in apical 4 CV – Selection of ROI 1 Position Cursor in the RV just beside the basal septum at mitral valve level and press Caliper Now move the cursor just outside the basal lateral wall and there- fore define the base line of the LV and press Caliper 2 Draw the ROI towards the apex by using the Trackball and therefore setup the ROI and Press ENTER TWICE 3 To change size or position of the defined ROI use the Sizeand/or Positionbuttons above the Trackball. Press ENTER after each manipulation 4 11

  14. SVHS AQ in apical 4 CV – Waveform Analysis Touch WAVEFORM 1 2 The composite Waveform should be green, indicating low beat to beat variability Press Freezeand touch Global Function 3 Insert the LV-Volumes and EF displayed into the CRF-Page 15: ABD a4CV 4 12

  15. DIGITAL Step 11 - Capture LOOP 5 (apical 4 CV Colour Kinesis unenhanced) Touch 2 D 1 Touch Annotate and set Annotation to 5 2 3 Image apical 4 CV 4 Touch AQ and Change from Image ABD to Image Systole by turning the respective knob on the right panel Define ROI (as described for AQ) 5 6 Optimise Image for CK by Gain, TGC and LGC Capture Loop 7 13

  16. DIGITAL Step 12 to 14 - Capture LOOP 6-8 (apical 2 CV, 3 CV and parasternal SAX Colour Kinesis unenhanced) Touch 2 D 1 2 Touch Annotate and change Annotation to 6 (7,8) Take care to update the Annotation BEFORE CAPTURE of the RESPECTIVE LOOPS 3 Image respective view Touch AQ and Change from Image ABD to Image Systole by turning the respective knob on the right panel 4 Loop 6: apical 2 CV Loop 7: apical 3 CV Loop 8: parasternal SAX Define ROI (see page 14) 5 a2CV & a 3CV & parasternal SAX Optimise Image for CK by Gain, TGC and LGC 6 Capture respective Loop 7 14

  17. DIGITAL CK in a2 CV, a3CV and SAX – Selection of ROI Cursor Position a2CV ->Inferior – Anterior at MVL 1 Cursor Position a3CV ->Posterior – Anteroseptal at MVL 2 Cursor Position SAX ->Position Cursor in the middle of RV at the RV-EBD of IVS; Press CALIPER ONCE Move the circle-shaped ROI to its correct position and press ENTER twice 3 15

  18. Review of captured Loops DeFreeze 1 Touch Loop on left Touch Panel 2 Press Display 3 Toggle through the loops by turning thepage knob 4 16

  19. DIGITAL Step 15 - Erase Storage Buffer (please erase storage buffer now and apply new patient name as described) Perform loop review (8 loops should be in storage buffer) 1 If IDI is activated, the MRN-Field a has to be filled in; please repeat the last name field (i.e. BBG-Pat.No-S) 2 Touch 2 D 7 Press Patient ID 3 Press Patient ID Select Manual Entry(necessary only if IDI-Box is installed and activated –otherwise go to step 3 directely 4 -S BBG090101 JRE 5 Press ENTER (New Patient) • Entry Patient Data: • Last Name Field: Insert BBG-Pat.Noand add „-S“ to label the loops as „SonoVue“First Name Field: Insert Pat. Initials 6 17

  20. SonoVue Preparation of SonoVue Preparation SonoVue 18

  21. DIGITAL Step 16 - Capture LOOP 9(SonoVue enhanced apical 4 CV) Select Preset BBG012 - SonoVue 1 Annotate via Homeset; set Annotation to 9 2 Start SonoVue Infusion at an infusion rate of 1 ml/min and adjust dose 3 Image apical 4 CV 4 Capture Loop 9 5 19

  22. DIGITAL Step 17 to 19 - Capture LOOP 10 - 12(SonoVue enhanced apical 2 CV, apical 3CV, parasternal SAX) Touch ANNOTATE and change Annotation to 10,(11,12) 1 Take care to update the Annotation BEFORE CAPTURE of the RESPECTIVE LOOPS Acquire Loops Loop 10: apical 2 CV Loop 11: apical 3 CV Loop 12: parasternal SAX 2 20

  23. SVHS Step 20 - Optimisation of AQ / CK with SonoVue • Provide sufficient contrast concentration (infusion rate; use bolus if necessary) in LV chamber and homogenous contrast • Optimisation of Gain Settings(inverted to unenhanced AQ)Adjust Overall Gain (normally increase !)Adjust Lateral Gain Comp. (LGC) • If dose optimisation is problematic -> increase MI,especially if shadowing appearsAdjustment of Compression may improve visual image quality, but has no influence on extent of automatic border tracking 21

  24. SVHS Step 21 - AQ in apical 4 CV (SonoVue) Clear Annotation ->Touch ANNOTATE  CLEAR ALL 1 2 Touch AQ and Image ABD afterwards optimise border detection by adaption of Gain (increase Gain), TGC and LGC Touch ROIto select Region of Interest 3 Perform Waveform analysis and document on CRF Page 18 4 22

  25. DIGITAL Step 22 - Capture LOOP 13 (SonoVue enhanced apical 4 CV Colour Kinesis) Touch 2 D 1 2 Touch Annotate and set Annotation to 13 3 Image apical 4 CV 4 Touch AQ and Change from Image ABD to Image Systole by turning the respective knob on the right panel 5 Define ROI (as described for AQ) 6 Optimise Image for CK by Gain, TGC and LGC Capture Loop 7 23

  26. DIGITAL Step 23 - Capture LOOP 14-16 (SonoVue enhanced apical 2 CV, 3 CV and parasternal SAX Colour Kinesis) Touch 2 D 1 Touch Annotate and change Annotation to 14 (15,16) 2 Take care to update the Annotation BEFORE CAPTURE of the RESPECTIVE LOOPS 3 Image respective view Touch AQ and Change from Image ABD to Image Systole by turning the respective knob on the right panel 4 Loop 14: apical 2 CV Loop 15: apical 3 CV Loop 16: parasternal SAX 5 Define ROI (see page 14) a2CV & a 3CV & parasternal SAX Optimise Image for CK by Gain, TGC and LGC 6 Capture respective Loop 7 24

  27. SVHS Step 24 - MCE-Real Time Perfusion Touch Tools  TCE 3 1 2 Touch Angio (on the right Touch Panel) 3 Image a4CV, a3CV and a2CV (storage on SVHS) Apply Destruction Flashs and image at least two flash replenishmant cycles in a 4CV 4 Flash Adjust Focus Position to verify perfusion defects, i.e. move focus to apex in case of apical defect to exclude artifacts 5 25

  28. SVHS Setting of Flash in MCE-Real Time Perfusion Touch Impulse 1 Adjust number of destruction frames if necess.: Touch IFrames and turn respective knob 2 To adjust Flash MI go toSecondary Controls and then to Ipower in the right touchpanel. Default Setting is 0.0 dB = maximum(MI ~ 1.5) 3 Impulse / FlashAngio-MODE Frames per FlashMI 26

  29. Step 25 - ReEntry Hospital Name PressSetup 1 Touch System on right Touch Panel 2 Press Institute Name, an empty field will now appear: Insert the Institute Name 3 Go to OK and Confirm with Enter 4 Finalize withSetup 5 27

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