GE Vivid 7 User Manual
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Stress Echo Vivid7/Vivid7 PRO Users Manual147 FC092326-03 Chapter 4 Stress Echo This chapter includes the following information: • Introduction ................................................................................... .. 148 • Selection of a stress test protocol template .............................. .. 149 • Image acquisition .......................................................................... .. 150 • Starting acquisition ................................................................... 151 • Continuous capture mode ........................................................ 155 • Analysis ......................................................................................... .. 163 • Image selection for analysis ..................................................... 163 • Scoring acquired loops ............................................................. 165 • Quantitative TVI Stress echo analysis ........................................ .. 169 • Accessing QTVI Stress analysis tools ...................................... 171 • Vpeak measurement ................................................................ 171 • Tissue Tracking ........................................................................ 175 • Quantitative analysis ................................................................ 176 • Editing/creating a template .......................................................... .. 177 • Entering the Template editor screen ........................................ 177 • Template editor screen overview ............................................. 178 • Editing/Creating a template ...................................................... 181
Stress Echo 148Vivid7/Vivid7 PRO Users Manual FC092326-03 Introduction The Vivid 7/Vivid 7 PRO ultrasound unit provides an integrated stress echo package, with the ability to perform image acquisition, review, image optimization, and wall segment scoring and reporting for a complete, efficient stress echo examination. The stress package provides protocol templates for exercise, as well as, pharmacological stress examinations. In addition to preset factory protocol templates, templates can be created or modified to suit users needs. Users can define various quad screen review groups, in any order and combination, that will suit their normal review protocol. When reviewing stress examination images, the images are viewed at their original image quality, and different post-processing and zoom factors may be applied to the images under review for effective image optimization. The protocol template may be configured for Continuous capture. In addition to standard wall motion scoring analysis, the user can perform quantitative stress analysis based on tissue velocity information (TVI). A stress echo examination consists of three steps: • Selection of a stress test protocol template (page 149) • Image acquisition (page 150) • Stress analysis (page 163) • Quantitative Stress analysis (page 169)
Stress Echo Vivid7/Vivid7 PRO Users Manual149 FC092326-03 Selection of a stress test protocol template 1. Press PROTOCOL to enter the stress echo mode. The Protocol screen is displayed (see Figure 4-1) showing the default stress protocol for the current probe. To create or edit a template see page 177.2. •To use the current template: Turn freeze off to initiate scanning. •To use another template: Press the assignable TEMPLATE. The template list is displayed. 3. Trackball to the desired template. 4. Press SELECT. 5. Turn freeze off to initiate scanning using the new template. Figure 4-1: The Protocol screen 1. Projection selection 2. Level 3. Current acquisition 4. Projection 5. Group of views
Stress Echo 150Vivid7/Vivid7 PRO Users Manual FC092326-03 Image acquisition Images are acquired in a pre-defined order, according to the selected template. The highlighted cell (green) of the matrix, displayed in the Clipboard window indicates which view is currently being acquired (see Figure 4-2). The names of both the view and the level for the current cell is displayed on the top corner of the image area and under the template matrix. Figure 4-2: The stress mode acquisition screen 1. Current view label 2. Template matrix 3. Current view (Green cell) 4. Timers
Stress Echo Vivid7/Vivid7 PRO Users Manual151 FC092326-03 Star ting acquisition To use the Timer, see page 154.1. Turn freeze off to initiate scanning. 2. Perform a scan that conforms with the view that is highlighted in the template matrix on the Clipboard window. Smart Stress is turned on by de- fault in factory tem- plates. If the selected template has the option Smart Stress turned on (see page 180), a subset of the image acquisition settings for each view in the baseline level will be stored and automatically reused in the corresponding views in the next levels. 3. Press STORE. For further infor- mation on stress test configuration, see page 177.• If the actual stress level is configured to preview cineloop before storing, use the cineloop controls to select the most appropriate heart cycle and, if desired adjust the loop markers (see ’Cineloop operation’ on page 62 for further information). Press STORE to save the selected cineloop. • If the actual stress level is not configured to preview cineloop before storing, the system will automatically store the last cardiac cycle. When storage of the cineloop is completed, the actual highlighted cell in the template matrix displays a 2D icon indicating that the view has been acquired. After storing the loop, the system automatically highlights the next view in the matrix to be acquired. For further infor- mation on stress test configuration, see page 177.Stress levels can be configured for side by side display/ comparison of the reference loop from baseline or previous level and the loop to acquire (see Figure 4-3). 4. Repeat previous steps until all required views are completed. The template used can be configured so that analysis is automatically started, displaying the first protocol group. The wall segment scoring diagrams for each view is displayed in the Parameters window on the right side of the screen (see Figure 4-9, page 165). CAUTIONIf using DICOM Server dataflow for stress-echo acquisition, images should not be saved to permanent archive before the complete protocol exam is acquired.
Stress Echo 152Vivid7/Vivid7 PRO Users Manual FC092326-03 Figure 4-3: Display of the Reference loop during acquisition Selecting a view during acquisition A fixed protocol is provided for scanning, based on the selected template. The system automatically highlights the next view to be acquired in the template matrix, as images are stored. However, the order of scanning may be changed manually as follow: Manual selection of a view during acquisition 1. Use the arrow keys on the alphanumeric keyboard to highlight the cell that represents the view that is to be acquired. The selected cell in the template matrix is highlighted in red, indicating non-default position and is blinking if it contains a previously stored acquisition. 2. Turn freeze off to initiate scanning. 3. Scan and save the selected loop as explained in the previous section. After storage the system automatically highlights the next available view to be acquired. 1. Current acquisition loop 2. Corresponding reference loop
Stress Echo Vivid7/Vivid7 PRO Users Manual153 FC092326-03 Replacing an acquired image 1. Use the arrow keys on the alphanumeric keyboard to highlight the cell that represents the view that is to be replaced. The selected cell in the template matrix is highlighted in red, indicating non-default position. 2. Turn freeze off to initiate scanning. 3. Scan and save the selected loop as explained in the previous section. After storage the system automatically highlights the next available view to be acquired. Moving an acquired image An Image can be moved from one cell to another during acquisition. There are two ways to move images: Procedure 1 1. When in the Protocol screen, press MORE (assignable menu). 2. Press the assignable MOVE IMAGES. 3. Trackball to the image to move (source cell). 4. Press SELECT. 5. Trackball to the destination cell. 6. Press SELECT. The image is moved from the souce cell to the destination cell. Procedure 2 1. In the Protocol screen, trackball to the cell containing the image to move (source cell). 2. Press and hold down SELECT. 3. With the SELECT key still depressed, trackball to the destination cell. 4. Release the SELECT key. The image is moved from the source cell to the destination cell. Stored images can- not be moved.If the destination cell contains an image, the images from the source and destination cells will be exchanged when moving an acquired image.
Stress Echo 154Vivid7/Vivid7 PRO Users Manual FC092326-03 Blood Pressure and hear t rate data The blood pressure (systolic and diastolic) and heart rate can be manually entered during acquisition (or during Wall motion analysis). 1. Press MEASURE. The Measurement menu is displayed. 2. Select Wall Motion. The systolic and diastolic blood pressure and the heart rate for the active cell stress-level are displayed on the button over the scoring diagrams (see Figure 4-9, page 165). By pressing this button it is possible to enter blood pressure and heart rate values for all stress levels. Timers Two timers can be displayed in the Stress mode acquisition screen, beside the template matrix (see Figure 4-4). Figure 4-4: The timers in the acquisition screen • T1 displays the elapsed time from the start of the stress examination. • T2 starts when entering live scanning on the second stress level Both T1 and T2 timers can be manually stopped and restarted during the acquisition from the System Menu (Press MENU on the control panel). The display of T1 and T2 is user-configurable (see page 177). 1. Timers display
Stress Echo Vivid7/Vivid7 PRO Users Manual155 FC092326-03 Continuous capture mode Continuous capture mode enables the user to perform acquisition continuously for all views at any level depending on the selected template configuration. Continuous capture consists of temporary saving images acquired in a storage buffer. To enable best possible use of the limited storage buffer capacity, a Pause/Capture mode is provided, as opposed to the normal Freeze/Scan mode. The Pause mode enables scanning and live display on the screen, without any capture, thereby leaving the buffer available. To run Continuous capture, the user has to select a template where this feature is activated (see page 177 about template configuration). The buffer bar When entering a level with Continuous capture enabled, a Buffer bar is displayed in the Info window (see Figure 4-5). The Buffer bar displays the following information: • The units scanning state: • PAUSE (live scanning without storing) • CAPTURE (live scanning with storing to buffer) • The percentage of the buffer that is filled • The buffer filling progression showed by a green filling gauge • The capturing sessions, reflected by the red lines along the Buffer bar
Stress Echo 156Vivid7/Vivid7 PRO Users Manual FC092326-03 Figure 4-5: The buffer bar in Continuous capture Controlling the capture process When entering a stress level with Continuous capture enabled, the unit is automatically set in Pause mode. 1. Press IMAGE SRORE or 2D FREEZE to start image capture. “Capture” is displayed in the buffer bar, the gauge starts filling and the percentage of filled memory buffer increases (see Figure 4-5, page 156). 2. Press IMAGE SRORE or 2D FREEZE again to stop capture. “Pause” is displayed in the buffer bar. When 90% of the memory buffer is filled up, the text display in the buffer bar turns red. The unit enters Freeze mode automatically once the buffer is full and the captured loops are displayed in the Continuous capture selection screen (see below). 1. Scanners state: 2. Capture session 3. Pause session 4. Buffer gauge 5. Percentage of filled buffer 2 345