Vivid E9 UM

Technical Publications
Vivid E9
Version 113
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User Manual
GB092107 — English
Rev. 05
Operating Documentation
Copyright 2015 By General Electric Co.
Regulatory requirement
This product complies with regulatory requirements of the following European

Directive 93/42/EEC concerning medical devices.
0123
This manual is a reference for the Vivid E9. It applies to all versions of the 113
software for the Vivid E9 ultrasound system.
Manual status:
GB092107-05
18 08 2015 (DD MM YYYY)
Manufacturer:
GE VINGMED ULTRASOUND A/S
Strandpromenaden 45
N-3191 Horten, Norway
Tel.: (+47) 3302 1100 Fax: (+47) 3302 1350
Regulatory Requirements
Conformance Standards
The GE Healthcare product families are tested to meet all
applicable requirements in relevant EU Directives and
European/International standards. Any changes to accessories,
peripheral units or any other part of the system must be
approved by the manufacturer: GE Vingmed Ultrasound.
Ignoring this advice may compromise the regulatory approvals
obtained for the product.
This product complies with the regulatory requirement of the
following:
Standard/Directive Scope
93/42/EEC Medical Devices Directive (MDD)
2006/42/EC Machinery Directive (MD)
2002/96/EC Waste Electrical and Electronic Equipment (WEEE)
EN55011 Emitted noise according to Class A requirements
IEC60601-1 Medical Electrical Equipment, Part 1; General Requirements

EN60601-1 for Safety
UL60601-1
CAN/CSA-C22.2 No 601.1-M90
IEC60601-1 Medical Electrical Equipment, Part 1; General requirements

for basic Safety and essential performance
IEC60601-2-37 Medical electrical equipment - Part 2-37. Particular

requirements for the safety of ultrasonic medical diagnostic
and monitoring equipment
IEC1157 / EN61157 Requirements for the declaration of the acoustic output of

medical diagnostic ultrasonic equipment.
IEC60601-1-1 / EN60601-1-1 Safety requirements for medical systems
EN60601-1-2 Medical Electrical Equipment - part 1-2. Collateral standard:

Electromagnetic compatibility - Requirements and tests.
EN60601-1-4 Medical Electrical Equipment - part 1-4. Collateral standard:

Programmable electrical medical systems
Vivid E9 – User Manual i-1

GB092107 05
Standard/Directive Scope
IEC60601-1-6 Medical Electrical Equipment - part 1-6. Collateral standard:

Usability.
NEMA/AIUM UD-3 Standard for real-time display of thermal and mechanical

acoustic output indices on diagnostic ultrasound equipment.
ISO10993-1 Biological evaluation of medical devices
Country Specific Approvals

• JAPAN
MHLW Approved Number:
• CHINA
SFDA:
Product Standard Number:
• KOREA
KFDA:
Importer Information
• TURKEY
Certifications
• GE Vingmed Ultrasound is ISO 9001 and ISO 13485
certified.
i-2 Vivid E9 – User Manual

GB092107 05
Classifications
According to 93/42/EEC Medical Device Directive, this is
Class IIa Medical Device.
The following classifications are in accordance with the IEC/
EN 60601-1:
• According to IEC/EN 60601-1, Equipment is Class I, with BF
or CF Applied Parts.
Type of protection against electric shock:
• Class I Equipment
Degree of protection against electric shock:
• Type BF Applied part (for Probes marked with BF symbol)
• Type CF Applied part (for PCG, ECG and probes marked
with CF symbol)
• The ECG applied part is protected against defibrillation.
Continuous Operation
System is Ordinary Equipment (IPX0).
Footswitch is IPX8.
Class I Equipment
EQUIPMENT in which protection against electric shock not rely
on BASIC INSULATION only, but includes an earth ground. This
additional safety precaution prevents exposed metal parts from
becoming LIVE in the event of an insulation failure.

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Type BF Applied part
TYPE BF APPLIED PART providing a specified degree of
protection against electric shock, with particular regard to
allowable LEAKAGE CURRENT.
Normal mode Single fault condition
Patient leakage current <100 microA <500 microA
Type CF Applied part

TYPE CF APPLIED PART providing a degree of protection
higher than that for Type BF Applied Part against electric shock
particularly regarding allowable LEAKAGE CURRENT.
Normal mode Single fault condition
Patient leakage current <10 microA <50 microA
Original Documentation
• The original document was written in English.
Software License Acknowledgements

• WindowBlinds™ OCX © Stardock ®

GB092107 05
Table of Contents
Conformance Standards - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-1

Country Specific Approvals - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-2
Importer Information - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-2
Certifications - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-2
Classifications - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-3
Class I Equipment- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-3
Type BF Applied part - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-4
Type CF Applied part - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-4
Original Documentation - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-4
Software License Acknowledgements- - - - - - - - - - - - - - - - - - - - - - - - - - i-4
Table of Contents
Chapter 1 — Introduction
Overview
Attention - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1-2
Safety - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1-2
Interference caution - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1-2
Indications for use - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1-3
Contraindications - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1-3
Manual contents - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1-3
Conventions used in this manual - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1-4
Contact Information
Contacting GE Healthcare Ultrasound - - - - - - - - - - - - - - - - - - - - - - - - 1-5
Manufacturer - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1-10
Chapter 2 — Getting started
Introduction
Preparing the unit for use
Site requirements - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-3
Connecting the unit - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-4
Switching On/Off- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-6
Control panel adjustment- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-8
LCD monitor adjustment - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-9
Connecting and disconnecting probes - - - - - - - - - - - - - - - - - - - - - - - 2-10
Moving and transporting the unit
Wheels - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-11
Moving the unit - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-12
Transporting the unit - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-13
Reinstalling at a new location- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-14
System description
System overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-15

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Starting an examination
Creating a new patient record - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-23
Selecting an existing patient record - - - - - - - - - - - - - - - - - - - - - - - - - 2-23
Ending an examination - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2-24
Chapter 3 — Basic operations
Trackball area
Touch panel
Removable media
Intended use - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-5
Supported removable media - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-5
About removable media and long-term image storage - - - - - - - - - - - - - 3-6
USB desktop hard drive- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-7
Recommendation concerning CD and DVD handling - - - - - - - - - - - - - 3-10
Formatting removable media - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-10
Ejecting removable media - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-11
Physiological traces
Pinout on AUX connectors- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-13
ECG/Respiration- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-13
Phono - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-14
Connecting the Pulse pressure transducer - - - - - - - - - - - - - - - - - - - - 3-15
Using Physios - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-15
Cineloop
Cineloop overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-18
Zoom
Display zoom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-20
HR zoom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-20
Annotations
To insert an annotation - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-21
To edit annotations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-23
To erase annotations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-23
Bodymark - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-24
Annotation and bodymark configuration - - - - - - - - - - - - - - - - - - - - - - 3-24
Configuration – System and presets
About system Configuration - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-28
General system settings - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-30
System users - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3-32
Chapter 4 — Scanning Modes
2D-Mode
2D-Mode overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-3
Using 2D-Mode - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-3
Optimizing 2D- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-4
M-Mode
M-Mode overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-6
Using M-Mode - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-7
Optimizing M-Mode- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-8
Color Mode
Color 2D Mode overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-9

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Color M-Mode overview- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-10
Using Color Mode - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-10
PW and CW Doppler
PW and CW Doppler overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-13
Using PW/CW Doppler modes - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-14
Optimizing PW/CW Doppler modes - - - - - - - - - - - - - - - - - - - - - - - - - 4-14
Tissue Velocity Imaging (TVI)
TVI overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-16
Using TVI- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-16
Optimizing TVI - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-17
Tissue Tracking
Tissue Tracking overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-18
Using Tissue Tracking- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-19
Optimizing Tissue Tracking - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-19
Strain rate
Strain rate overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-20
Using Strain rate- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-20
Optimizing Strain rate - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-21
Strain
Strain overview- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-22
Using Strain - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-22
Optimizing Strain - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-23
Tissue Synchronization Imaging (TSI)
TSI overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-24
Using TSI- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-25
Additional scanning features
LogiqView - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-27
Compound - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-28
B-Flow - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-28
Blood flow imaging - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-29
Image controls
Control panel - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-30
Touch panel and rotaries - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-31
Scan Assist Pro
Introduction - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-39
Scan Assist Pro overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-40
Setting up Scan Assist Pro - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-41
Using Scan Assist Pro- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-43
Configuration – Imaging
Global imaging settings - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-45
Application presets - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-46
Application menu configuration - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-49
6VT-D TEE probe configuration - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4-50
Chapter 5 — 4D and Multi-plane Modes
4D-Mode
Introduction - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-2
4D-Mode - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-3

GB092107 05
4D Color Flow mode - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-14
Slice Mode - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-19
Basic operations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-23
6 Slice - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-37
4D-Mode controls - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-40
Multi-plane mode
Multi-plane mode overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-45
Using Multi-plane mode- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-49
Bi-plane prepare - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-49
Multi-plane mode controls - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5-53
Chapter 6 — Stress Echo
Introduction
Multi-plane Stress Echo- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-2
4D Stress Echo - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-2
Selection of a stress test protocol template
Image acquisition
Starting acquisition - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-4
Continuous capture mode - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-8
Stress Echo analysis
Image selection for analysis- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-15
Wall motion scoring- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-17
Multi-plane Stress Echo
Multi-plane Stress Echo acquisition - - - - - - - - - - - - - - - - - - - - - - - - - 6-21
Multi-plane Stress Echo analysis - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-26
4D Stress Echo
4D Stress Echo acquisition - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-28
4D Stress Echo analysis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-33
Quantitative TVI Stress echo analysis
Accessing QTVI Stress analysis tools - - - - - - - - - - - - - - - - - - - - - - - - 6-38
Vpeak measurement - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-39
Tissue Tracking - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-42
Quantitative analysis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-42
References - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-42
Editing/creating a Stress Echo protocol template
Entering the Template editor screen - - - - - - - - - - - - - - - - - - - - - - - - - 6-43
Editing/Creating a template - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6-44
Multi-plane Stress Echo Template setup - - - - - - - - - - - - - - - - - - - - - - 6-47
Configuration
Chapter 7 — Contrast Imaging
Introduction
Data acquisition - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7-2
Quantification - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7-4
Useful link - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7-4
Data acquisition
Left Ventricular Contrast Imaging - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7-5
Contrast Low MI - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7-8

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Vascular/Abdominal Contrast Imaging - - - - - - - - - - - - - - - - - - - - - - - 7-12
Chapter 8 — Measurements and analysis
Introduction
General recommendations about measurements - - - - - - - - - - - - - - - - - 8-4
About Measurement results display - - - - - - - - - - - - - - - - - - - - - - - - - - 8-4
Assign and Measure modality
Measure and Assign modality
Measurements on volume renderings - - - - - - - - - - - - - - - - - - - - - - - - - 8-9
Measurements on protocol images
Advanced cardiac measurements and analysis
Event timing measurements- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-11
TSI Measurements - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-12
Automated Function Imaging - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-19
AutoEF measurements - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-38
Pediatric Z score measurement study - - - - - - - - - - - - - - - - - - - - - - - - 8-43
4D/Multi-plane LV measurements and analysis
Introduction - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-45
4D Automated Left Ventricular Quantification - - - - - - - - - - - - - - - - - - 8-45
Manual left ventricular volume measurements - - - - - - - - - - - - - - - - - - 8-58
TSI surface model- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-63
4D MV-Assessment
Starting the 4D MV-Assessment application - - - - - - - - - - - - - - - - - - - 8-65
Advanced vascular measurements and analysis
Intima-Media Thickness- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-66
OB measurements
OB graphs - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-70
Measurement package configuration
Measurement package configuration - example - - - - - - - - - - - - - - - - - 8-77
User-defined formulas - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-80
Advanced settings - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-87
Normal values - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-93
Measurement result table
Minimizing the Measurement result table - - - - - - - - - - - - - - - - - - - - - 8-96
Moving the Measurement result table - - - - - - - - - - - - - - - - - - - - - - - - 8-96
Deleting measurements- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-96
Worksheet
Overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-97
Using the Worksheet- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 8-97
Chapter 9 — Quantitative Analysis
Introduction
Q Analysis overview
Starting Q Analysis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-3
Q Analysis screen- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-4
Using Q Analysis
Generation of a trace - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-9
Saving/retrieving Q Analysis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-12

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Frame disabling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-12
Optimization - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-14
Switching modes or traces- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-17
Curve fitting analysis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-18
Anatomical M-Mode - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9-25
Chapter 10 — Archiving
Introduction
The dataflow concept
Dataflows available - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-3
Storing images and cineloops
Storing an image - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-6
Storing a cineloop - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-7
Saving images and cineloops to a standard format - - - - - - - - - - - - - - 10-8
MPEGVue/eVue - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-10
Retrieving and editing archived information
Searching for a patient record - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-13
Editing data in the archive - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-16
Deleting archived information- - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-22
Moving examinations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-23
Review images in archive
Review the images from a selected examination - - - - - - - - - - - - - - - 10-25
Select images from the Image list screen - - - - - - - - - - - - - - - - - - - - 10-26
Connectivity
The dataflow concept - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-30
Dataflow selection- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-33
Scanner connectivity configuration - - - - - - - - - - - - - - - - - - - - - - - - - 10-33
Export/Import patient records/examinations
Exporting patient records/examinations- - - - - - - - - - - - - - - - - - - - - - 10-44
Importing patient records/examinations- - - - - - - - - - - - - - - - - - - - - - 10-50
Disk management
Configuring the Disk management function - - - - - - - - - - - - - - - - - - - 10-54
Running the Disk management function - - - - - - - - - - - - - - - - - - - - - 10-56
Data Backup and restore
Backup procedure- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-61
Restore procedure - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-65
Configuration – Archiving
Archiving presets - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-68
TCP/IP configuration - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-70
Dataflow - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-70
Remote path setting - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-73
Export configuration - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-74
Additional outputs - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-76
Unlock patient record - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10-79

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Chapter 11 — Report
Introduction
Creating a report
Working with the report function
To choose another report template - - - - - - - - - - - - - - - - - - - - - - - - - - 11-5
To change patient information - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-6
Images in the report - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-6
To print a report - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-6
To store a report - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-7
Report sign-off - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-7
Retrieving an archived report - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-8
Deleting an archived report - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-9
Structured Findings
Prerequisite - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-10
Starting Structured Findings- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-11
Using Structured Findings - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-13
Structured Findings configuration - - - - - - - - - - - - - - - - - - - - - - - - - - 11-16
Direct report
Creating comments- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-26
Creating pre-defined text inputs - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-27
Report designer
Accessing the Report designer- - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-28
Report designer overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-29
Designing a report template - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-30
Saving the report template- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-41
To exit the Report designer - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11-42
Report templates management
Configuration of the Template selection menu - - - - - - - - - - - - - - - - - 11-43
Export/Import of Report templates - - - - - - - - - - - - - - - - - - - - - - - - - 11-45
Chapter 12 — Probes
Probe overview
Supported probes - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-2
Probes/Applications overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-5
Maximum probe temperature - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-9
Probe orientation - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-10
Probe labelling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-11
Probe Integration
Connecting the probe - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-12
Activating the probe - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-14
Disconnecting a probe- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-15
Coupling gels - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-15
Care and Maintenance
Planned maintenance - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-16
Inspecting the probe - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-16
Cleaning and disinfecting probes - - - - - - - - - - - - - - - - - - - - - - - - - - 12-17
Probe safety
Electrical hazards - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-20

GB092107 05
Mechanical hazards - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-20
Biological hazards- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-21
Biopsy
Precaution concerning the use of biopsy procedures - - - - - - - - - - - - 12-23
Preparing the Biopsy guide attachment - Convex, Sector and Linear probes
12-24
Preparing the Biopsy guide attachment - endocavity probe - - - - - - - - 12-28
Displaying the Guide zone - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-29
Biopsy needle path verification- - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-29
Starting the biopsy procedure - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12-30
Cleaning, disinfection and disposal- - - - - - - - - - - - - - - - - - - - - - - - - 12-30
Chapter 13 — Peripherals
Introduction
DVR
DVR Overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13-3
Using the DVR - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13-4
Printing
To print an image - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13-7
Printer configuration - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13-7
Chapter 14 — Maintenance
System Care and Maintenance
Inspecting the system - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14-2
Cleaning the unit- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14-3
Cleaning the probes - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14-11
Prevention of static electricity interference- - - - - - - - - - - - - - - - - - - - 14-12
System self-test
System malfunction- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14-13
Software upgrade
Software download and installation- - - - - - - - - - - - - - - - - - - - - - - - - 14-15
Create an Insite permanent user - - - - - - - - - - - - - - - - - - - - - - - - - - 14-19
Save TCP/IP settings - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14-20
Chapter 15 — Safety
Introduction
Owner responsibility
Notice against user modification- - - - - - - - - - - - - - - - - - - - - - - - - - - - 15-3
Acoustic output
Definition of the acoustic output parameters - - - - - - - - - - - - - - - - - - - 15-4
Acoustic output and display on the Vivid E9 - - - - - - - - - - - - - - - - - - - 15-5
ALARA - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15-7
Safety statement- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15-7
System controls affecting acoustic output - - - - - - - - - - - - - - - - - - - - - 15-7
Important safety considerations
Patient safety - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15-10
Personnel and equipment safety - - - - - - - - - - - - - - - - - - - - - - - - - - 15-12
Electromagnetic Compatibility (EMC) - - - - - - - - - - - - - - - - - - - - - - - 15-16
Environmental protection - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15-22
System disposal - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15-22

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Device labels
For China only - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15-25
Chapter 16 — Appendix
Scan Assist Pro Creator
Overview - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16-2
Protocol export from Vivid E9 and off scanner installation of the Scan Assist
Pro Creator - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16-2
Starting Scan Assist Pro Creator - - - - - - - - - - - - - - - - - - - - - - - - - - - 16-4
File handling- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16-5
Creating new Protocols - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16-6
Saving Protocols- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16-7
Views - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16-8
Step attributes - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16-10
Index

GB092107 05
GB092107 05
Chapter 1
Introduction
The Vivid E9 ultrasound unit is a high performance

digital ultrasound imaging system with total data
management.
The system provides image generation in 4D, 2D (B)

Mode, Color Doppler, Power Doppler (Angio), M-Mode,
Color M-Mode, PW and CW Doppler spectral, Tissue
Velocity imaging, advanced Strain and Contrast
applications.
The fully digital architecture of the Vivid E9 unit allows

optimal usage of all scanning modes and probe types,
throughout the full spectrum of operating frequencies.
Vivid E9 – User Manual 1-1

GB092107 05
Introduction
Overview
Attention
Read and understand all instructions in the User's Manual
before attempting to use the ultrasound unit. Keep the manual
with the equipment at all time. Periodically review the
procedures for operation and safety precautions.
CAUTION For USA only:

United States law restricts this device to sale or use by, or on
the order of a physician.
Safety
All information in Chapter ‘Safety’ on page 15-1, should be
read and understood before operating the ultrasound unit.
Interference caution
CAUTION Use of devices that transmit radio waves near the unit could
cause it to malfunction.
Devices which intrinsically transmit radio waves such as cellular

phones, radio transceivers, mobile radio transmitters,
radio-controlled toys, and so on, should preferably not be
operated near the unit. See page 15-21 about the
recommended minimum separation distances between portable
and mobile RF communications equipment and the ultrasound
unit.
Medical staff in charge of the unit are required to instruct
technicians, patients, and other people who may be around the
unit, to fully comply with the above recommendations.
1-2 Vivid E9 – User Manual

GB092107 05
Overview
Indications for use

The ultrasound unit is intended for the following applications:
• Abdominal
• Fetal/Obstetrics
• Pediatric
• Small Organ
• Adult and Neonatal Cephalic
• Cardiac
• Peripheral Vascular
• Musculoskeletal
• Transesophageal
• Intraoperative
Contraindications
The ultrasound unit is not intended for ophthalmic use or any
use causing the acoustic beam to pass through the eye.
Manual contents
The User's Manual is organized to provide the information
needed to start scanning immediately.
CAUTION The safety instruction must be reviewed before operation of the

unit.
NOTE: Not all features or products described in this document may be

available or cleared for sale in all markets. Please contact your
local GE Healthcare Ultrasound representative to get the latest
information.
Finding information
Table of Contents, lists the main topics and their location.

Headers and Footers, give the chapter name and page
number.
Index, provides an alphabetical and contextual list of topics.

GB092107 05
Introduction
Conventions used in this manual

Buttons and other controls on the Touch panel or on the monitor
screen are indicated by bold type.
Program windows, screens and Dialogue boxes are indicated by
italic type.
The following icons, highlight safety issues as follow:
DANGER Indicates that a specific hazard exists that, given inappropriate

conditions or actions, will cause severe or fatal personal injury
with or without substantial property damage.
WARNING Indicates that a specific hazard exists that, given inappropriate

conditions or actions, can cause severe or fatal personal injury
with or without substantial property damage.
CAUTION Indicates that a potential hazard may exist that, given

inappropriate conditions or actions, can cause minor injury or
property damage.

GB092107 05
Contact Information
Contact Information
Contacting GE Healthcare Ultrasound

For additional information or assistance, please contact your
local distributor or the appropriate support resource listed on the
following pages:
INTERNET http://www.gehealthcare.com
http://www.gehealthcare.com/usen/ultrasound/products/
probe_care.html
Clinical Questions For information in the United States, Canada, Mexico and parts
of the Caribbean, call the Customer Answer Center.
TEL: (1) 800-682-5327 or (1) 262-524-5698
In other locations, contact your local Applications, Sales, or
Service Representative.
Service Questions For service in the United States, call GE CARES.
TEL: (1) 800-437-1171
In other locations, contact your local Service Representative.
Information To request technical product information in the United States,
Requests call GE Healthcare.
TEL: (1) 800-643-6439
Placing an Order To order accessories, supplies, or service parts in the United
States, call the GE Healthcare Technologies Contact Center.
TEL: (1) 800-558-5102

GB092107 05
Introduction
AMERICAS
ARGENTINA GE Healthcare TEL: 11-5298-2400

Nicolas Vedia 3616, piso 5
Buenos Aires
BRAZIL GE Healthcare Clinical Systems

Equipamentos Médicos Ltda TEL: 3067-8493
Av. Das Nações Unidas, 8501 FAX: (011) 3067-8280
3º andar parte - Pinheiros
São Paulo SP – CEP: 05425-070
C.N.P.J.: 02.022.569/0001-83
CANADA GE Healthcare TEL: (1) 800-668-0732

Ultrasound Service Engineering
9900 Innovation Drive
Wauwatosa, WI 53226
Customer Answer Center TEL: (1) 262-524-5698
LATIN & SOUTH GE Healthcare TEL: (1) 262-524-5300

AMERICA Ultrasound Service Engineering
Wauwatosa, WI 53226
Customer Answer Center TEL: (1) 262-524-5698
MEXICO GE Sistemas Medicos de Mexico S.A. de C.V.

Rio Lerma #302, 1º y 2º Pisos TEL: (5) 228-9600
Colonia Cuauhtemoc FAX: (5) 211-4631
06500-Mexico, D.F.
USA GE Healthcare TEL: (1) 800-437-1171

Ultrasound Service Engineering FAX: (1) 414-721-3865
Wauwatosa, WI 53226

GB092107 05
Contact Information
ASIA
ASIA PACIFIC GE Healthcare Asia Pacific

JAPAN 4-7-127, Asahigaoka
Hinoshi, Tokyo
191-8503, Japan
TEL: +81 42 585 5111
AUSTRALIA Building 4B, 21 South St

NEW ZEALAND Rydalmere NSW 2116
Australia
TEL: 1300 722 229
8 Tangihua Street
Auckland 1010
New Zealand
TEL: 0800 434 325
CHINA GE Healthcare - China TEL: (8610) 5806 8888

No. 1, Yongchang North Road FAX: (8610) 6787 1162
Beijing Economic & Technology Development Area
Beijing 100176, China
KOREA GE Healthcare Korea

8F, POBA Gangnam Tower, 343
Hakdong-ro, Gangnam-gu
Seoul, 135-820, Korea
TEL: +82 2 6201 6119
SINGAPORE 1 Maritime Square #13-012

HarbourFront Center
Singapore 099253
TEL: +65 6291 8528
TURKEY GE Healthcare Türkiye

Istanbul Office TEL: +90 212 398 07 00
Levent Ofis FAKS: +90 212 284 67 00
Esentepe Mah. Harman Sok.
No:8 Sisli-Istanbul
Ankara Office TEL: +90 312 289 77 00

Mustafa Kemal Mah. FAKS: +90 312 289 78 02
2158.Sok No:9
Çankaya-Ankara

GB092107 05
Introduction
EUROPE
AUSTRIA General Electric Austria GmbH TEL: (+43) 1 97272 0

Filiale GE Healthcare Technologies FAX: (+43) 1 97272 2222
EURO PLAZA, Gebäude EWienerbergstrasse 41A-1120 Vienna
BELGIUM & GE Healthcare BVBA TEL: (+32) 2 719 7204

LUXEMBURG Eagle Building FAX: (+32) 2 719 7205
Kouterveldstraat 20
1831 DIEGEM
CZECH REPUBLIC GE Medical systems CR s.r.o

Vyskocilova 1422/1a
140 28 Praha
DENMARK GE Medical Systems Ultrasound TEL: (+45) 43 295 400

Park Alle 295, 2605 Brøndby FAX: (+45) 43 295 399
ESTONIA & GE Healthcare Finland Oy TEL: (+358) 10 39 48 220

FINLAND Kuortaneenkatu 2, 000510 Helsinki FAX: (+358) 10 39 48 221
P.O.Box 330, 00031 GE Finland
FRANCE GE Medical Systems SCS

24 Avenue de l'Europe - CS20529
78457 Velizy Villacoublay Cedex
FAX: (+33) 13 44 95 202
TEL: (+33) 13 449 50 00
GERMANY GE Healthcare GmbH TEL: (+49) 212-28 02-0

Beethovenstrasse 239 FAX: (+49) 212-28 02 380
42655 Solingen
GREECE GE Healthcare TEL: (+30) 210 8930600

8-10 Sorou Str. Marousi FAX: (+30) 210 9625931
Athens 15125 Hellas
HUNGARY GE Hungary Zrt. Ultrasound TEL: (+36) 23 410 314

Division, Akron u. 2. FAX: (+36) 23 410 390
Budaors 2040 Hungary
NORTHERN GE Healthcare TEL: (+44) 28 90229900

IRELAND Victoria Business Park 9, Westbank Road, Belfast BT3 9JL.
REPUBLIC OF GE Healthcare TEL: (+353) 1 4605500

IRELAND 3050 Lake Drive, Citywest Business Campus
Dublin 24
ITALY GE Medical Systems Italia spa TEL: (+39) 02 2600 1111

GB092107 05
Contact Information
Via Galeno, 36, 20126 Milano FAX: (+39) 02 2600 1599
NETHERLANDS GE Healthcare TEL: (+31) 33 254 1290

De Wel 18 B, 3871 MV Hoevelaken FAX: (+31) 33 254 1292
PO Box 22, 3870 CA Hoevelaken
NORWAY GE Heathcare TEL: (+47) 23 18 50 50

Sandakerveien 100c, 0484 Oslo
GE Healthcare TEL: (+47) 33 02 11 16 Strandpromenaden 45,

P.O. Box 141, 3191 Horten
POLAND GE Medical Systems Polska TEL: (+48) 22 330 83 00

Sp. z o.o., ul. Woloska 9 FAX: (+48) 22 330 83 83
02-583 Warszawa, Poland
PORTUGAL General Electric Portuguesa SA TEL: (+351) 21 425 1300

SA. Avenida do Forte, n° 6-6A FAX: (+351) 21 425 1343
Edificio Ramazzotti, 2790-072 Carnaxide
RUSSIA GE Healthcare TEL: (+7) 4957 396931

12th floor, 10C, Presnenskaya nab.
Moscow 123317 Russia
TEL: (+7) 495 739 69 31
FAX: (+7) 495 739 69 32
SPAIN GE Healthcare España TEL: (+34) 91 663 2500

C/ Gobelas 35-37 FAX: (+34) 91 663 2501
28023 Madrid
SWEDEN GE Healthcare Sverige AB TEL: (+46) 8 559 50010

FE 314, SE-182 82 Stockholm, Sweden
SWITZERLAND GE Medical Systems (Schweiz) AG TEL: (+41) 1 809 92 92

Europastrasse 31, FAX: (+41) 1 809 92 22
8152 Glattbrugg
UNITED ARAB GE Healthcare Holding ME SA

EMIRATES (UAE) Dubai Internet City, Building No. 18
TEL: (+971) 4 429 6161
Fax (+971) 4 429 6200/01/02
P. O. Box # 11549, Dubai
U.A.E
UNITED KINGDOM GE Healthcare TEL: (+44) 1707 263570

71 Great North Road FAX: (+44) 1707 260065
Hatfield, Hertfordshire, AL9 5EN

GB092107 05
Introduction
For all other European countries not listed, please contact your
local GE Healthcare distributor or the appropriate support
resource listed on www.gehealthcare.com.
Manufacturer
GE VINGMED ULTRASOUND AS
Strandpromenaden 45
N-3191 Horten, Norway
Tel.: (+47) 3302 1100 Fax: (+47) 3302 1350

GB092107 05
Chapter 2
Getting started
This chapter describes:
‘Site requirements’ on page 2-3
‘Connecting the unit’ on page 2-4
‘Switching On/Off’ on page 2-6
‘Control panel adjustment’ on page 2-8
‘LCD monitor adjustment’ on page 2-9
‘Moving and transporting the unit’ on page 2-11
‘System overview’ on page 2-15
‘Starting an examination’ on page 2-23.

GB092107 05
Getting started
Introduction
Only qualified physicians or ultrasound sonographers should

perform scans of patients for medical diagnostic reasons.
Request training, if needed. Ensure that unauthorized personnel
do not tamper with the unit.
Service representatives authorized by GE Ultrasound will
unpack and install the unit. Do not attempt to install the unit
alone.
WARNING All the warnings in Chapter ‘Safety’ on page 15-1, should be

read and understood before operating the unit.
Never set liquids on the unit in order to avoid spillage into the
unit or the control panel. Maintain a clean environment. Turn off
the circuit breaker before cleaning the unit. Refer to ‘System
Care and Maintenance’ on page 14-2 for cleaning instructions.
To carry out regular preventative maintenance refer to Chapter
‘System Care and Maintenance’ on page 14-2.

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The ultrasound unit must operate within the proper environment

and in accordance with the requirements described in this
section. Before using the system, ensure that the requirements
are met.
Site requirements
Optimal operation of the unit can be obtained by implementing
the following requirements:
Power requirements
The ultrasound unit uses a separate power outlet for 100–

230 VAC, 50/60 Hz.
Operating Environment
Ensure that there is sufficient air flow around the ultrasound unit
when installed in a fixed location.
Environmental requirements
The ultrasound unit requires constant maintenance of its

operational environment. Different temperature and humidity
requirements are specified for operation, storage and
transportation.
Requirement Temperature Humidity Air Pressure
Operational 10–35 ºC 30–85% 700–1060 hPa
Storage -20–60 ºC 30–95% 700–1060 hPa
Transport -20–60 ºC 30–95% 700–1060 hPa

GB092107 05
Getting started
Electromagnetic interferences
The ultrasound unit is approved for use in hospitals, clinics and

other environmentally qualified facilities, in terms of the
prevention of radio wave interference. Operation of the unit in an
inappropriate environment can cause electronic interference to
radios and television sets situated near the medical equipment.
Ensure that the unit is protected from electromagnetic
interferences as follows:
• Operate the unit at least 4.5 meters (15 feet) away from
equipment that emits strong electromagnetic radiation.
• Shield the unit when operating it in the vicinity of radio
broadcasting equipment, if necessary.
Connecting the unit

A GE-qualified person should perform the initial system
installation.
Connecting the ultrasound unit involves preliminary checks of
the power cord, voltage level and compliance with electrical
safety requirements.
Use only power supply cords, cables and plugs provided by or
designated by GE Medical Systems.
Ensure that the power cord and plug are intact and that the
power plug is the proper hospital-grade type (where required).
The unit should be connected to a fixed power socket which has
the protective grounding connector. Never use an extension
cord or adapter plug.
WARNING Failure to provide an adequate earth circuit can cause electrical

shock, resulting in serious injury.

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WARNING Connection of additional protective earth conductors or

potential equalization conductors is not necessary in most
cases and is only recommended for situations involving
multiple equipment in a high-risk patient environment to
provide assurance that all equipment is at the same potential
and operates within acceptable leakage current limits. An
example of a high-risk patient would be a special procedure
where the patient has an accessible conductive path to the
heart such as exposed cardiac pacing leads
Voltage level check
Check the rating label on the rear side of the system (see
Figure 2-1).
Figure 2-1. The rating label
Check the voltage range indicated on the label:

• 100–230 VAC, 50/60 Hz, 1100 W
At 110 V: 10.0 A
At 115 V: 9.6 A
At 230 V: 4.8 A

GB092107 05
Getting started
Connecting to the electrical outlet
WARNING POWER OUTAGE MAY OCCUR. The ultrasound unit requires

a dedicated single branch circuit. To avoid circuit overload and
possible loss of critical care equipment, make sure you DO
NOT have other equipment operating on the same circuit.
The unit’s power must be supplied from a separate, properly
rated outlet to avoid risk of fire. Refer to ‘Power requirements’
on page 2-3 for rating information.
The power cord should not, under any circumstances, be
altered to a configuration rated less than that specified for the
current.
Do not use an extension cord or adapter plug.
1. Ensure that the wall outlet is of appropriate type, and that

the power switch is turned off.
2. Uncoil the power cable, allowing sufficient slack so that the
unit can be moved slightly.
3. Attach the power plug to the system and secure it in place
by using the retaining clamp.
4. Secure the power plug in the wall outlet.
Switching On/Off
To switch on the unit
1. Switch on the circuit breaker on the rear of the unit (see

Figure 2-2).
2. Press the on/off button on the top left of the control panel
(see Figure 2-2).
After initialization the default scanning screen is displayed.

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Figure 2-2. The Circuit breaker and On/Off button
To switch off the unit
When the ultrasound unit is switched off, the system performs

an automatic shutdown sequence. It is recommended to perform
a full shutdown at least once a week.
Shutdown
1. Press the on/off button on the top left of the control panel.
The Exit dialogue window is displayed.
Figure 2-3. The Exit dialogue window
NOTE: In case of total lockup of the system, hold the on/off button
down a few seconds to turn the system off.

GB092107 05
Getting started
2. Select Shutdown.
The shutdown process takes a few seconds and is
completed when the color of the on/off button changes from
green to amber.
NOTE: After switching off the system, wait at least ten seconds before
turning it on again.
To switch off before moving the unit, follow the additional steps
below:
1. Wait until the on/off button has turned amber and set the
circuit breaker to OFF.
2. Remove the plug from the mains power socket.
3. Secure the unit power cable around the cable storage hooks
on the rear of the unit.
Control panel adjustment

The system Control panel can be freely moved in all directions.
The vertical displacement of the Control panel is motor driven.
The control buttons are situated around the handles
(Figure 2-4).
CAUTION To avoid injury or damage, make sure nothing is within the

range of motion before moving the Control panel. This includes
both objects and people.
Ensure that the hands of the patient are away from the Control
panel arm when moving the Control panel.
1. Lock and brake release button: unlock and move the Control panel
2. Up/Down button: move the Control panel up or down
Figure 2-4. Control panel adjustment controls

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To raise/lower the Control panel
1. Press and hold down the Up/Down button (Figure 2-4,

button 2) accordingly to raise or lower the Control panel.
2. Release the button when the Control panel is at the desired
height.
To unlock/lock the Control panel
To unlock the Control panel

1. Press and hold down the Lock and brake release button(s)
(Figure 2-4, button 1) and pull the Control panel out of the
locked position until the Control panel is in the desired
position.
2. Release the button(s).
To lock the Control panel

1. Press and hold down the Lock and brake release button(s)
(Figure 2-4, button 1) while pushing the Control panel in the
locked position.
2. Release the button(s).
To move the Control panel
1. The unlocked Control panel can be easily moved by

pressing and holding down the Lock and brake release
button(s) (Figure 2-4, button 1) and move the Control panel
in any direction.
2. Release the button when the Control panel is at the desired
position.
LCD monitor adjustment

The LCD monitor can be swiveled and tilted.
CAUTION To avoid injury or damage, make sure nothing is within the

range of motion before moving the monitor and monitor arm.
This includes both objects and people.

GB092107 05
Getting started
To unlock/lock the LCD monitor
To unlock the LCD monitor

1. Turn the release knob counter clockwise to unlock the LCD
monitor (Figure 2-5-B).
The LCD monitor can be moved freely in all directions.
To lock the LCD monitor

1. Turn the release knob clockwise to raise the lock and move
the LCD monitor into the parked position (Figure 2-5-A).
A B
1. Unlocked LCD monitor

2. Locked LCD monitor
Figure 2-5. LCD monitor locking mechanism
To tilt the monitor

1. Grab the upper side of the LCD monitor and tilt the monitor
to the desired angle.
Connecting and disconnecting probes

See ‘Probe Integration’ on page 12-12.

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Wheels
The wheels of the unit are controlled by the pedals situated
between the front wheels of the unit (see Figure 2-6).
Examine the wheels frequently for defects to avoid breaking or
jamming.
Wheel Characteristics
Front Swivel, swivel lock and brake
Rear Swivel and brake
1. Swivel lock pedal

2. Brake
3. Release front wheel brake or swivel lock
4. Front wheels
5. Rear wheel brakes
6. Rear wheels
Figure 2-6. Wheels
1. Press the right pedal to engage the front wheel brakes.

GB092107 05
Getting started
2. Press the center pedal to release the front wheel

brakes.
3. Press the left pedal to engage the Swivel lock.
4. Press the center pedal to release the Swivel lock.
CAUTION Use the additional brakes on the rear wheels during transport
or if parking the system on an incline. Avoid ramp steeper than
10 degrees.
Moving the unit
To prepare the unit to be moved
1. If not locked, move the keyboard Control panel and LCD

monitor to the park position (see ‘Control panel adjustment’
on page 2-8 and ‘LCD monitor adjustment’ on page 2-9).
2. Turn the system off, including the circuit breaker (see
‘Switching On/Off’ on page 2-6), and remove the plug from
the wall.
3. Disconnect all cables linking the unit to any off-board
peripheral devices and network.
4. Secure the unit’s power cable.
5. Place all probes in the probe holder. Ensure that the probe
cables do not protrude from the unit or interfere with the
wheels.
6. Ensure that no loose items are left on the unit
7. Fold down the monitor.
8. Unlock the brake.
To ensure safety while moving the unit
1. Ensure that the Control panel and LCD monitor are in locked
position (see ‘Control panel adjustment’ on page 2-8 and
‘LCD monitor adjustment’ on page 2-9). Flip down the LCD
monitor so that the display is face down.
WARNING Do not move the unit if the Control panel and LCD Monitor
are in free position.

GB092107 05
2. Proceed cautiously when crossing door or elevator

thresholds. Grasp the front handle grips or the back handle
bar and push or pull. Do not attempt to move the unit using
cables or probe connectors. Take extra care while moving
the unit on inclines.
3. Ensure that the unit does not strike the walls or door frames.
4. Ensure that the pathway is clear.
5. Move the unit slowly and carefully.
CAUTION Avoid ramps that are steeper than 10 degrees.
6. Use two or more persons to move the unit over long

distances or on inclines.
Transporting the unit

Take extra care when transporting the unit by vehicle. In addition
to the moving precautions listed on ‘Moving the unit’ on
page 2-12, follow the procedure described below.
1. If not locked, move the Control panel and LCD monitor to
the park position (see ‘Control panel adjustment’ on
page 2-8 and ‘LCD monitor adjustment’ on page 2-9).
WARNING Do not move/lift the unit if the Control panel and LCD monitor
are in free (unlocked) position.
2. Disconnect all probes and secure them in their boxes.

3. Ensure that the transporting vehicle is appropriate for the
unit’s weight. The recommended load capacity is a minimum
of 128 kg (283 lbs).
4. Park the vehicle on a level surface for loading and
unloading.
5. Secure the unit while it is on the lift, to prevent rolling. Do not
attempt to hold it in place by hand. Cushion the unit and
strap the lower part so that it does not break loose.
6. Ensure that the unit is secured inside the vehicle. Secure it
with straps to prevent movement while in transit.
7. Drive cautiously to prevent vibration damage.

GB092107 05
Getting started
Reinstalling at a new location

1. When the unit is in place at a new location, lock the wheel
brakes.
2. Follow the installation procedure described in ‘Connecting
the unit’ on page 2-4.
Unit acclimation time
Following transport the unit may be very cold or hot. Allow the
unit to acclimate before being switched on. Acclimation will take
one hour for each 2.5 oC increment when the unit’s temperature
is below 10 oC or above 40 oC.
oC 0 2.5 5 7.5 10 35 40 42.5
o
F 32 36.5 41 45.5 50 95 104 108.5
Hours 4 3 2 1 0 0 2 3
oC 45 47.5 50 52.5 55 57.5 60
o
F 113 117.5 122 126.5 131 135.5 140
Hours 4 5 6 7 8 9 10

GB092107 05
System description
System description
System overview
1. Display monitor 9. Wheel controls

2. Speakers 10. Probe ports
3. Touch panel 11. CD/DVD drive
4. USB ports 12. DVR, Digital Video Recorder
5. Alphanumeric Keyboard (see page 2-18) 13. Control panel
6. Video printer 14. Probe and gel holder
7. USB port and Doppler probe connector
8. Patient I/O connection panel
Figure 2-7. Vivid E9 (front)

GB092107 05
Getting started
1. Air intake 5. Power cable hooks

2. Identification label 6. External I/O panel
3. Air filter 7. Power cable socket, circuit breaker and rating
4. Serial number label
Figure 2-8. Vivid E9 (rear)
Additional gel cup
An additional soft insert gel cup is provided. The soft insert gel
cup can be mounted in one of the rear probe holders by
replacing the soft probe holder insert in place.
Figure 2-9. Mounting the additional gel cup

GB092107 05
System description
Control panel
1. On/Off button (see page 2-6) 9. Print, secondary capture

2. Patient selection, Probe selection, Protocol 10. Freeze, 2D Freeze
based acquisition, Worksheet and Image review 11. Measurement, image store
3. Active mode gain 12. Auto, cursor and angle
4. 2D Gain 13. Trackball (see page 3-2)
5. Scan mode selection 14. TGC sliders
6. Zoom 15. Loudspeaker volume control
7. Depth 16. Touch panel with adjustment rotaries (see
8. Display controls, Annotation page 3-3)
17. USB port
Figure 2-10. The control panel

GB092107 05
Getting started
Key illumination
The keys on the control panel are illuminated according to their
availability:
• Illumination in green: the key function is currently active.
• Illumination in yellow: the key function is available (but not
active) in the current state of the scanner.
• No illumination: The key is not available in the current state
of the scanner.
The alphanumeric keyboard

The alphanumeric keyboard is situated on a drawer under the
control panel.
Key Description
F1 Displays the on-line version of the user manual. Also available from Utility/
Help on the Touch panel.
F2 Displays the configuration dialog box, allowing user configuration of various

settings on the scanner. Some settings are configured for each application,
press Appl. to access to application-specific settings. Also available from
Utility/Config on the Touch panel.
F4 Displays the DICOM spooler window. The DICOM spooler is used for checking
the current job’s status when a job is saved or when the total spooler status on
the right of the Archive windows displays an error. Also available from Utility/
Spooler on the Touch panel.

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System description
Peripheral/accessory connector panel
The Peripheral/accessory connector panel is situated on the

rear side of the unit behind the rear door (see Figure 2-11).
Figure 2-11. Peripheral/accessory connector panel
WARNING Accessory equipment connected to the analogue and digital

interfaces must be certified according to the respective IEC
standards (e.g. IEC 60950 for data processing equipment and
IEC 60601-1 for medical equipment). Any person connecting
additional equipment to the signal input part or output part is
configuring the medical system, and is therefore responsible
that the system complies with the requirements of the system
standard IEC 60601-1-1. If in doubt, consult the technical
service department or your local representative.
Do not touch the conducting parts of the USB or Ethernet
cables when connecting equipment to the unit.
WARNING Any devices or cables, other than those sold with the
ultrasound unit, connected to the Peripheral /accessory
connector panel or to an USB port on the unit may result in an
increase of the electromagnetic emission from the unit, or a
decrease of the electromagnetic immunity of the unit.

GB092107 05
Getting started
Socket Signal type Device type Note
Audio Out Audio VCR Audio amplifier Line level 1 Vp-p

R = Right
L = Left
USB Universal serial bus Printer
DVI Digital signals only Digital monitor This is a DVI-I connector, but
there is no analog signal
transmission. Only digital
monitors can be connected.
Ethernet 1000 Base-TX Network device

Ethernet IEEE 802.3
Wired Footswitch (Option)
You can attach this Footswitch to the system by connecting it to

one of the USB port on the rear of the system.
CAUTION To avoid damage of the cable, keep the cable away from the
wheels. Disconnect the Footswitch before moving the system.

GB092107 05
System description
Figure 2-12. Footswitch and USB Cable
This is a 3-pedal Footswitch. You can configure its functionality

from the Config/Imaging/Application (see page 4-46).
CAUTION When using the Footswitch, DO NOT hold down the footswitch
pedal. Press and release the Footswitch pedal. Pushing and
holding down the pedal behaves the same way as pushing and
holding down a key on the keyboard.

GB092107 05
Getting started
The Scanning screen
1. Title bar 5. Probe orientation marker

- Current patient data 6. Measurement
- Institution 7. Scanplane indicator (TEE probe)
- Date & time 8. Greyscale/Color bar
- Operator ID 9. Parameter window
- Probe 10. Clipboard
- Application 11. Prompt/Status information
- Mechanical & Thermal Index 12. Trackball assignment
2. Measurement result table 13. - Caps lock on/off
3. Focal zone and depth scale - Access to service platform
4. Physiological traces, ECG, Phono, Resp - Network status
- CD status
14. Frame counter and timer
Figure 2-13. The scanning screen (composite)

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Creating a new patient record

1. Press Patient on the Control panel.
If required, log on by typing the user ID and password.
The Search/Create patient window is displayed (Figure 2-14
on page 2-25).
2. In the Search/Create patient window select the desired
dataflow.
3. Type the patient Last Name, and/or ID.
NOTE: The unit can be configured to automatically generate a
patient ID (see page 10-68).
When default configured, the system automatically
searches to see if the patient is already in the archive. The
result of this search is displayed in the Patient list field.
4. To create a new patient record, press Create patient.
The unit is ready for scanning or the Patient information
window is displayed (Figure 2-15 on page 2-26) depending
on system configuration (see page 10-68).
If the unit is configured to display the Patient information
window, follow the steps below:
1. Enter additional patient information if required.
Select between Cardiac, Obstetric, Gynecology... etc. to
enter application specific patient info (Displayed when the
button More is depressed, see Figure 2-15 on page 2-26.).
2. Press Patient or any active scanning key to start the
examination.
Selecting an existing patient record

The Search/Create patient window is displayed (Figure 2-14
on page 2-25).
dataflow.

GB092107 05
Getting started
3. Type the patient Last Name, and/or ID or another query that

identifies a patient.
NOTE: The unit can be configured to automatically generate a
patient ID (see page 10-68).
4. Highlight a patient record in the Patient list filed.
NOTE: You can select [+] in front of the actual patient record to
display the examinations belonging to the patient record.
5. Press Open Exam.
The Examination List window for the actual patient is
displayed.
6. To start a new examination, press Add Exam.
Ending an examination
2. Press End Exam on the Touch panel.
If the images on the clipboard were not previously stored a
prompt window is displayed where the user can choose to
store all, none or a selection of the images saved to the
clipboard.
3. Select:
• All: to store all images and end the exam
• None: to end the exam without storing any images
• Select: to select the images to store from the Review
screen and end the exam.

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1. Select archive and other pre-defined services. 4. Press one of the headings to sort the list
2. Change user. accordingly (ascending/descending).
3. Advanced search filters, the system can be 5. Expended Patient record displaying belonging
configured to display the advanced search examinations
filters as default (see ‘Patient management
presets’ on page 10-69).
The Search/Create patient window may be slightly different depending on the Dataflow selected
Figure 2-14. The Search/Create Patient window

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Getting started
1. The date format is configurable (see 3. The Address field is configurable (see
page 3-30). page 10-68).
2. The window can be configured to display the 4. Select patient information category.
expanded patient info as default (see
page 10-68).
Figure 2-15. The Patient information window (cardiac)

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Chapter 3
Basic operations
‘Trackball area’ on page 3-2
‘Touch panel’ on page 3-3
‘Removable media’ on page 3-5
‘Physiological traces’ on page 3-12
‘Cineloop’ on page 3-18
‘Zoom’ on page 3-20
‘Annotations’ on page 3-21
‘Configuration – System and presets’ on page 3-28.

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Basic operations
Trackball area
Different functions can be assigned to the trackball.

The trackball functions are organized in functional groups which
are displayed in the lower right corner of the screen. The
Trackball key (Figure 3-1, [3]) is used to toggle between the
functional groups.
Each functional group can have one or more functions. The
Select key (Figure 3-1, [2]) is used to toggle between the
functions within the active group.
1. Trackball
• Adjusts the selected control
• Moves the pointer
2. Select keys:
• Toggles between the functions within the active group. Groups with several functions are marked with
a + symbol.
• Performs the selected control or highlighted menu item
3. Trackball key: toggles between trackball functional groups.
4. Update/Menu key:
• In Freeze: displays a pop-up System menu.
• In Live duplex mode (Doppler or M-mode): toggles Live/Freeze between the 2D image and the
spectrum image.
5. Upper key: configurable as either a select key, a pointer, an Image store button or an Image cursor (see
page 4-45).
Figure 3-1. The Trackball area

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Touch panel
Touch panel
The Touch panel enables the access of modality driven controls.

The mode/function controls are organized in tabbed folders.
Several pages may be accessed within each folder.
At the bottom of the Touch panel, there are five rotary/push
buttons. The functionality of these buttons changes, based on
the active mode/function.
1. Select a folder. The yellow dot on the tab indicates the active mode.
2. Each folder may have multiple pages.
3. Rotary/Push buttons with mode/function specific controls.
• : rotate the button to adjust the active control
• : press the button to apply the active control
Note: If two controls are adjusted by rotating the same button, press the button to toggle between the two
controls.
Figure 3-2. Touch panel
There are different types of control buttons.

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Basic operations
Button Function
Push button: toggles the control between on and off states.

• Light blue = Off
• Dark blue = On
Off
On
Opens a menu on screen. The selection in the menu is done using

the trackball and the Select Key. The current selection from the
menu is displayed inside the button.
Control with variable adjustment
Dual button: combines two controls that exclude each other mutually
(e.g. toggling between Dual and Quad screen display)
Toggle button: toggles a control between two or three different states

(e.g. switch between Lower/Upper/Mid annotation texts.)

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Removable media
Removable media
Intended use
Removable media can be used for the following purposes:
• Long-term image storage: the final destination of the
images, after they are moved out of the system harddisk by
using the Disk Management feature (see page 10-53).
• Backup of patient database and system configuration
presets (see page 10-61)
• Patient archive sneaker-net: copy a set of patient records
between a scanner and EchoPAC Software Only using the
Import/Export feature (see page 10-44) with a removable
media.
• DICOM export to copy a set of patient records to a third
party DICOM review station.
• MPEGVue export: review exported images on a Windows
computer (see page 10-10).
• Excel export: exports demographics, measurements and
reporting data from the unit to a third party reporting
application using a removable media (see page 10-44).
• Copy of system configuration presets between to units using
the Backup/Restore feature (see page 10-61).
• Save images as JPEG, MPEG, AVI, DICOM or RawDICOM
for review on a regular computer.
Supported removable media

The following removable media are supported:
• CD-R
• DVD-R
• USB Flash card
• USB external desktop hard drive (Iomega Ultramax or
ICY BOX USB desktop hard drive) (Option)

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Basic operations
CAUTION USB Flash card:

• Use only shielded USB Flash cards that are verified for
EMC performance according to EN55011/EN55022. The
use of other USB Flash cards may cause interference on
the system itself or on other electronic devices.
Media/Purposes compatibility
USB Flash
USB HD CD-R DVD-R card
Long-term image storage +1 + +
Backup of patient database and + + + +

system configuration presets
Patient archive sneaker-net + + + +
DICOM export + + + +
MPEGVue export + + + +
Excel export + + + +
System configuration presets + + + +
Save images as JPEG, MPEG or + + + +

AVI
1
Recommended media
About removable media and long-term image storage

We recommend to run the Disk management feature with USB
desktop hard drive for long-term image storage, because of the
longevity and reliability of this media. It is not recommended to
use CD or DVD for long-term storage, because of weaker
performance in general when it comes to longevity and
reliability. However, Disk management does not prevent the use
of CD/DVD for long-term image storage. If CD/DVD is used it is
recommended to use Archival Grade or Medical Grade CD/
DVD.
No matter which media is used, it is always highly
recommended to take a backup of the media, which is the
responsibility of the customer. The unit does not offer
functionality for taking backup of images saved on long-term
storage media.

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Removable media
USB desktop hard drive

NOTE: Only connect one USB desktop hard drive to the Vivid E9 at a
time.
CAUTION If connected to Vivid E9, the USB desktop hard drive must not
be placed inside the patient environment (refer to local
regulation and IEC60601-1-1 (2000)).
1. Patient environment
Figure 3-3. Patient environment
CAUTION To avoid leakage current above safety limits as prescribed by

IEC 60601-1 and to ensure continuity of protective earth, do
not connect Vivid E9 and mains operated accessories to a
common multi-socket extension cord.
To avoid circuit overload and possible power outage, the USB
desktop hard drive’s power must be supplied from a different
circuit than the one used for the Vivid E9.
Iomega Ultramax desktop hard drive (option)
The Iomega Ultramax desktop hard drive is an external desktop

hard drive that can be connected to Vivid E9 via USB. It is
configured as RAID 1, so the content is mirrored on two hard
disk drives.
Iomega Ultramax unit connection

1. Connect the Iomega Ultramax unit to Vivid E9 using the
USB cable provided with the unit. The USB cable must be
connected to the combined USB/eSATA (Duolink) socket at
the rear of the Iomega Ultramax unit (Figure 3-4).

GB092107 05
Basic operations
NOTE: Do not use any of the other USB sockets (USB hub) at the
rear of the Iomega Ultramax unit.
2. Connect the cable from the power supply to the DC IN
connector on the rear of the Iomega Ultramax unit
(Figure 3-4).
Connect the power cord from the power supply to the mains
AC outlet.
1. USB/eSATA (Duolink) connector

2. DC IN Power connector
3. On/Off switch
Figure 3-4. Iomega Ultramax unit, rear view
ICY BOX desktop hard drive (option)
The ICY BOX desktop hard drive is an external desktop hard

drive that can be connected to Vivid E9 via USB. It is configured
as RAID 1, so the content is mirrored on two hard disk drives.
ICY BOX unit connection

1. Verify that the volume configuration is set to RAID 1 as
shown below.

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Removable media
Mode Switch 1 Switch 2
JBOD OFF OFF
RAID 0 ON OFF
RAID 1 OFF ON
Note: if changing the RAID mode, push the button over the switches to
confirm the new setting.
Figure 3-5. RAID 1 setup (rear side)
2. Connect the ICY BOX unit to Vivid E9 using the USB cable
provided with the unit. The USB cable must be connected to
the USB 3.0 socket at the rear of the ICY BOX unit
(Figure 3-6).
3. Connect the cable from the power supply to the DC
connector on the rear of the ICY BOX unit (Figure 3-6).
Connect the power cord from the power supply to the mains
AC outlet.
Figure 3-6. ICY BOX unit, rear view

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Basic operations
Recommendation concerning CD and DVD handling

To avoid data loss, never touch the recordable surface of a disk.
Handle the disk only by the outer edge. Do not place it face
down on a hard surface. Fingerprints or scratches will make the
disk unusable. Before usage, verify that the disk surface has no
visible scratches. If there are any scratches, do NOT use the
disk.
Formatting removable media

CD-R and DVD-R have to be formatted.
CAUTION The formatting process will erase any data present on the disk.
To format a removable media:

1. Insert the media in the drive.
2. Press Utility/Config on the Touch panel.
3. If required, log on to the system.
The Configuration package is opened.
4. Select the category Connectivity and select the sheet
Tools (Figure 3-7).
Figure 3-7. The Tools sheet

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Removable media
5. Select the removable media from the Media drop-down

menu.
6. Enter a name for the removable media in the Label field.
NOTE: Only the following characters and signs can be used when
labelling a media: A - Z, a - z, 0 - 9, “_” and “-”. Do not use
more than 11 characters or signs. Do not use space.
7. Select Format.
A confirmation window is displayed.
8. Select OK to continue.
9. Wait for the display of the Information window indicating that
the formatting process is completed.
10. Select OK.
11. Eject the media as described below.
NOTE: Removable media used during Disk space management,
Backup, Export or Save as do not need to be formatted in
advance as the formatting process is part of these procedures if
required.
Ejecting removable media

1. Press Utility/Eject.
NOTE: Do not eject CD/DVD using the button on the CD/DVD drive.
The Eject device menu is displayed (Figure 3-8).
Figure 3-8. The Eject device menu
2. Select the relevant media.

The selected media is ejected.

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Basic operations
The physiological module consists of three channels: ECG/

Respiration, Phono, AUX. The channel AUX is capable of
handling a pulse/pressure signal. The scanned image that is
displayed is synchronized with the ECG, respiration and phono
traces. In M-Mode or Doppler, the traces are synchronized to
that particular mode's sweep.
CAUTION Use only GE Healthcare accessories

Conductive parts of electrodes and associated connectors for
applied parts, including neutral electrodes should not contact
other conductive parts, including earth.
Simultaneous use of two or more applied parts will cause
summation of patient leakage currents.
CAUTION The heart-rate may be adversely affected by the operation of

cardiac pacemaker pulses or by cardiac arrhythmias.
1. Phono
2. ECG
3. AUX (Pressure/Pulse)
Figure 3-9. The patient (I/O) connection panel

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Pinout on AUX connectors

The pinout for the AUX connector is described in the table
below:
AUX
1. pin 1: input -
2. pin 2: input +
3. pin 3: gnd
4. pin 4: nasal sensor 1
5. pin 5: nasal sensor 2
AUX
(Pressure/Pulse)
AUX is default a 1 Vpp (Volt peak-peak) input with a max

frequency of 300 Hz. The inputs are differential. For a single
ended sensor signal, the pin 1 (input -) should be connected to
the gnd of the sensor.
AUX has a programmable high gain mode with a maximum input
signal of 300 mVpp (millivolt peak-peak).
ECG/Respiration
The ECG cable is a modular cable consisting of two different
cables parts:
• The Trunk: a single cable connecting to the system at one
end, and providing a cable splitter device at the other end
(see Figure 3-10).
• The triple color-coded electrode cable: to be inserted in
the splitter device. Each electrode cable hooks up to the
appropriate stick-on electrode by a color-coded clip type
connector.
The color-coding of the electrodes follows one of two standards
that are common in different parts of the world. The cable splitter
device has a drawing defining the color codes, names and body
location for the two standard color codes (see Figure 3-10).

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Basic operations
AHA (USA) IEC (Europe, Asia, ROW)
1. RA: White 1. R: Red

2. LA: Black 2. L: Yellow
3. LL: Red 3. F: Green
Figure 3-10. The cable splitter device with electrode placement conventions
To connect the internal ECG
1. Connect the ECG trunk cable into the rectangular-shaped

socket marked ECG on the patient trace (I/O) panel. The
patient trace (I/O) panel is located in the front left of the
ultrasound unit (see Figure 3-9).
2. Hook up the electrode cables to the electrodes, following the
appropriate convention (see Figure 3-10).
Phono
1. Microphone
2. Phono adapter (color code: blue)
3. Phono socket on the ultrasound unit
Figure 3-11. The phono device

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To connect the Phono
1. Plug the phono connector to the phono adapter and plug the
adapter connector to into the socket marked Phono on
Patient (I/O) panel.
Connecting the Pulse pressure transducer
1. Pulse transducer
2. Pulse pressure adapter (color code: yellow)
3. Pulse pressure socket on the ultrasound unit
Figure 3-12. The Pulse pressure transducer
To connect the pulse pressure transducer
1. Plug the pulse pressure connector to the pulse pressure

adapter and plug the adapter connector into the socket
marked AUX Pressure/Pulse on Patient (I/O) panel.
Using Physios
Display ECG trace
Figure 3-13. ECG controls

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Basic operations
1. The ECG is turned on by default in all cardiac applications.

For all other applications, press the tab Physio on the Touch
panel. and press ECG (Figure 3-13).
2. The following controls can be adjusted:
• Horiz. Sweep: adjusts the sweep speed stepwise (1, 2,
3, 4, 6, 8, 12 and 16 sec., 4 sec. is default).
• Gain: adjusts the trace amplitude.
• Position: moves the trace vertically.
• ECG Lead: selects the desired lead:
- Lead 1: RA (-) to LA (+) (right left or lateral)
- Lead 2: RA (-) to LL (+) (superior inferior)
- Lead 3: LA (-) to LL (+) (superior inferior)
ECG Trigging
1. Press ECG Trig.
2. Adjust Trig 1 to position the first trig on the ECG (delay in
ms from R-wave to triggered frame).
3. Adjust ECG Trig Interval (number of cardiac cycles
between triggered images).
4. Press Dual Trig if dual triggering is desired.
5. Adjust Dual Trig delay (delay in ms from the first triggered
frame to the second triggered frame).
Display Phono trace
Figure 3-14. Phono controls
1. Press the tab Physio on the Touch panel. Select Page 2

and press Phono (Figure 3-14).
2. The following controls can be adjusted:
• Horiz. Sweep: adjusts the sweep speed.
• Gain: adjusts the trace amplitude.
• Position: moves the trace vertically.

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Basic operations
Cineloop
When the scan mode is frozen, the unit automatically displays

cineloop boundary markers on either side of the last detected
heart cycles. The cineloop boundaries can be adjusted using the
cineloop controls on the Touch panel to cover one or more heart
cycles.
Cineloop overview
1. Left marker (cineloop start) 3. Right marker (cineloop end)

2. Current frame 4. Cine speed
Figure 3-15. Cineloop display
Using cineloop
Selection of a cineloop
1. Press Freeze.
The left and right markers are displayed on either side of the
last detected heart cycle on the ECG trace.
2. Press 2D Freeze.
The selected heart beat is played back.
3. Press 2D Freeze to freeze the cineloop.

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Cineloop
4. Use the trackball to scroll through the acquisition and find

the sequence of interest.
5. Adjust Cycle select to move from heart beat to heart beat
and select the heart cycle of interest.
6. Adjust Num cycles to increase or decrease the number of
heart beats to be played back.
7. In Freeze, press Set left or Set right to set the
corresponding cineloop boundary to the current frame.
8. Adjust Left marker and Right marker to trim or expand the
cineloop boundaries.
9. Press Img. Store to store the cineloop (see ‘Storing a
cineloop’ on page 10-7) or Freeze to return to live scanning.
NOTE: Cineloop storage can be configured to store heart cycles
with additional time before and after the R-wave and to
display a preview before storage (see ‘Global imaging
settings’ on page 4-45).
Adjustment of cineloop playback

1. Use the trackball or adjust Speed to increase or decrease
the speed of the cineloop playback.
The speed factor (%) is displayed on the right side of the
ECG.
To view a cineloop frame by frame

1. In freeze, use the trackball or adjust Frame to scroll through
the cineloop frame by frame.
To synchronize playback of several cineloops

1. Press Sync to phase synchronize playback of several
cineloops running on the screen.
Storage of a cineloop
See ‘Storing a cineloop’ on page 10-7.

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Basic operations
Zoom
The unit supports two types of zoom:

• Display zoom: magnifies the image display of a selected
area.
• High resolution (HR) zoom: concentrates the image
processing to a selected area of the image, resulting in an
improved image quality and a higher frame rate in the
chosen ROI.
Display zoom
1. Rotate the Zoom knob clockwise.
The resulting magnified image appears in the acquisition
window. An un-magnified image is displayed in the right
corner showing the outlined zoomed region.
2. Use the trackball to position the zoom area over the desired
portion of the image.
3. To turn off the Display zoom, rotate the Zoom knob counter
clockwise.
HR zoom
1. Press the Zoom knob.
2. Use the trackball to position the zoom area over the desired
portion of the image.
3. Increase size as desired by turning the Zoom knob
clockwise.
4. Press Zoom one more time to turn off the HR zoom.

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Annotations
Annotations
Text annotations may be inserted anywhere on the image area.

The annotation can be free text or a pre-defined text from an
application-specific annotation library displayed on the Touch
panel.
Annotations can be done on two separate layers to enable
selective display of annotations.
CAUTION Annotations (text, arrow or bodymark) are created on separate

layers. When viewing annotated images on a different system
or when zooming the image, the position of the annotations on
the image may be slightly changed.
To insert an annotation
Free text
1. Type the required text using the alphanumeric keyboard.

To change/add line press Enter.
2. Trackball the text entered to the insertion position.
3. Press Select to add the annotation.
Pre-defined text
1. Press Text on the Control panel.

The Text folder with annotations specific to the current
application is displayed on the Touch panel.
NOTE: To select annotations from another application, press
Library and select the desired application library.
2. On the Touch panel, press the pre-defined text to insert.
The word is displayed on the screen.
NOTE: Some buttons toggle between two or three related
annotation texts (i.e pressing the annotation Left will insert
the text “Left” and toggle the button to the annotation Right).

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Basic operations
Annotation buttons with toggle functionality are marked with

a circular arrow.
3. Position the text on the screen with the trackball.
4. Press Select to add the annotation.
1. Selects application specific library

2. Displays Bodymarks
3. Inserts Arrow
4. Creates layered annotations
5. Adjustment tools
6. Button with toggle function
Figure 3-16. Annotation Touch panel (Example)
Layered annotations
Annotations can be entered on two different layers (called Text 1

and Text 2). This function enables the user to show/hide
different annotations on the same image.
1. Press Text 1 on the Touch panel.
The Text 1 layer is displayed. Enter an annotation.
2. Press Text 2.
The Text 2 layer is displayed (the Text 1 layer is hidden).
Enter an annotation.

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Annotations
To edit annotations
To move annotations
1. Move the text marker over the annotation to move and press
Select.
2. Move the selected annotation with the trackball to a new
location and press Select.
To edit annotations
Replacing text
1. Press Highlight on the Touch panel to browse through the
annotations entered word by word until the word to edit is
selected.
NOTE: To browse backward, press and hold down Shift while
pressing Highlight.
2. To select several words, rotate Grab Word on the Touch
panel.
3. Type a new text to replace the selected text or press Delete
word on the Touch panel (or Backspace) to delete the
selection.
Adding text
1. Move the text marker over the annotation to move and press
Select.
2. The text in the selected annotation can be edited using the
following alphanumeric keys:
• Right arrow: moves the text cursor forward.
• Left arrow: moves the text cursor backward.
• Tab: moves the text cursor by word forward.
• Shift + Tab: moves the text cursor by word backward.
• Enter: move the cursor to the nest line.
• Backspace: deletes backward.
• Delete: deletes forward.
• Insert: toggles the text entry state from overwrite to
insert mode.
To erase annotations
To erase all annotations:

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Basic operations
1. Press Page erase on the Touch panel.

If using layered annotations, all texts from both layers are
deleted.
Bodymark
Bodymarks are small graphic images that represent the
anatomy being examined. Using bodymarks, the user can
indicate the position that the probe was in during the
examination.
Inserting a bodymark
1. Press Text.
The Text folder is displayed on the Touch panel.
2. Press Bodymark.
The bodymarks specific to the current application are
displayed.
NOTE: To select bodymarks from another application, press
Library and select the desired application library.
3. Press the bodymark to insert.
The selected bodymark with a probe marker is displayed on
the scanning screen.
4. Using the trackball, adjust the position of the probe marker.
5. Adjust Rotate probe marker to set the probe marker
orientation.
6. To move the bodymark:
• Press Move pattern.
• Move the bodymark to a new location with the trackball.
• Press Move pattern to anchor the bodymark to the new
location.
7. Press Select.
Annotation and bodymark configuration

Annotation and bodymark configuration enable the user to:
• Create new application specific text and bodymark libraries
• Edit existing application specific text and bodymark libraries
• Delete user-defined libraries
A library is a list of up to 30 text inputs that are accessed from
the Touch panel (two pages).

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Annotations
To access to the Annotation and bodymark configuration screen:

1. Press Utility/Config on the Touch panel and log on as
administrator if required.
2. Select the Meas/Text category and Text or Bodymark
subgroup.
The corresponding screen is displayed (Figure 3-17).
Figure 3-17. The Text and Bodymark sheets

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Basic operations
To edit an existing library
1. In the Library field, select the library to edit.

2. To change or add a pre-defined text, select the text entry or
a blank location and do one of the following.
Annotation library:
• Type a text
• Select a text from the Copy from existing list.
Bodymark library:
• Select a bodymark form the Bodymark available field.
3. Press Save.
NOTE: If a factory library is edited, the original library can be restored
by pressing Reload default.
Toggling pre-defined annotations

It is possible to assign up to three related texts to one location
enabling the user to toggle between the text entries when
pressing the button on the Touch panel (i.e pressing the toggling
annotation Left will insert the text “Left” and toggle the button to
the annotation Right). Annotation buttons with toggle
functionality are marked with a circular arrow.
To create a toggling annotation:
1. Enter up to three text entries separated by a colon in the
desired location (i.e “Left:Right”).
To create a library
1. In the User defined library field, type a name for the library
to create, then select Create.
2. Enter pre-defined texts as described in step 2 above.
3. Press Save.
General options
Text, Bodymark and arrow default options can be specified from

the Option category.

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Annotations
Figure 3-18. The Options sheet
Parameter Description
Text color Select the color for annotation text.
Text boundary Select Group Move or Word Wrapping
Enable type over mode When selected, the user can place the cursor in an existing annotation
and start typing to insert new text.
Text overlay in multiple images When selected, if in dual mode, hides annotations in both images when
toggling Text 1/Text 2. If unchecked, hides annotations in the active
image only.
Erase text when unfrozen Deletes annotations when unfreezing the image.
Erase Bodymark when unfrozen Deletes bodymark when unfreezing the image.
Delete Bodymark on page The Bodymark inserted is deleted when applying Page erase.
erase
Bodymark as start page on text Sets the Bodymark Touch panel as default page when pressing Text on
button the Control panel.
Arrow length Select the default arrow length.
Arrow thickness Select the default arrow thickness.
Text and bookmark library Set availability for up to six libraries for the current application and select
the default library. Reset reloads the factory default setting.

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Basic operations
About system Configuration

The configuration package enables customizing of the global
configuration of the unit, application-specific settings, system
connectivity and data management settings.
The configuration management package is divided in different
setup categories with subgroups.
Only users with administration rights have access to all the
subgroups.
Setup category Description Subgroup Access
Imaging Global imaging and Global All

application configuration
Application All
Application menu All
Meas/Text Measurements and Measurement menu All

Annotation configuration
Advanced All
Modify Calcs All
OB Tables All
Text All
Bodymark All
Options All
Report Report configuration Template All
Diagnostic codes All
Comments All
Structured findings All

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Setup category Description Subgroup Access
Connectivity System connectivity Dataflow Admin
Additional outputs All
Tools All
Formats All
TCP/IP Admin
System General system settings Settings Admin

and system test
Test Admin
About System information System version All
Firmware version All
HW version All
Probes All
Admin Data management and Disk Management All

user account
Backup Admin
Restore Admin
Users Admin
System Admin Admin
Unlock patient Admin
Service Service Service Admin

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Basic operations
General system settings

2. Select the System category and Settings subgroup.
The Settings sheet is displayed.
Figure 3-19. The Settings sheet
Location
1. Hospital: enter the hospital name (up to 64 characters).

This information is displayed on the scanning screen's Title
bar (up to 24 characters) and on the image properties of all
saved images.
2. Department: enter the department name (up to 64
characters). This information is displayed on the image
properties of all saved images.
Date and time
Changes will be effective only after rebooting the system.

1. Date: select the correct date from the pop-up window.
2. Time: Press the arrow head buttons to set the time (hour
minute and second).

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3. Time Format: select the desired format (24 or 12 AM/PM)

from the pop-up menu.
4. Date Format: select the desired format (EU or US) from the
pop-up menu.
5. Default Century: select the desired format (1900, 2000 or
None) from the pop-up menu.
1900: the number 19 is automatically displayed when
entering the year in the patient date of birth (to edit century,
press Backspace twice).
2000: the number 20 is automatically displayed when
entering the year in the patient date of birth (to edit century,
press Backspace twice).
None: the four digits have to be typed when entering the
year in the patient date of birth.
Language, units and video settings
Changes will be effective only after rebooting the system.

1. Language: select the desired language for the system from
the pop-up menu.
2. Manual Language: select the desired language for the
Online manual. If not available the English manual will be
displayed as default.
3. Units: select the desired units (Metric or US) from the
pop-up menu.
4. Video settings: select between PAL and NTSC from the
pop-up menu.

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Basic operations
System users
The ultrasound unit requires operator registration.
Users are divided in groups with different rights. There are two
types of groups:
• User groups: members of these groups are allowed to login
on the system when selected together with the group
Operator. They have group specific rights (see tables
below).
• Referring groups: members of these groups (Diagnosing
physician and Referring doctors) are not allowed to login on
the system. They are registered as references that can be
associated to a patient record.
Right (see definition below)
Preset admin
Store report
Print report
Diagnose
Service
Create
Admin
Delete
Group
Cardiologist + + + + Activated with

a Dongle
Physician + +
Sonographer + +
Fellow + +
Sys Admin + + + +
Hosp admin + +
GE admin + + + +
Diagnosing physician +
Referring doctor
The rights associated to the user groups are:
Right Definition
Create Create and update patient record, examination, user and referring
members.
Import/Export patient records, examinations
Move examinations.
Delete Delete patient record, examination, user and referring members.

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Right Definition
Diagnose Make the Diagnosing physician available in the Patient info and exam
screen.
Preset admin Make application presets protected.

Delete protected application presets.
Print report • Print a report
Store report • Store reports, sign and unsign reports
Admin • System administration
Service • Access to the service platform

2. Select the Admin category and Users subgroup.
The Users sheet is displayed.
Figure 3-20. The Users sheet
Creating a user or a referring member
1. Press New.
2. Enter the user’s information.
3. Select the type of user/referring member in Member of
Group(s).

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Basic operations
CAUTION To be able to login on the system, the group Operator

MUST be selected.
Editing a user configuration
1. Select the actual user in the User list.

2. Make the desired changes.
3. Press Config or any active scanning key to exit the
Configuration management package.
Deleting a user
1. Select the actual user in the User list.

2. Press Delete.
The user is removed from the User list.
Auto logon and auto screen lock
Auto logon
1. Select the desired logon setup from the pull down menu:
• Disabled: no default user is selected when logging on.
• Last user: the last user is selected automatically when
logging on.
• A specific user: select one of the users to be the
default user when logging on.
Auto screen lock

1. Set the time span (from 10 min.) for the system to
automatically get locked when not in use. When the system
is locked, the current user may either log on again or the
system may be restarted by a different user.

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Chapter 4
Scanning Modes
‘2D-Mode’ on page 4-3
‘M-Mode’ on page 4-6
‘Color Mode’ on page 4-9
‘PW and CW Doppler’ on page 4-13
‘Tissue Velocity Imaging (TVI)’ on page 4-16
‘Tissue Tracking’ on page 4-18
‘Strain rate’ on page 4-20
‘Strain’ on page 4-22
‘Tissue Synchronization Imaging (TSI)’ on page 4-24
‘Additional scanning features’ on page 4-27
‘Image controls’ on page 4-30

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Scanning Modes
‘Scan Assist Pro’ on page 4-39
‘Configuration – Imaging’ on page 4-45.

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2D-Mode
2D-Mode
2D-Mode overview
1. Focus marker
2. Probe orientation marker
3. Parameter window
Figure 4-1. The 2D screen (cardiac)
Using 2D-Mode
The 2D-Mode is the system's default mode.
1. Press 2D on the control panel to access 2D mode.
2. Optimize the image by adjusting the image controls (see
below).
If necessary use preset for optimum performance with
minimum adjustment (see ‘Application presets’ on
page 4-46).

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Scanning Modes
Optimizing 2D
The following controls can be adjusted to optimize the 2D Mode
display:
• If using a 4D probe:
• Adjust the Quick Rotate control on the Touch panel or
press Angle on the Control panel to rotate the scan
plane to predefined angles.
• Adjust the Rotate rotary on page 2 of the Touch panel to
fine tune the angle adjustment.
NOTE: The Quick Rotate and Rotate controls are on page 2 of
the Touch panel if using a transthoracic 4D probe, and
on page 1 if using the transesophageal 4D probe.
A scan plane indicator is displayed showing the angle
position of the scan plane.
• Press CTO on the Touch panel to turn on Continuous Tissue
Optimization. CTO optimizes the radial and lateral uniformity
and brightness of the tissue continuously in real-time.
• The CTO adjustment may be further optimized by
adjusting the CTO Gain rotary on page 2 of the Touch
panel.
The mention “CTO” is displayed on the upper right corner of
the image area if CTO has been used during acquisition.
NOTE: CTO may alter the local gain differently in separate
(non-neighboring) regions of the image. CTO is only
available in live scanning and cannot be turned off when the
image is stored.
• Press Auto on the Control panel to turn on Automatic
Tissue Optimization. ATO optimizes the 2D image by
adjusting the gray scale curve.
• Use the Gain and TGC controls to optimize the overall
image.

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2D-Mode
Gain increases or decreases the amount of echo

information displayed. TGC compensates for depth-related
attenuation in the image.
• Use the Depth control to adjust the range to be imaged.
• Use the Focus control to center the focal point around the
region of interest.
• Use the Frequency control (move to higher frequencies) or
the Frame rate control (move to lower frame rate) to
increase resolution in image.
• Use the Frequency control (move to lower frequency) to
increase penetration.
• Use the Reject control to reduce noise in the image.
• Use the DDP control to optimize imaging in the blood flow
regions and make a cleaner, less noisy image.
• Use UD Clarity (Cardiac) or UD Speckle reduce
(non-cardiac) to reduce image speckle. Extra care must be
taken to select the optimal Speckle reduction level, as too
much filtering of speckle can mask or obscure desired
image detail.
• Press Color maps and select a grey map from the menu on
screen.
WARNING Always use the minimum power required to obtain acceptable

images in accordance with applicable guidelines and policies.

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Scanning Modes
M-Mode
M-Mode overview
1. Time motion cursor conventional M-Mode

2. Time motion cursor curved anatomical M-Mode
3. Time motion cursor anatomical M-Mode
4. Depth scale
5. Focus marker
6. Time scale
7. Parameter window
Note: The sweep speed information displayed in the bottom right corner of the image represents the user
selected sweep speed and should be used only as a reference to confirm that the image was acquired at the
selected sweep speed. It is not to be used for measurements or analysis. This is not an absolute value, but
simply a reference number. Users performing studies using standardized protocols may find this sweep
speed information useful for reading studies from other institutions.
Figure 4-2. The M-Mode screen

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M-Mode
This unit has three types of M-Mode:

• Conventional M-Mode (MM): displays a distance/time plot of
a cursor line in the axial plane of the 2D-image.
• Anatomical M-Mode (AMM): displays a distance/time plot
from a cursor line, which is independent from the axial
plane. AMM is available in greyscale, color, TVI, Tissue
Tracking, Strain rate and Strain modes.
• Curved Anatomical M-Mode (CAMM): displays a distance/
time plot from a free-drawn cursor line. CAMM is available in
greyscale, color, TVI, Tissue Tracking, Strain rate and Strain
modes.
Conventional M-Mode can be combined with Color Mode.
Using M-Mode
Conventional M-Mode
1. To access M-Mode from any other scan mode, press MM on

the control panel.
2. Use the trackball to position the cursor over the required
area of the image.
3. Press Freeze.
4. Use the trackball to scroll through the data acquired.
Anatomical M-Mode
1. In M-Mode or 2D-Mode Freeze, press AMM on the Touch

panel.
NOTE: Anatomical M-Mode can also be used with previously
acquired digitally stored 2D images. More than one heart
cycle should be stored if performing M-Mode in post
processing.
2. Use the trackball (assigned function: Pos) to position the
cursor over the required area of the image.
3. Press Trackball to allow free rotation of the solid full-length
cursor line throughout the 2D image (trackball assigned
function: Angle).
4. Rotate the solid cursor line to the desired direction.
Curved Anatomical M-Mode
1. In M-Mode, press Curved AMM.

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Scanning Modes

starting point of the time motion curve.
3. Press Select to anchor the starting point of the time motion
curve.
4. Use the trackball to position the next point of the time motion
curve.
5. Press Select to anchor the point of the time motion curve.
6. Repeat step 4 and 5 up to draw a complete time motion
curve.
NOTE: The time motion curve can be edited by following the curve
back to the desired point and redraw.
7. On the last point, press Select twice to terminate the curve.
NOTE: To edit the time motion curve, select a point, move it to a
new position and press Select.
Optimizing M-Mode
The use of preset gives optimum performance with minimum
adjustment. If necessary, the following controls can be adjusted
to further optimize the M-Mode display:
NOTE: Refer to ‘Application presets’ on page 4-46 about creating
presets.
• Adjust Horizontal sweep to optimize the display resolution.
• Adjust Gain and TGC controls to adjust the range to be
imaged.
• Use the Frequency (move to higher frequencies) or the
Frame rate control (move to lower frame rate) to increase
resolution in image.
• Adjust Dynamic range to optimize the useful range of
incoming echoes to the available greyscale.
• Adjust Compress and Edge Enhance to further optimize
the display.
• Adjust Reject to reduce noise while taking care not to
eliminate significant low-level diagnostic information.

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Color Mode
Color Mode
Color 2D Mode overview
1. Probe orientation marker

2. Color bar
3. Color sector marker
4. Parameter window
Figure 4-3. The Color Mode screen

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Scanning Modes
Color M-Mode overview
1. Time motion cursors (M-Mode, AMM and Curved AMM)

2. Color bar
3. Focus marker
4. Flow sector marker
5. Time scale
6. Parameter window
Figure 4-4. The Color M-Mode screen (top/bottom display)
Using Color Mode
Color 2D
1. From an optimized 2D image, press Color.

ROI frame over the area to be examined.
3. Press Select. The instruction Size should be highlighted in
the trackball status bar.
NOTE: If the trackball control Pointer is selected, press Trackball to
be able to select between Position and Size controls.
4. Use the trackball to adjust the dimension of the ROI.
5. Press Img. Store.

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Color Mode
Color M-Mode
1. From M-Mode press Color.

color area in the M-Mode display.
4. Use the trackball to adjust the dimension of the color area.
Optimizing Color Mode

to further optimize the Color Mode display:
presets.
• Adjust the Active mode gain to set the gain in the color flow
area.
• Adjust Scale to the highest setting that provides adequate
flow detection.
NOTE: The scale value may affect FPS, Low Velocity Reject, and
Sample Volume.
• Adjust Low Velocity Reject to remove low velocity blood
flow and tissue movement that reduces image quality.
• Adjust Variance to detect flow disturbances.
• Adjust Sample volume (SV) to a low setting for better flow
resolution, or a higher setting to more easily locate disturbed
flows
• Adjust Frequency to optimize the color flow display. Higher
settings improve resolution. Lower settings improve depth
penetration and sensitivity. This does not affect the
frequency used for 2D and M-Mode.
NOTE: Frequency setting may affect FPS, SV and Low Velocity
Reject.
• Adjust Power to obtain an acceptable image using the
lowest setting possible.
NOTE: The Power setting affects all other operating modes.

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Scanning Modes
Adjust the following settings to further optimize display of the

image:
• Use Invert to reverse the color assignments in the color flow
area of the display.
• Use Tissue priority to emphasize either the color flow
overlay, or the underlying greyscale tissue detail.
• Use Baseline to emphasize flow either toward or away from
the probe.
• Use Radial and Lateral Averaging to reduce noise in the
color flow area. Radial and Lateral Averaging smooths the
image by averaging collected data along the same
horizontal line. An increase of the lateral averaging will
reduce noise, but this will also reduce the lateral resolution.
CAUTION Use all noise reduction controls with care. Excessive

application may obscure low level diagnostic information.

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PW and CW Doppler
PW and CW Doppler
PW and CW Doppler overview
1. Sample volume (PW only)

2. Angle correction marker
3. Velocity scale
4. Low velocity reject
5. Nyquist velocity
6. Doppler baseline
7. Frequency scale (configurable, see page 4-45)
8. Parameter window
Note: the sweep speed information displayed in the bottom right corner of the image represents the user
selected sweep speed and should be used only as a reference to confirm that the image was acquired at the
selected sweep speed. It is not to be used for measurements or analysis. This is not an absolute value, but
simply a reference number. Users performing studies using standardized protocols may find this sweep
speed information useful for reading studies from other institutions.
Figure 4-5. The PW/CW Doppler Mode screen

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Scanning Modes
Using PW/CW Doppler modes
Alternative 1
1. Press PW or CW. A scanning screen is displayed with a

Doppler cursor on the 2D mode image and a Doppler
spectrum in the lower part of the screen.
2. Use the trackball to position the Doppler cursor line and in
PW the sample volume location over the area of interest.
3. In PW, adjust the Sample Volume.
NOTE: Sample Volume adjustment may affect the Scale, Frame
rate and LV rej. settings.
Alternative 2
1. Press Cursor on the control panel. A cursor line is displayed

on the 2D image.
2. Select the cursor type on the Touch panel.
3. With the trackball adjust the position of the cursor line.
4. Press PW or CW.
Optimizing PW/CW Doppler modes

to further optimize the PW/CW modes display:

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PW and CW Doppler

presets
• Adjust the Active mode gain to set the gain in the spectral
Doppler area.
• Adjust Low velocity reject to reduce unwanted low velocity
blood flow and tissue movement.
• In PW mode, adjust Sample volume to low setting for better
resolution, or higher setting to more easily locate the
disturbed flows.
• Adjust the Compress setting to balance the effect of
stronger and weaker echoes and obtain the desired intensity
display.
• Adjust Frequency to optimize flow display. Higher setting
will improve resolution and the lower setting will increase the
depth penetration.
• Adjust Frame rate to a higher setting to improve motion
detection, or to a lower setting to improve resolution.
NOTE: Frequency and Frame rate settings may affect the Low
Velocity Reject.
• Adjust Power to obtain an acceptable image using the
lowest setting possible. This is particularly important in CW
mode, as the energy duty cycle is 100% (constant).
NOTE: The Doppler Power setting affects only Doppler operating
modes.
CAUTION Use all noise reduction controls with care. Excessive

application may obscure low level diagnostic information.
Adjust the following settings to further optimize the display of the

image.
• Use the Horizontal sweep to optimize the sweep speed.
• To view signal detail, adjust Scale to enlarge the vertical
spectral Doppler trace.
• Use Invert to reverse the vertical component of the spectral
Doppler area of the display.
• Use Angle correction to steer the ultrasound beam to the
blood flow to be measured (Not typically required during
cardiac studies).

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Scanning Modes
TVI overview
Figure 4-6. The TVI Mode screen
Tissue Velocity Imaging (TVI) calculates and color-codes the

velocities in tissue. The tissue velocity information is acquired by
sampling of tissue Doppler velocity values at discrete points.
The information is stored in a combined format with greyscale
imaging during one or several cardiac cycles with high temporal
resolution.
Using TVI
1. While in 2D mode press TVI on the control panel.
ROI frame over the area to be examined.

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Optimizing TVI
to further optimize the TVI display:
presets.
• To reduce quantification noise (variance), the Nyquist limit
should be as low as possible, without creating aliasing. To
reduce the Nyquist limit: Reduce the Scale value.
NOTE: The Scale value also affects the frame rate. There is a trade
off between the frame rate and quantification noise.
• TVI provides velocity information only in the beam direction.
The apical view typically provides the best window since the
beams are then approximately aligned to the longitudinal
direction of the myocardium (except near the apex). To
obtain radial or circumferential tissue velocities, a
parasternal view must be used. However, from this window
the beam cannot be aligned to the muscle for all the parts of
the ventricle.
NOTE: PW will be optimized for Tissue Velocities when activated
from inside TVI.

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Scanning Modes
Tissue Tracking
Tissue Tracking overview
1. Tissue Tracking color bar

2. Track start and track end markers
3. Tracking start and end from detected QRS
4. Parameter window
Figure 4-7. The Tissue Tracking Mode screen
Tissue Tracking calculates and color-codes the displacement in

the tissue over a given time interval, typically the systole. The
displacement is defined as the distance the tissue moves during
this time interval. The displacement is found as the time integral
(sum) of the tissue velocities during this interval.
Only displacements in the beam direction are found. Only
positive (systolic) displacements are mapped into colors,
negative displacements are mapped into greyscale.

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Tissue Tracking
Using Tissue Tracking

1. From TVI Mode, press Tissue Tracking.
2. Adjust Tracking start close to the R-peak.
3. Adjust Tracking end to end systole.
4. Use the trackball to position the ROI frame over the area to
be examined.
Optimizing Tissue Tracking

reduce the Nyquist limit, reduce the scale while in TVI.
• To check for aliasing, freeze the loop and apply velocity
trace (Press Freeze and Q-Analysis), see also
‘Quantitative Analysis’ on page 9-1).
• The main use of Tissue Tracking is to map positive systolic
displacements. This means that Tracking start and
Tracking end controls should be adjusted to pick out the
systolic phase of the cardiac cycle: Adjust Tracking start
close to the R-Peak. Adjust Tracking end to end systole,
typically near the T-wave.
• Negative displacement can be mapped by pressing invert.
Tracking start and Tracking end must then be adjusted to
pick out the diastolic phase of the cardiac cycle.
• The maximum displacement that is color-coded can be
adjusted using Tracking scale. If set too low, most of the
wall will show the color indicating maximum displacement. If
set too high, the maximum displacement color is never
reached.
• Tissue Tracking provides velocity information only in the
beam direction. The apical view typically provides the best
window since the beams are then approximately aligned to
the longitudinal direction of the myocardium (except near
the apex).

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Scanning Modes
Strain rate
Strain rate overview
1. Strain rate color bar

2. Strain length and Strain rate reject
3. Parameter window
4. Parameter window
Figure 4-8. The Strain rate mode screen
Strain rate calculates and color-codes the deformation per unit

time i.e the speed at which the tissue deformation occurs.
Strain rate is calculated as the spatial gradient of velocity data.
Using Strain rate

1. From TVI Mode, press Strain rate.
be examined.

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Strain rate

Optimizing Strain rate

reduce the Nyquist limit, reduce the scale while in TVI.
• To check for aliasing, freeze the loop and apply velocity
trace (Press Freeze and Q-Analysis), see also
‘Quantitative Analysis’ on page 9-1).
• Strain rate provides information only in the beam direction.
The apical view typically provides the best window since the
direction of the myocardium (except near the apex).
• There is a trade-off between noise and spatial resolution
controlled by the Strain length control. To minimize noise
the Strain length should be maximized.
• The maximum Strain rate that is color-coded can be
adjusted using the SRI scale control. If set too low, most of
the wall will show the color indicating maximum Strain rate.
If set too high, the maximum Strain rate color is never
reached.
• Low strain rates may be masked out with a green color
using the SRI Reject control.

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Scanning Modes
Strain
Strain overview
1. Strain color bar

2. Strain start and end markers
3. Strain start and end from detected QRS and Strain sample size
4. Parameter window
Figure 4-9. The Strain mode screen
Strain calculates and color-codes the extent of tissue

deformation (lengthening or shortening) relative to the original
size over a given time interval, typically the systole.
Using Strain
1. From TVI Mode, press Strain.
2. Adjust Strain Start close to the R-peak.
3. Adjust Strain end to end systole, typically near the T-wave.

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Strain
be examined.
Optimizing Strain
• From an optimized Strain rate display adjust strain tracking
to pick out the systolic phase.
• The main use of Strain is to map negative systolic
deformation. This means that Strain start and Strain end
should be adjusted to pick out the systolic phase of the
cardiac cycle: Adjust Strain start close to the R-Peak.
Adjust Strain end to end systole, typically near the T-wave.
• The maximum deformation that is color-coded can be
adjusted using the Strain scale control. If set too low, most
of the wall will show the color indicating maximum
deformation. If set too high, the maximum deformation color
is never reached.
• Strain provides information only in the beam direction. The
apical view typically provides the best window since the
direction of the myocardium (except near the apex).
• Low strain values may be masked out with a different color
using the SI Reject control.

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Scanning Modes
Tissue Synchronization Imaging

(TSI)
TSI overview
1. TSI start/end and TSI Cut-off

2. TSI start and end markers
3. QRS marker
4. TSI color bar
5. Parameter window
Figure 4-10. The TSI mode screen
TSI calculates and color-codes the time from detected QRS to a

detected event, typically the time to peak systolic velocity.

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Tissue Synchronization Imaging (TSI)
CAUTION TSI is only recommended for adult cardiac images acquired

with the following probes: M5Sc-D, M5S-D, 6T, 6Tc, 3V-D, 4V-D
or 6VT-D. The measurement accuracies of the TSI
time-to-peak values reported in the Reference manual are
verified with these probes.
Using TSI
CAUTION TSI requires correct QRS detection to function properly.

Therefore always check that the yellow circle markers on the
ECG are positioned correctly on each QRS complex before
proceeding with the analysis.
1. Ideally, perform the AVO and AVC Event Timing

measurements prior to starting TSI. See ‘Event timing
measurements’ on page 8-11.
2. From TVI, Tissue Tracking, Strain or Strain rate mode,
select TSI.
be examined.
5. Use the trackball to adjust the dimensions of the ROI.
TSI markers adjustments
The default TSI markers settings are:

• TSI start: The time of the Event Timing measurement Aortic
Valve Opening (AVO). (If no AVO measurement is available,
60 ms from the detected QRS is used.)
• TSI end: The time of the Event Timing measurement Aortic
Valve Closure (AVC). (If no AVC measurement is available,
an estimated time of end systole is used.).
The system can be configured to not use AVO and AVC for TSI
start and end, or to use other events.
The configuration alternatives are:
• TSI start: AVO, 60, 80, 100, 120 ms, or Manual control
• TSI end: AVC, AVC - 200 ms, AVC - 150 ms, AVC - 100 ms,
AVC - 50 ms, AVC, AVC + 50 ms, AVC + 100 ms,

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Scanning Modes
AVC + 150 ms, AVC + 200 ms, MVO, MVO + 100 ms,
MVO + 160 ms, MVO + 200 ms, MVO + 260 ms,
ES - 200 ms, ES - 150 ms, ES - 100 ms, ES - 50 ms,
ES + 50 ms, ES + 100 ms, ES + 150 ms, ES + 200 ms or
Manual control.
NOTE: Manual adjustment of TSI start and TSI end markers is
available in Q Analysis. To store the modified marker
settings, press Img. Store and choose the configuration
setting Manual control to avoid automatic adjustment of the
markers.
To configure TSI markers:
1. Press Utility/Config on the Touch panel and select the
category Meas/Text.
2. In the Measure category, select the sheet Advanced.
3. In the Application specific parameters section adjust TSI
start and TSI end parameters by selecting a new value from
the combo menu displayed upon selection.
Optimizing TSI
• Use apical view when imaging and ensure that the LV wall
or opposing wall are in the view.
• Activate TSI from an optimized TVI or Strain rate display.
• Low time to peak values may be masked out with a different
color using the TSI Cutoff control.
• When analyzing TEE images where systolic velocities are
negative, the detection mode may be changed to “Time to
peak negative velocity” using the Invert control.

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LogiqView
LogiqView provides the ability to construct and view a static 2D
image which is wider than the field of view of a given transducer.
This feature allows viewing and measurements of anatomy that
is larger than what would fit in a single image.
LogiqView constructs the extended image from individual image
frames as the operator slides the transducer along the surface
of the skin in the direction of the scan plane.
LogiqView is available with all linear array probes, except IO
probe.
Using LogiqView
1. Perform a detailed examination of the anatomy/pathology.

Optimize parameters for tissue texture and visible window
prior to activating LogiqView.
2. Press LogiqView.
3. To start acquiring the image, press 2D freeze key.
Scan slowly and in a uniform motion lengthwise.
• Continuous contact is required throughout the length of
the extended image.
• Always keep the transducer perpendicular to the skin
surface.
• Keep the motion within the same scan plane.
• Do not make abrupt changes in speed of motion.
4. If required, press 2D freeze again to restart LogicView.
5. To complete the scan, press Freeze.
6. Adjust LogiqView rotate to rotate the acquisition.
NOTE: The quality of the resulting image is somewhat user-dependent
and requires some additional skill and practice to develop
proper technique.

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Scanning Modes
Compound
Compound is a process of combining three (default) or five
frames from different steering angles into a single frame. The
combined single image has the benefits of reduced speckle
noise, reduced clutter, and continuity of specular reflectors.
Therefore, this technique can improve contrast resolution.
Compound is available with all curved and flat linear probes,
except IO probe. Compound is on by default.
Using compound
1. Press Compound.
A three frames compounded image is produced.
2. To change the number of compounded frames, adjust
Compound frames on the Touch panel. Three or five
frames can be selected.
B-Flow
B-Flow provides an intuitive representation of non quantitative
hemodynamics in vascular structures. B-Flow enables
visualization of complex hemodynamics and highlights moving
blood and tissue. There are no artifacts such as bleeding,
blooming, or aliasing.
B-Flow is available with all probes except IO and TEE probes.
Using B Flow
1. While in Color flow, press B-Flow.

2. Adjust Flow speckle. Increased Flow speckle enhances
hemodynamics.
The greater the speed, the better the image scatter density and
size. If the scan direction is the same as the flow direction, then
the image scatter is elongated; if the scan direction is the
opposite as the flow direction, then the image scatter is tighter.
Therefore, have the scan direction opposite to that of flow
direction. Switch the way you hold the probe, with the probe
orientation marker inferior to maintain correct orientation on the
monitor. Flow starts from where the focal zone is located.

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Blood flow imaging

Blood flow imaging (BFI) is a Color flow mode with added
speckle information. The speckle information visualizes the
blood flow direction.
NOTE: When scanning in BFI triplex mode it is normal to have a time
delay between the Doppler display / Doppler audio and the BFI
color display.
BFI is available with all probes except IO and TEE probes.
Using Blood flow imaging
1. While in Color flow, press BFI.

2. Adjust Flow speckle. Increased Flow speckle enhances
hemodynamics.

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Scanning Modes
Image controls
Control panel
Focus
2D, M-Mode, Changes the location of the focal point(s). A triangular focus marker indicates the
Contrast depth of the focal point. Adjust the Focus around the region of interest.
Dual Focus
2D, CF, TVI Activates Dual focus mode. To adjust the Dual focus, rotate the Focus Pos.
2D Gain
2D When rotated clockwise, increases the overall gain applied to the received echo
signals equally for all depth.
Time Gain Compensation TGC
2D Compensates for depth-related attenuation in an image. The sliders nearest the

operator affect the far field. TGC amplifies returning signals to correct for the
attenuation caused by tissue at increasing depths.
Automatic Tissue Optimization (ATO)
2D ATO provides an automatic optimization of the 2D image by adjusting the gray

scale curve. Press Auto to toggle ATO on or off. When activated, ATO is displayed
in the information window.
Depth
2D Sets the maximum (far field) distance that will be imaged. Decreasing the depth
may allow higher frame rates.

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Image controls
Touch panel and rotaries
Width/2D width
2D, TVI, TT, SRI, SI Controls the size or angular width of the 2D image sector. A smaller angle
generally produces an image with a higher frame rate.
Frequency
2D, M-Mode Enables the adjustment of the probe's operating frequency. The selected
frequency is displayed in the Parameter window. For some probes/applications the
lowest frequency settings will be Octave imaging settings.
CF, Doppler, TVI, Enables the adjustment of the transmission frequency to control the sensitivity or
SRI the level of penetration. The selected frequency is displayed in the Parameter
window. Adjusting Frequency may affect Sample Volume and LVR settings.
B Color Map
2D, M-Mode Displays the Tissue color menu to optimize the greyscale presentation. The menu
enables the selection of non-linear gray-curves or different 2D-colorized curves to
be selected.
Frame rate
2D, TVI, TT, SR, SRI, Adjusts frame rate (FPS). The relative setting of the frame rate is displayed in the
TSI Parameter window. When adjusting frame rate, there is a trade off between spatial
and temporal resolution.
Cineloop/Cine Exit
2D, CF, TVI, TT, SRI, Starts/stops the cineloop.

SI, TSI
Up/Down
2D, M-Mode Up/Down: enables the 2D image to be flipped 180 degrees.
Left/Right
2D Left/Right: enables a mirror image of the 2D image to be created. The left/right

reference marker V moves to the other side of the image.
Compress
2D, M-Mode Controls the amount of contrast in the 2D image. An index number is displayed in
the Parameter window to indicate the relative level of compression.

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Scanning Modes
Compress
Doppler Enables control over the contrast of the Doppler spectrum. When compression is
raised, the spectrum image becomes softer and some low level background noise
may appear. Compress is available in both Live and Freeze.
TVI, SRI Controls the amount of color compression. The color bar is adjusted accordingly.
Reject
2D, M-Mode Adjusts the rejection level. When this control is increased, low-level echoes are
rejected and appear darker in the 2D image. An index number is displayed in the
Parameter window to indicate the relative level of rejection.
Doppler Enables undesirable background noise to be removed from the Doppler spectrum
resulting in a darker background. Reject is available in both Live and Freeze.
TVI Adjusts the cut-off level for the low velocity of TVI to be discarded when generating
the color image.
Dynamic Range
2D, M-Mode Enables control of the dynamic range or contrast of the image. When dynamic
range is set high, the image is softer and more low-level data is visible.
Data Dependent Processing (DDP)
2D Performs a temporal processing which reduces random noise without affecting the
motion of significant tissue structures. An index number is displayed in the
Parameter window to indicate the relative DDP level.
Tilt
2D Enables the axis of the 2D image to be tilted to the left or right. By default the axis
of symmetry of a 2D image is vertical.
Continuous Tissue Optimization (CTO)
2D CTO optimizes the radial and lateral uniformity and brightness of the tissue
continuously in real-time. CTO may alter the local gain differently in separate
(non-neighboring) regions of the image. CTO is only available in live scanning and
cannot be turned off when the image is stored.
UD Clarity
2D (Cardiac) Enables the user to create a personalized appearance of the tissue. A decrease of
UD Clarity creates a smoother image, though keeping boundaries sharp. An
increase of UD Clarity creates a crisper image.

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Image controls
UD Speckle reduce
2D (non-Cardiac) Reduces the unwanted effects of speckle in the ultrasound image. Image speckle
usually appears as a grainy texture in otherwise uniform areas of tissue. Its
appearance is related to image system characteristics, rather than tissue
characteristics, so that changes in system settings, such as probe type, frequency,
depth, and others, can change the appearance of the speckle. Too much speckle
can impair image quality and make it difficult to see the desired detail in the image.
Likewise, too much filtering of speckle can mask or obscure desired image detail.
Extra care must be taken to select the optimal Speckle reduction level.
Edge Enhance
2D, M-Mode Controls image processing related to the extent of edge enhancement applied to
an image.
PRF
2D Affects the level of reverberations in the image. When turned on, the frame rate (or
the number of focal zones) will decrease, while the reverberations will be
attenuated.
Power
2D, M-Mode, CF, Controls the amount of acoustic power applied in all modes. When power is set to
Doppler, TVI, TT, maximum, it is equal to or less than the maximum acoustic power permitted by the
SRI, SI, TSI FDA. The Thermal Index (TI) and the Mechanical Index (MI) are displayed on the
screen.
When power is reduced, it reduces the signal-to-noise ratio, so that the image may
become noisier.
Horizontal sweep
M-Mode, Doppler Adjusts the horizontal refresh rate of the M-Mode or Doppler area of the display.
Horizontal sweep is available in live and cine replay.
Scale
CF, Doppler, TVI Adjusts the repetition rate of the Doppler pulses transmitted to acquire the data for
color flow mapping. The Scale (Nyquist limit) should be adjusted so that no aliasing
occurs, while still having good resolution of velocities. The Nyquist limit should be
somewhat above the maximum velocity found in the data.
Baseline
CF Adjusts the color map to emphasize flow either toward or away from the probe.
Baseline is available in both Live and Freeze.

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Scanning Modes
Baseline
Doppler Enables the Doppler baseline to be shifted up and down. The default Doppler
baseline is set at the center of the vertical aspect of the Doppler display, dividing
evenly the flow toward and away from the probe. By adjusting the baseline a larger
portion of the analysis is assigned to the flow direction present. Baseline is
available in live and cine replay.
TVI Adjusts the color map to emphasize tissue motion either toward or away from the
probe. Baseline is available in both Live and Freeze.
Invert
CF Enables the color scheme assigned to positive and negative velocities to be

inverted. Invert is available in live and cine replay.
Doppler Enables the Doppler spectrum to be flipped 180 degrees, so that negative
velocities are displayed above the baseline and positive velocities below the
baseline. Invert is available in live and cine replay.
TVI Enables the color scheme assigned to positive and negative tissue velocities to be
inverted. Invert is available in live and cine replay.
TT Enables the color scheme assigned to the tissue displacements to be inverted.

Invert is available in live and cine replay.
SRI Enables the color scheme assigned to strain rate to be inverted. Invert is available
in live and cine replay.
SI Enables the color scheme assigned to shortening and elongation tissue

deformation to be inverted. Invert is available in live and cine replay.
Variance
CF Controls the amount of variance data added to a color display. Variance enables
computer-aided detection of turbulent flow (e.g. jets or regurgitation). Variance is
available in live and cine replay.
Color Maps
CF, TVI Displays the Color menu for selection of different color maps. Each color map is
assigning different color hues to different velocities.
Tissue priority
CF Emphasizes either the color of the color mode or the grey scale tissue detail of the
2D image. Tissue priority is available in both Live and Freeze.
Sample volume
CF Adjusts the size of the color flow Doppler sampling area. Lower setting gives better
flow resolution while a higher setting increases sensitivity and helps to locate
turbulent flows.

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Image controls
Low Velocity Rejection (LVR)
CF LVR, also called Wall motion filter, enables the extent of low velocity removal to be
adjusted. Color data produced by very low flow may cause interference.
Doppler Enables the low velocity portions of the spectrum to be filtered, since the Doppler
spectrum and audio may contain strong wall-motion signals. The amount of Low
Velocity Reject. is indicated by the green vertical bar at the right end of the
baseline.
Lateral averaging
CF, TVI, TT, SRI, SI Smooths the image by averaging collected data along the same horizontal line. An
increase of the lateral averaging will reduce noise, but this will also reduce the
lateral resolution.
Radial averaging
CF, TVI, TT, SRI, SI Smooths the image by averaging collected data along the same radial line. An
increase of the radial averaging will reduce noise, but this will also reduce the
radial resolution.
LPRF
PW Doppler Sets the Pulse Repetition Frequency (PRF) for the PW Doppler acquisition of flow
data. When the Doppler PRF is raised beyond a certain limit, more than one
Doppler gate is displayed on the screen.
D Color maps
Doppler Displays the Doppler Color menu for selection of different Doppler colorization
maps.
Angle correction and Quick angle
PW Doppler Enables correction of the Doppler velocity scale by defining the angle between the
Doppler beam and the investigated blood vessel or blood flow. A thin cross bar on
the Doppler cursor will rotate as the control is adjusted. Angle correction is
available in both Live and Freeze. Angle correction adjusts the angle between zero
and 90 degrees with one degree increment.
Quick angle adjusts the angle by 60 degrees.
Sample volume
PW Doppler In PW mode, set the longitudinal size of the region to be sampled for
measurement. Adjusting Sample volume may affect the PRF (Nyquist limit)
settings. SV does not apply to CW mode, where the volume sampled is the full
length of the area indicated by the cursor line.

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Scanning Modes
TSI
TVI, TT, SRI, SI Starts TSI mode.
Simultaneous
CF, TVI, TT, SRI, SI, Enables simultaneous display of a 2D image and a 2D image with color coded
TSI mode.
TVI visible
TVI Turns TVI display on/off.
Q Analysis
TVI, TT, SRI, SI, TSI Starts the Quantitative analysis application.
(In Freeze)
Threshold
TVI, TT, SRI, SI, TSI Controls the level of greyscale intensity that is used as a threshold for color.
Transparency
TVI, TT, SRI, SI, TSI Controls the degree of transparency of the color display.
Track start
TT The time after ECG R-peak when the integration should start.
Track end
TT The time after tracking start when the integration should end.
Tracking scale
TT Controls the color cut-off value of max displacement displayed. The chosen values
are shown on the color bar.
SRI scale
SRI Defines the scale for the color coding of the strain rate.
Strain length
SRI, SI Determines the strain sample volume size.

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Image controls
SRI reject
SRI Adjust the cut-off level of the low Strain rate to be discarded when generating the
color image. Rejected values are displayed in green.
Strain start
SI The time after ECG R-peak when the strain calculation should start. The strain
start time is displayed on the screen and is represented on the ECG by a red
marker.
Strain end
SI The time after strain start when the strain calculation should end. The strain end
time is displayed on the screen and is represented on the ECG by a red marker.
Strain scale
SI Defines the scale for the color coding of the tissue deformation.
Strain reject
SI Adjusts the cut-off level of the low tissue deformation to be discarded when
generating the color image. Rejected values are uncolored.
Cine compound
TT, SRI, SI, TSI Calculates and displays cineloops generated from a temporal averaging of multiple
consecutive heart cycles. The number of cycles averaged is user adjustable. The
number of averaged cycles is displayed on the top left corner.
TSI Cut-off
TSI Controls the cut-off time: using this control it is possible to color all parts of the TSI
image that has a time to peak less than a certain cut-off time.
T1/T2 (Timer)
Stress echo Starts a timer.
ECG Trig 1
All modes Specifies the delay (ms) from R-wave to the triggered frame.
Dual Trig Delay
All modes Specifies the delay (ms) from the first triggered frame (ECG Trig 1) to the second
triggered frame. Only active when Dual Trig is turned on.

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Scanning Modes
ECG Trig Interval
All modes Controls the number of cardiac cycles between triggered images.
ECG Trig
All modes Enables intermittent imaging based on the ECG.
Persistence
Vascular Contrast Enables the adjustment of color images, so that the current frame retains some
color information from previous frames, in order to minimize noise.

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Scan Assist Pro
Scan Assist Pro
Introduction
Scan Assist Pro provides an automated exam script that guides
you through an exam step-by-step. The system automatically
invokes the correct mode and imaging parameters, advances to
the next step in an exam, annotates the image, initiates
measurements, and assigns the measurements to the
worksheet/report.

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Scanning Modes
Scan Assist Pro overview
1. Protocol name
Completed steps/number of steps
2. Step instruction area
3. Protocol steps
Check mark: completed step
Frame: current step (The frame is
green when the Protocol is active or
yellow when it is paused.)
4. This column indicates the scanning
mode or when a measurement needs
to be made.
5. This column indicates the action to
move the Protocol to the next step.
6. Navigation: Stop, Pause/Continue the
Protocol.
Figure 4-11. Scan Assist Pro window
1. Category: the Protocols are grouped according to the exam categories (e.g. Cardiac, Abdominal... etc)
Config: display Scan Assist Pro config sheet (Figure 4-13 on page 4-42).
2. Protocols available for the selected category.
3. Stop, Pause/Continue and restart Protocol.
4. Change current step.
Change position and size of the Scan Assist Pro window.
Figure 4-12. Scan Assist Pro Touch panel

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Scan Assist Pro
Setting up Scan Assist Pro

Scan Assist Pro is ready to use with factory Protocols. However
user-defined Protocols customized to better suit the user’s
needs can be added to the list of available Protocols on the
Vivid E9.
User-defined Protocols are created using the Scan Assist Pro
Creator program, either on scanner or off scanner (see ‘Scan
Assist Pro Creator’ on page 16-2).
To set up Scan Assist Pro with user-defined Protocols you need
to:
• Import the user-defined Protocol that was created using the
Scan Assist Pro Creator.
NOTE: You do not need to import the user-defined Protocol if it was
created with the on scanner Scan Assist Pro Creator
program.
• Add the Protocol to the Protocol selection so that it is
available from the Touch panel.
Importing a Protocol
1. Insert the media with the saved Protocol from the Scan
Assist Pro Creator or exported Protocol from another
Vivid E9.
Refer to ‘Scan Assist Pro Creator’ on page 16-2 for more
information on how to create a Protocol.
2. Press Utility/Config on the Touch panel and log on if
required.
3. Select Imaging/Scan Assist Pro.

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Scanning Modes
Figure 4-13. The Scan Assist Pro sheet
4. Select Import from the Scan Assist Pro sheet.

The Import Protocols window is displayed.
Figure 4-14. Import Protocols
5. In the Source field, select the media that the Protocol is

stored on.
6. Highlight the Protocol(s) to be imported. If a folder is
highlighted, all Protocols in the folder are selected.
7. Select Import. The Protocol(s) are stored to the Vivid E9.

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Scan Assist Pro
NOTE: If the Protocol(s) already exist a confirmation dialog is

displayed asking the user to confirm the replacement of the
existing Protocol(s).
Add the imported Protocol to the Protocol selection
The imported Protocol(s) must be added to the Protocol

selection to be available on the Scan Assist Pro Touch panel.
1. Select the desired Category under Protocol Selections on
the right-hand side of the Scan Assist Pro sheet
(Figure 4-15).
2. Select the imported Protocol from Available Protocols/
Custom Protocols on the left-hand side of the Scan Assist
Pro sheet. Press the Right arrow button to add the
imported Protocol to the selected exam category.
NOTE: Use the Up and Down arrow buttons to move the Protocol
up and down in the list that will be displayed on the Scan
Assist Pro Touch panel.
Figure 4-15. Add Protocol
Using Scan Assist Pro

1. Press Protocol on the Control panel and select the Protocol
to run on the Touch panel.
NOTE: The Protocols displayed on the Touch panel correspond to
the current exam category. To use a Protocol from another
exam category, Press Category on the Touch panel and
select a Protocol from a different category.
The Scan Assist Pro window is displayed on screen with the
first step active. In the example below the annotation for the
first step has been automatically added on the image, ready
for you to scan the specified anatomy.

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Scanning Modes
NOTE: You can change the size and position of the Scan Assist Pro
window using the rotary button under the Touch panel.
Figure 4-16. Scan Assist Pro screen
2. Follow the steps indicated in the Protocol: image/measure

the appropriate anatomy.
3. Perform the indicated trigger to move to the next step in the
Protocol (e.g Img. store, Unfreeze... etc).
4. To pause or unpause Scan Assist Pro, press the Pause
button either in the Scan Assist Pro window or on the Touch
panel. You can also press the Left/Right arrow key on the
keyboard.
5. To stop a Protocol, press the Stop button either in the Scan
Assist Pro window or on the Touch panel. A dialog is
displayed to confirm the operation.
6. To restart a Protocol, press Restart on the Touch panel. A
dialog is displayed to confirm the operation.
7. To skip a step or move to a certain step, press the Up/Down
arrow key on the keyboard or select the step you want to
move to using the trackball.

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Global imaging settings

required.
2. Select Imaging/Global.
Figure 4-17. The Global sheet

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Scanning Modes
The followings settings can be configured:
Cineloop store • Time before/after heart cycle: sets the total storage time span
of the cineloop in ECG mode.
• Time span (no ECG): sets the total storage time span of the
cineloop with no ECG.
• Preview loop before store: when selected enable review of
cineloops before storage.
Crop images In the Analysis screen, removes top and bottom of the image
when more than two images have been selected.
Doppler • Show KHz scale: when selected, displays the KHz scale on the
left side of the Doppler spectrum (see Figure 4-5 on page 4-13).
Biopsy Guides Configure the biopsy guide zone display
Patient Info • Title bar Line 1 & 2: selects from the drop-down menu the
patient information to display on the Title bar.
• Anonymous patient: when checked, no patient information is
displayed on the Title bar.
Stereo vision Enable Polarized stereo support: polarized stereo vision is

enabled.
Enable Polarized stereo support: anaglyph stereo vision is
enabled.
See ‘Stereo vision’ on page 5-28 for more information.
Scan Info • Select the scan information to be displayed on the video record.
Upper Select button The upper button on the Trackball area can be configured as:
• a Select key
• a pointer
• an Image store button
• an image cursor
Application presets
required.
2. Select Imaging/Application.

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Figure 4-18. The Application preset sheet
Create a new Application preset
The application preset created is probe dependant. Select the

desired probe before creating a new application preset.
1. Adjust the settings as desired (see table below).
2. Press New.
A Dialogue window is displayed.
3. Enter a name for the new application.
4. Press Save.

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Scanning Modes
The followings settings can be configured:
Image Store settings • Single frame (live store):

: Store cineloop
: Store single frame image only
• Number of heart cycles: select the number of
heart cycles to store (Single frame must be
unchecked).
Auto freeze • Freeze 2D image in Doppler: the last 2D or

color flow image is displayed when entering in
Doppler mode.
• Auto freeze after: sets the time after which the
system enters in freeze when not in use.
Footswitch functionality Configure the footswitch pedals. For each pedal,

select the operation to perform from the drop-down
menu when in Live or in Freeze.
Templates and Packages Defines the default stress protocol associated to

the application.
Auto invert on steer In Color flow, the color bar is inverted when
steering the color flow sector angle.
Keep cursor when pressing 2D The PW, CW or M-Mode cursor is kept on the 2D
display when pressing 2D on the Control panel.
Keep cursor when changing mode
Keep cursor when pressing 2D The PW, CW or M-Mode cursor is kept in the 2D
display when turning off these modes (by pressing
Keep cursor when changing mode
PW, CW or M-Mode on the Control panel).
The PW, CW or M-Mode cursor is removed in the
2D display when pressing 2D on Control panel.
Keep cursor when changing mode If cursor is active while in PW, CW or M-Mode,
display the Cursor Touch panel when switching
Stay in cursor state when cursor is active
mode.
Sort application list on exam category Display only the factory application in the
Application menu when pressing Probe on the
Control panel.
Enable to change Category from the Application
menu when pressing Probe on the Control panel.
Application preset protection

By default a user defined application preset is unprotected and
can be overwritten. Only users with Hospital admin rights can
protect application presets (see ‘System users’ on page 3-32
about user rights).
It is not possible to both create and protect an application preset
in one operation. You have to first create and save the
application preset and then protect it as described below.

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To protect a user defined application preset:

1. Log on as a user with Hospital admin rights.
2. Select the probe and the application preset to protect.
4. Select Imaging/Application.
5. Press Save.
6. A confirmation window is displayed.
Figure 4-19. The Confirmation window
7. Check the option Protected and press OK.
Delete an application preset
Unprotected user defined application presets can be deleted by

any user with operator rights. Protected application presets can
only be deleted by user with Hospital admin rights (see ‘System
users’ on page 3-32 about user rights). Factory application
presets cannot be deleted.
1. Press Probe and select the application to delete.
2. Press Utility/Config on the Touch panel and select
Imaging/Application.
3. Press Delete to remove the selected application.
A confirmation window is displayed.
4. Press OK.
Application menu configuration

The Application menu can be configured to best suit the user's
requirements.

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Scanning Modes
The Application menu is a two-levels pop-up menu. The first

level called Application, displays the most frequently used
applications in any desired order. The second level called
More... displays the less frequently used applications.
required.
2. Select Imaging/Application menu.
Figure 4-20. The Application menu sheet
3. The following can be done:

• Move a selected application using the Arrow buttons.
• Set a selected application as default for the current
probe.
• Delete a selected application.
6VT-D TEE probe configuration

required.
2. Select Imaging/TEE probe.

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Figure 4-21. The TEE probe sheet
3. For each button on the TEE probe handle, select the

operation to perform from the drop-down menu when in Live
or in Freeze.
1. Button 1 (closest to the probe tip)

2. Button 2
3. Button 3
Figure 4-22. The TEE probe buttons

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Scanning Modes

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Chapter 5
4D and Multi-plane Modes
‘4D-Mode’ on page 5-2
‘Multi-plane mode’ on page 5-45.

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4D-Mode
Introduction
Real-time, single beat 4D imaging
The 4D probes on the Vivid E9 enable real-time, single beat 4D

tissue and color imaging. The volume data is displayed in
real-time with volume rendering techniques for visualization of
valves and structures.
Real-time, multi beat 4D imaging
The 4D probes on the Vivid E9 enable the acquisition of larger

tissue/color volumes with ECG gated acquisition. The data
acquired is displayed in real-time so that the user can control the
quality of the data acquired throughout the scanning process.

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4D-Mode
4D-Mode
Volume rendering screen
1. Volume rendering.
2. 2D image in the azimuth plane. The arrow indicates the viewing direction onto the volume rendering
relative to the azimuth plane.
3. 2D image in the elevation plane. The arrow indicates the viewing direction onto the volume rendering
relative to the elevation plane.
The brown line with X indicates the cropping applied to the Volume rendering.
4. Orientation window: displays a three-dimensional scene with acquisition sector and 2D image positions.
5. Trackball functions
Figure 5-1. The 4D-Mode screen (Volume rendering)

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Figure 5-2. The 4D-Mode Touch panel (Transthoracic acquisition)
Figure 5-3. The 4D-Mode Touch panel (Transesophageal acquisition)

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4D-Mode
4D-Mode acquisition
Real time single beat 4D acquisition

1. Select a 4D probe, and a cardiac application.
2. Enter 4D either by pressing the 4D button on the Control
panel or by selecting a 4D acquisition preset on the Touch
panel: Bird's view (small sector seen from the side),
Medium (medium size sector with top-down view, more
suited for transthoracic acquisition of the mitral valve) or
Large (large sector more suited for acquisition of the
complete LV).
NOTE: 4D acquisition may also be done in Multi-Slice mode (see
‘Multi-Slice acquisition’ on page 5-10) and 4D Zoom prepare
mode (see ‘4D Zoom prepare acquisition’ on page 5-13).
The volume acquisition is started.
3. The following parameters may be adjusted during
acquisition:
• Volume size: adjust the volume size. An increase of the
volume size will reduce the volume rate.
• Volume shape: adjust the ratio between the elevation
and azimuth widths. Changing the volume shape from
default will increase the volume rate.
• Frame rate: adjust the frame rate. There is a trade-off
between the frame rate and the image quality.
• Elevation tilt: tilt the volume in the elevation plane and
change the viewing direction accordingly.
• Other parameters: Frequency and Octave.
• Angle (on the Control panel): display different rendering
views.
• Layout (on the Control panel): display different layout
alternatives.
4. Optimize the image quality as necessary (2D Gain, 4D Gain,
Volume Optimize and UD Clarity).
If desired, select a Color map from the Touch panel to
colorize the volume rendering. The Depth color maps use a
combination of colors to improve depth perception.
Press Red or Color Laser lines on the Touch panel
(page 2) to visualize the 2D image locations in the volume
rendering. The 2D image locations are shown as overlaying
red or color coded lines following the surface in the volume
rendering. The color of the laser lines corresponds to the
color coding used for the 2D images.
5. Press Img. Store to store the acquisition.

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CAUTION The lower the volume rate, the longer is the delay between
acquisition of the different parts of the image. So settings with
low volume rate may introduce geometrical distortions on fast
moving structures.

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4D-Mode
Real time multi beat 4D acquisition

Real time multi beat 4D acquisition is based on ECG gated
acquisition of at least two sub-volumes. This technique enables
the acquisition of a larger volume without compromising the
spatial and/or temporal resolution, by combining sub-volumes
acquired over several heart cycles. When all sub-volumes have
been recorded, the process is repeated replacing the oldest
sub-volumes.
CAUTION ECG gated acquisition may by nature contain artifacts.

Artifacts may be caused by:
• Movements of the probe caused by the operator during
acquisition.
• Movements of the patient during acquisition, including
movements caused by respiration.
• Irregular heart rate during acquisition.
To validate the acquisition, press Multi-Slice and perform a
visual inspection. Stitching artifacts are shown as visible
transitions between the sub-volumes (Figure 5-4).
CAUTION The lower the volume rate, the longer is the delay between
acquisition of the different parts of the image. So settings with
low volume rate may introduce geometrical distortions on fast
moving structures.
To avoid spatial artifacts, make sure that the probe and the
patient are not moving during the acquisition. The patient
should, if possible hold his/her breath. The ECG trace should be
stable.
1. Connect the ECG device and make sure to obtain a stable
ECG trace.
2. Select a 4D probe, and a cardiac application.
3. Enter 4D either by pressing the 4D button on the Control
panel or by selecting a 4D acquisition preset on the Touch
panel: Bird's view (small sector seen from the side),
Medium (medium size sector with top-down view, more
suited for transthoracic acquisition of the mitral valve) or
Large (large sector more suited for transthoracic acquisition
of the complete LV).
NOTE: 4D acquisition may also be done in Multi-Slice mode (see
‘Multi-Slice acquisition’ on page 5-10) and 4D Zoom prepare
mode (see ‘4D Zoom prepare acquisition’ on page 5-13).
The volume acquisition is started.

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4. The following parameters may be adjusted during

acquisition:
• Volume size: adjust the volume size. An increase of the
volume size will reduce the volume rate.
• Volume shape: adjust the ratio between the elevation
and azimuth widths. Changing the volume shape from
default will increase the volume rate.
• Elevation tilt: tilt the volume in the elevation plane and
change the viewing direction accordingly.
• Other parameters: Frame rate, Frequency and Octave.
• Angle (on the Control panel): display different rendering
views.
• Layout (on the Control panel): display different layout
alternatives.
5. Press Multi beat on the Touch panel.
The gated acquisition is started. Ask the patient to hold her/
his breath at end expiration. Keep the probe steady and look
for stitching artifacts in both the volume rendering and the
elevation plane in the lower left window of the screen, or use
Multi-Slice (see page 5-10) to better assess the stitching
quality.
Attention should be brought on stitching quality during
acquisition rather than volume rendering quality.
6. You may adjust Num Cycles to change the number of heart
cycles the acquisition should be based on.
7. You may adjust Angle to get different rendering views. The
default top/down view is best for stitching quality
assessment.
8. Optimize the image quality as necessary (2D Gain, 4D Gain
and UD Clarity).
If desired, select a Color map from the Touch panel to
colorize the volume rendering. The Depth color maps use a
combination of colors to improve depth perception.
Press Red or Color Laser lines on the Touch panel
(page 2) to visualize the 2D image locations in the volume
rendering. The 2D image locations are shown as overlaying
red or color coded lines following the surface in the volume
rendering. The color of the laser lines corresponds to the
color coding used for the 2D images.
9. When no artifacts are seen over a few heart cycles, press
Freeze.
NOTE: It is recommended to acquire several heart cycles and use
Cycle select to select the best one.

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4D-Mode
Figure 5-4. Stitching artifacts

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Multi-Slice acquisition
Multi-Slice acquisition provides full volume data acquisition in
the same way as regular 4D single-beat or multi-beat
acquisition.
When using Multi-Slice acquisition the volume rendering display
is replaced by equidistant short axis views. The two Apical views
displayed on the left are for probe orientation purpose, while the
short axis views are used to ensure that the entire chamber is
included in the volume and to evaluate presence of stitching
artifacts (Figure 5-5).
1. While in 4D Live, press Multi-Slice on the Touch panel.
The Multi Slice screen is displayed showing equidistant
short axis views (Figure 5-5). The short axis views are
evenly distributed and maximized in size for best
assessment (e.g image quality, presence and visibility of all
walls, stitching artifacts when using real time multi beat
acquisition). Apical views are displayed on the left side for
orientation purpose.
1. Upper slice
2. Lower slice
Figure 5-5. Multi Slice screen
NOTE: Press Layout on the Control panel or use the dedicated

buttons on the Touch panel to get the following display
alternatives.

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4D-Mode
1. 5 Slice 3. 9 Slice
2. 7 Slice 4. 12 Slice
Figure 5-6. Multi Slice alternative displays
If required, apply zoom. All short axis views are zoomed in

simultaneously.
NOTE: Multi-Slice is also available in replay.
2. The following adjustments can be done:
• Place the cursor in the middle section of the top or
bottom slice intersection line in one of the apical views.
The cursor is changed to . Drag to change the slicing
area.
Alternatively, adjust Top and Bottom controls on the
Control panel.
• Place the cursor at one of the extremities of the top or
bottom slice intersection line in one of the apical views.
The cursor is changed to . Drag to rotate the slices
backward/forward and sideways, to align the slices with
the anatomical structure.

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Alternatively when in Freeze, adjust the Axis 1 and

Axis 2 controls on the control panel.
• Adjust Translate to move all slices up or down.
NOTE: The default position can be displayed again by pressing
Clear on the Control panel.
3. When imaging the left ventricle, press Dynamic on the
Touch panel. The structure is displayed dynamically through
the entire heart cycle (only available with thoracic
acquisitions in replay).
NOTE: When Dynamic is on the icon is displayed on screen.
4. Press Img. Store to save.
5. Press Multi-Slice to exit.

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4D-Mode
4D Zoom prepare acquisition

4D Zoom prepare acquisition is used to acquire real-time data of
isolated structures at a higher frame rate than what can be
obtained with a full volume acquisition. It is also useful because
acquisition is restricted to the structure of interest, reducing the
need for post processing.
4D Zoom prepare is available from 2D, Color Flow, 4D, 4D Color
Flow and Bi-plane modes.
4D Zoom acquisition is done in two steps:
• Prepare step: positioning of the probe for optimal acquisition
and adjustment of the zoom ROI in biplane mode.
• Acquisition step: Acquisition of zoomed 4D data.
1. To start 4D Zoom prepare:

• From 4D or 4D Color Flow mode: press the Zoom
button on the Control panel.
• From 2D, Color Flow or Bi-plane mode: press 4D Zoom
prepare on the Touch panel.
A biplane screen is displayed showing a ROI in the azimuth
and elevation plans.
NOTE: Transesophageal acquisition: press Mitral valve, AV SAX,
AV LAX or Top Down on the Touch panel to acquire a
volume rendering of the corresponding view.
2. Using the trackball adjust the position, size, width and tilt of
the ROI so that the ROI is correctly covering the structure of
interest in both planes.
• Press Select to toggle the trackball function between
ROI position (Pos) and ROI size (Size).
• Press Trackball to toggle the trackball function between
Pos/Size and Width/Tilt.
• Press Select to toggle the trackball function between
ROI width (Width) and ROI tilt (Tilt). The Width and Tilt
controls affect the ROI in the elevation plan only.
3. Press 4D on the Control panel to acquire 4D data in the
defined zoom area.
NOTE: You can do a single beat (see page 5-5) or a multi beat (see
page 5-7) acquisition.
NOTE: The tissue sector is slightly increased if entering 4D Color
Flow mode.

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4D Color Flow mode
Volume rendering screen
1. Volume rendering display with Color Flow

2. 2D Color Flow image in the azimuth plane. The arrow indicates the viewing direction onto the volume
rendering relative to the azimuth plane.
3. 2D Color Flow image in the elevation plane. The arrow indicates the viewing direction onto the volume
rendering relative to the elevation plane.
4. Orientation window: displays a three-dimensional scene with acquisition sector and 2D image positions.
Figure 5-7. 4D Color Flow screen (Volume rendering)

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4D-Mode
Figure 5-8. The 4D Color Flow mode Touch panel (Prepare)
Figure 5-9. The 4D Color Flow mode Touch panel (Acquisition)

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4D Color Flow acquisition
The 4D Color Flow acquisition is done in two steps:

• Prepare step: positioning of the probe for optimal volume
acquisition and adjustment of the Color Flow ROI position to
the desired location.
• Acquisition step: acquisition of 4D color flow volume.
NOTE: The 4D Color Flow acquisition can also be started using the 4D
Zoom prepare acquisition mode (see ‘4D Zoom prepare
acquisition’ on page 5-13).
Real time single beat 4D Color flow acquisition

Color Flow can be enabled in 2D mode before entering
4D mode or when in 4D mode.
1. Select a 4D probe and a cardiac application.
2. While in 2D, press Color.
3. Optimize the image quality (Gain, Depth, TGC... etc.).
4. Press 4D on the Control panel.
The 4D Color Flow Prepare mode is started.
5. Select one of the single beat acquisition presets on the
Touch panel (Small, Medium or Large).
6. Using the trackball adjust the position and size of the color
ROI as necessary.
7. Press Acquire Volume on the Touch panel or the 4D key or
the Update Menu key on the Control panel to start
acquisition.
NOTE: If the color ROI position is not optimal, press 4D CF Prepare
on the Touch panel or Update Menu on the Control panel to
start the 4D Color Flow Prepare mode again.

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4D-Mode
CAUTION Tissue structures may obscure relevant flow information. If

required, increase Tissue transparency setting.
Color flow data may obscure other relevant color flow
information (e.g. jet). If required adjust Flow transparency
setting.
In some settings the volume rate can be less than 10 volumes
per second. This may lead to small display mismatch between
the color and tissue data. This is because of the rapid
movement of structures (e.g. valves) compared to the time lag
between the tissue and the color volume acquisitions. Tissue
data should only be used as guidance for the localization of the
flow data.

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Real time multi beat 4D Color Flow acquisition

Real time gated 4D Color Flow acquisition is based on ECG
gated sub-volume acquisitions of color flow data.
CAUTION ECG gated acquisition may by nature contain artifacts. The

triggering works by acquiring the whole tissue volume during
the first heart beat, followed by several color sub-volumes that
are stitched together. Consequently, the tissue volume is not
updated for every heart beat, and only the color data may have
stitching artifacts.
Artifacts may be caused by:
• Movements of the probe caused by the operator during
acquisition.
• Movements of the patient during acquisition, including
movements caused by respiration.
• Irregular heart rate during acquisition.
To validate the acquisition, perform a visual inspection in both
the volume rendering and the elevation plane. Stitching
artifacts are shown as visible transitions between the
sub-volumes in the color flow data. The 6 Slice mode is also
well suited for evaluating the presence of stitching artifacts
while in live acquisition (see page 5-37).
1. Connect the ECG device and make sure to obtain a stable

ECG trace.
3. While in 2D, press Color.
4. Press 4D on the Control panel.
The 4D Color Flow Prepare mode is started.
5. On the Touch panel, press Multi beat and select one of the
multi beat acquisition presets (Small, Medium or Large).
NOTE: Real time multi beat 4D Color Flow can also be accessed
from Real time single beat 4D Color flow by pressing Multi
beat on the Touch panel.
6. Using the trackball adjust the position and size of the color
ROI as necessary.
7. Press Acquire volume on the Touch panel or the 4D key or
the Update Menu key on the Control panel to start
acquisition. The gated acquisition is started. Ask the patient
to hold her/his breath at end expiration. Keep the probe
steady and look for stitching artifacts in the color flow data in
both the volume rendering and the elevation plane in the
lower left window of the screen.

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4D-Mode
8. You may adjust Num Cycles to change the number of heart

cycles the acquisition should be based on.
9. Press Freeze.
In 2D Freeze, look for stitching artifacts in the color flow data
in both the volume rendering and the elevation plane in the
lower left window of the screen.
10. Rotate the volume to check the result. Use Cycle select to
select the best heart cycle.
4D Zoom prepare acquisition (Color Flow)

See ‘4D Zoom prepare acquisition’ on page 5-13.
Slice Mode
The Slice mode is used to extract 2D cut-planes from 4D data
sets. The Slice mode displays three perpendicular cut-planes
and a volume rendering. The cut-planes can be rotated and
translated independently of each other, or in combination (see
page 5-23). Slice mode is available from 4D and 4D Color Flow
mode in live and replay.

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Slice mode screen
1. Volume rendering
2. Cut-plane 1 (yellow)
3. Cut-plane 2 (white)
4. Cut-plane 3 (green)
Figure 5-10. The 4D screen (Slice mode)

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4D-Mode
Slice mode screen (Color flow)
1. Volume rendering
2. Cut-plane 1 (yellow)
3. Cut-plane 2 (white)
4. Cut-plane 3 (green)
Figure 5-11. 4D Color Flow screen (Slice mode)

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Figure 5-12. The Slice mode Touch panel

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4D-Mode
Basic operations
Rotating/Translating the view plane or crop plane
Rotation and translation can be performed in either Volume

rendering or Slice mode. Press Flexi-Slice to toggle between
the two modes.
Volume rendering mode

In Volume rendering mode, rotation applies to the viewing
direction onto the volume rendering. When View Crop on the
Touch panel is selected, the viewing direction and the crop plane
rotate together. When View crop is deselected rotation applies
only to the viewing direction.
Translation applies to a crop plane into the volume (see
‘Cropping’ on page 5-31 for more information about cropping).
1. Press Select to toggle between Rotate and Translate.
Rotation:
• Rotation with View crop selected: use the trackball to
rotate the active crop plane together with the viewing
direction. The viewing direction always coincides with
the crop plane.
• Rotation with View crop deselected: use the trackball to
rotate the viewing direction around the volume
rendering. The crop plane does not rotate.
Translation:
• Use the trackball to translate the crop plane into the
volume.
The default position can be displayed again by pressing
Clear.
Slice mode
In Slice mode each cut-plane may be rotated or translated
independently using the Trackball:
1. Press Yellow, White or Green on the Touch panel to select
the Reference plane.
The volume rendering is updated accordingly.
2. Place the cursor at one of the extremities of a cut-plane
intersection line in one of the cut-planes. The cursor is
changed to . Drag to rotate the cut-plane.

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3. Place the cursor in the middle section of a cut-plane

intersection line. The cursor is changed to . Drag to
translate the cut-plane.
4. Place the cursor at the intersection between two cut-plane
lines. the cursor is changed to . Both cut-planes are
translated simultaneously.
5. Click on a point in the volume rendering to move the
intersection of the two other cut-planes to that location.
• If Depth Mode is turned on: the reference plane is also
moved inside the volume rendering to the
corresponding selected depth.
• If Depth Mode is turned off: the reference plane is kept
at the current depth.
6. Place the cursor at the outer area of one of the cut-planes.
The cursor is changed to . Drag to rotate the cut-plane
image. The cut-plane lines remain fixed.
7. Place the cursor in the inner area of one of the cut-planes.
The cursor is changes to . Drag to pan the cut-plane
image. The cut-plane lines remain fixed.
Zooming
1. Rotate the Zoom knob clockwise on the control panel.

The volume rendering is magnified.
4D Views
4D Views enables quick access to standard 2D and 4D views.

4D Views requires slice alignment before standard views can be
selected.
4D Views is available in Freeze and replay.
1. Press 4D Views on the Touch panel.
The Slice alignment screen is displayed.

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4D-Mode
Figure 5-13. Slice alignment screen
Alignment – Transthoracic acquisition

1. Press Auto Align on the Touch panel (or Auto on the
Control panel).
The standard views are displayed with the left ventricle
centered to the center axis.
Further adjustment of the alignment can be done using the
slice alignment controls on the Touch panel or using the
trackball.
From the Touch panel, adjust as required:
Figure 5-14. Slice alignment controls
From the Trackball, adjust as required:

• Place the cursor outside one of the extremities of the
slice intersection lines in the Apical short axis view. The
cursor is changed to .Drag to rotate all apical views
around the main axis.
• Place the cursor at one of the extremities of the Apical
2 chamber slice intersection line (white) in the Apical

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short axis view. The cursor is changes to .Drag to

rotate the Apical 2 chamber slice around the main axis.
• Place the cursor at one of the extremities of the Apical
long axis slice intersection line (green) in the Apical
short axis view. The cursor is changes to .Drag to
rotate the Apical long axis slice around the main axis.
• Place the cursor at one of the extremities of a slice
intersection line in one of the apical views. The cursor is
changed to .Drag to tilt all slices around a
perpendicular axis to the apical view.
• Place the cursor in the middle section of a slice
intersection line in one of the apical views. The cursor is
changed to . Drag to pan all slices.
• Place the cursor on the blue intersection lines in one of
the apical views. The cursor is changed to . Drag to
translate the short axis plane.
NOTE: Press Clear on the Control panel to remove the alignment
and display the original probe position or previously
approved alignment.
2. Press Approve when alignment is done.
NOTE: Pressing Delete on the Touch panel will remove any
previously approved alignments and exit the Slice alignment
function.
3. Select the desired standard view on the Touch panel.
Figure 5-15. The 4D Views Touch panel (Transthoracic acquisition)
Alignment – Transesophageal acquisition

1. Perform slice alignment using the slice alignment controls
on the Touch panel or using the trackball.

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4D-Mode
From the Touch panel, adjust as required:
Figure 5-16. Slice alignment controls
From the Trackball, adjust as required:

• Place the cursor outside one of the extremities of the
slice intersection lines in the short axis view. The cursor
is changed to .Drag to rotate all views around the
main axis.
• Place the cursor at one of the extremities of the
2 chamber slice intersection line (white) in the short axis
view. The cursor is changes to .Drag to rotate the
2 chamber slice around the main axis.
• Place the cursor at one of the extremities of the
Mid-esophageal (ME) long axis slice intersection line
(green) in the short axis view. The cursor is changes to
.Drag to rotate the ME long axis slice around the
main axis.
• Place the cursor at one of the extremities of a slice
intersection line in one of the long axis views. The
cursor is changed to .Drag to tilt all slices around a
perpendicular axis to the view.
• Place the cursor in the middle section of a slice
intersection line in one of the long axis views. The
cursor is changed to . Drag to pan all slices.
• Place the cursor on the blue intersection lines in one of
the long axis views. The cursor is changed to . Drag
to translate the short axis plane.
NOTE: Pressing Clear on the Control panel will remove the
alignment and display the original probe position or
previously approved alignment.
2. Press Approve when alignment is done.
NOTE: Pressing Delete on the Touch panel will remove any
previously approved alignments and exit the Slice alignment
function.
3. Select the desired standard view on the Touch panel.

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Figure 5-17. The 4D Views Touch panel (Transesophageal acquisition)
Stereo vision
4D Stereo Vision is a display technique that enhances the

perception of depth in the 3D renderings. This is achieved by
mixing two different volume renderings with slightly separated
viewing angle and presenting them separately to the user’s left
and right eyes.
Two stereo display modes are supported.
• Anaglyph stereo vision: can be displayed on any monitor
and requires anaglyph stereo glasses (glasses with one red
and one cyan lens).
• Polarized stereo vision: can be displayed only on an
external monitor supporting this display (currently only Sony
LMD-2451MT is supported). The monitor has to be
connected to the digital video output on the Peripheral/
accessory connector panel on the rear side of the system.
Polarized stereo vision requires polarized stereo glasses.
The image will look only slightly blurred if viewed without
glasses or on monitors not supporting polarized stereo
vision.
Polarized stereo vision is available as an option. Anaglyph
stereo vision is available as default on the system.
Stereo vision is started by pressing Stereo vision on the Touch
panel while in 4D mode. Either anaglyph or polarized stereo
vision is started depending on the configuration (see below).
Make sure to use the correct glasses.

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4D-Mode
1. 3D anaglyph glasses 2. Circular polarizer 3D glasses
Figure 5-18. 3D glasses
NOTE: Not all users may be able to perceive depth using stereoscopic
display techniques.
Stereo vision configuration

Anaglyph stereo vision is the default stereo display mode and
does not require further configuration. Polarized stereo vision
must be enabled and the display options configured before it
can be used.
Connecting the Sony LMD-2451MT monitor
CAUTION Read thoroughly the monitor’s user manual before attempting

to use the monitor.
1. Connect the external monitor to the system using a DVI

cable.

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Figure 5-19. External monitor connection
2. Connect the external monitor to the mains as described in

the monitor’s user manual.
To enable polarized stereo vision

1. Make sure the Sony LMD-2451MT monitor is connected to
the system and turned on.
administrator.
3. Select Imaging/Global.
4. Check the option Enable Polarized stereo support.
To activate both screens
1. In config, select the Service sub-group.
NOTE: This sub-group is only available if logged in as administrator.
2. From the Monitor drop-down menu, select 17 inch LCD +
Sony LMD-2451MT Monitor.
3. Restart the system.
Dynamic
Dynamic is a tissue tracking tool. When Dynamic is on the

cropping plane applied to the volume rendering is moving
together with the tissue structure through the entire heart cycle.
Only longitudinal displacements relative to the basal LV are
detected. Dynamic tool may enable a better visualization of

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4D-Mode
anatomical structures (e.g. MV annulus) through the entire heart

cycle.
Dynamic is only available with transthoracic acquisitions.
CAUTION Use Dynamic only on apical greyscale acquisitions.

Do not compare measurements performed on static and
dynamic slices.
2-click cropping
2-click crop enables to quickly extract any views for visualization

of 4D structures. Two crop planes are created by clicking twice
in one of the 2D images or in the volume rendering.
1. Press 2-Click Crop on the Touch panel.
2. Place the cursor in one of the 2D views (or the volume
rendering) and press Select to create the first crop plane.
3. Move the cursor to a new location. The volume rendering is
updated simultaneously showing the cropped view.
4. Press Select to create the second crop plane.
NOTE: If desired repeat the procedure to create a new cropped
view.
5. Press 2-Click Crop to go back to the Volume rendering
screen.
Parallel cropping
Parallel cropping applies two parallel crop planes in the volume

rendering. This setting can be useful for valves and shunts
renderings.
When using Parallel Crop, both crop planes move together,
when translating and rotating. The thickness of the parallel crop
is adjusted using the Thickness control.
Press Dynamic to display the structure dynamically through the
entire heart cycle.
NOTE: When Dynamic is on the icon is displayed on screen.
To remove parallel cropping, press Parallel Crop again.
Cropping
The volume rendering can be cropped to only display the

structure of interest.

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There are two crop planes that can be adjusted in each of the
azimuth, elevation, and short axis planes.

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4D-Mode
Crop planes in the azimuth plane

Azimuth crop plane 1
Azimuth crop plane 2
1. Depressed button: active crop plane.

Check mark: cropping is applied.
2. Active crop plane in the volume rendering.
3. Crop plane intersection. The X symbols indicate the cropped side.

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Crop planes in the elevation plane

Elevation crop plane 1
Elevation crop plane 2


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4D-Mode
Crop planes in the short axis plane

Short axis crop plane 1
Short axis crop plane 2

1. Press Crop tool on the Touch panel (page 2).

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2. On the Touch panel, select the crop plane to adjust.

3. The adjustment of the crop plane is done with the trackball.
Press Select to toggle the trackball function between
translation (Transl) and rotation (Rot).
• Transl: translates the crop plane into the volume.
• Rot: rotates the view plane around the volume
rendering.
To rotate the crop plane, press Rotate crop on the
Touch panel and use the trackball to apply rotation.
Press Rotate crop again when done.
4. Use the Rotate red and Rotate blue controls on the Touch
panel to fine tune the adjustment of the crop plane.
The Rotate Red control rotates the crop plane about the red
indicator in the center of the crop plane. Similarly, the
Rotate Blue control rotates the crop plane about the blue
indicator. The Spin Red&Blue control changes the
orientation of the red and blue indicators, to facilitate
cropping in oblique angles.
5. Other possible adjustments:
• Press Dynamic to display the structure dynamically
through the entire heart cycle. This applies to the last
applied crop plane.
NOTE: When Dynamic is on the icon is displayed on
screen.
• Press Flip crop to remove the data on the other side of
the current crop plane. The viewing direction is flipped
180 degrees.
• Press Parallel crop to add a crop plane parallel to the
current crop plane. This setting can be useful for valves
and shunts renderings.
When using Parallel Crop, both crop planes move
together, when translating and rotating. The thickness of
the parallel crop is adjusted using the Thickness
control.
To remove parallel cropping, press Parallel Crop again.
Press Reset Active to undo the adjustments made on the
current active crop plane.
Press En face view to display a straight forward view of the
active crop plane.
6. On the Touch panel, select another crop plane and make the
required adjustments as described above.
NOTE: Pressing down a button containing a check mark will make
the corresponding existing crop plane active. Pressing a

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4D-Mode
button without a check mark will introduce a new crop plane,

and make it active.
7. To remove crop planes:
• To remove the active crop plane (indicated by a
depressed button with check mark), press the
corresponding button again.
• To remove a crop plane that is defined (indicated by a
check mark) but not active, press the corresponding
button twice.
• To remove all crop planes, press Angle or Clear on the
Control panel.
8. Press Crop tool to exit the cropping mode.
6 Slice
The 6 slice mode is used during live 4D color acquisition or
during Freeze/Replay to assess image quality, and stitching
artifacts.
6 Slice enables simultaneous display of six equidistant short
axis views and two long axis views generated from a 4D Color
Flow acquisition.
1. Make a 4D Color Flow acquisition (see page 5-18).
2. Press 6 Slice.
The 6 Slice screen is displayed (Figure 5-20). The six slices
are evenly distributed across the sector.

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1. Upper slice
2. Lower slice
Figure 5-20. 6 Slice screen
If required, zoom in. All short axis views are zoomed in

simultaneously.
3. The following adjustments can be done:
• Place the cursor in the middle section of the upper or
lower slice intersection line in one of the views. The
cursor is changed to . Drag to change the slicing
area.
Alternatively adjust Top and Bottom controls on the
Control panel.
• Place the cursor at one of the extremities of the upper or
lower slice intersection line in one of the views. The
cursor is changed to . Drag to rotate the slices
backward/forward and sideways, to align the slices with
the anatomical structure.
Alternatively when in Freeze, adjust the Axis 1 and
Axis 2 controls on the control panel.
• Adjust Rotate Z to rotate all six slices around the center
axis.
• Adjust Translate to move all six slices up or down.
NOTE: The default position can be displayed again by pressing
Clear on the Control panel.
4. Press Img. Store to save.

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4D-Mode
5. Press 6 Slice to exit.

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4D-Mode controls
Control panel
4D Gain (Active Gain rotary)
4D, 4D Color Affects the transparency of the volume rendering. Too much 4D Gain applied will
take away structures, too little will leave opaque “Gray clouds” in the ventricle.
Zoom (4D Zoom prepare)
4D, 4D Color Enters 4D Zoom prepare acquisition:

Enables 4D Zoom prepare acquisition displaying a biplane screen with an
adjustable zoom ROI in the azimuth and elevation plans. After adjustment of the
ROI, press 4D to acquire 4D data for the defined ROI (see page 5-13).
Layout
4D, 4D Color Toggles the display between different screen layouts.
Trackball
4D, 4D Color The trackball has multiple functions. The trackball functions are organized in
several functional groups.
The function selected is displayed in the lower right corner of the screen.
• Press Select to toggle between the trackball functions within the active functional
group. Groups with several functions are marked with a + symbol.
• Press Trackball to toggle between the functional groups.
The functions available are:
Volume rendering mode:

Group 1:
• Rotate: rotates the viewing direction onto the volume rendering. The active crop
plane is also rotated if View crop is selected on the Touch panel.
• Translate: translates a crop plane into the volume rendering.
Group 2:
• Speed: adjusts cine replay speed.
• Scroll: scrolls through a cineloop (in Freeze).
Volume rendering, cropping mode:

Group 1:
• Translate: translates the current crop plane.
• Rotate:
• Rotates the viewing direction onto the volume rendering.
• Rotates the crop plane if Rotate is selected on the Touch panel.
Slice mode:
Group 1:
• Rotate: rotates the selected cut-plane.
• Translate: translates the selected cut-plane.
Group 2:

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4D-Mode
Update Menu
4D, 4D Color Depending on the situation:

• Toggles between 4D Color Flow Prepare mode and 4D Color Flow acquisition.
• Toggles between 4D/4D Color Flow Zoom mode and 4D/4D Color Zoom prepare
mode.
Angle
4D, 4D Color Sets the cut-planes and crop planes to predefined positions.
Clear
4D, 4D Color Sets the cut-planes and crop planes to the default position.
Volume size
4D Controls simultaneously the azimuth and elevation widths. An increase generates

a bigger volume with a lower volume rate. A decrease generates a smaller volume
with a higher volume rate.
Volume shape
4D Adjusts the ratio between the elevation and azimuth widths. Changing the volume
shape from default will increase the volume rate.
Elevation tilt (Front/Back)
4D Tilts the volume in the elevation plane and change the viewing direction
accordingly.
Flexi-Slice
4D, 4D Color Toggles the display between Volume rendering (Figure 5-1 on page 5-3) and Slice
mode (Figure 5-10 on page 5-20).
4D Views
4D, 4D Color 4D Views enables quick access to standard 2D and 4D views.
Dynamic
4D Dynamic is a tissue tracking tool. When Dynamic is on the cropping plane applied
to the volume rendering is moving together with the tissue structure through the
entire heart cycle.
Available only for transthoracic acquisitions.

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Multi Slice
4D, 4D Color Multi Slice enables simultaneous display of equidistant short axis views generated
from a volume acquisition. Alternative displays are available from the Touch panel
or by pressing Layout on the Control panel.
6 Slice
4D Color 6 Slice enables simultaneous display of six equidistant short axis views and two
long axis views generated from a 4D Color Flow acquisition.
Crop tool
4D, 4D Color Enters the crop mode (see page 5-31).
View Crop
4D, 4D Color Crop mode where the view plane and the crop plane always coincide.
Parallel Crop
4D, 4D Color Crop mode where two parallel crop planes are applied (see page 5-31).
Flip Crop
4D, 4D Color Sets the crop plane so that the opposite volume is cropped and the viewing
direction is flipped 180 degrees.
Bird’s View / Medium / Large
4D, 4D Color 4D Acquisition presets: sets the volume size for the 4D acquisition.
• Bird’s View: small sector seen from the side
• Medium: medium size sector with top-down view, more suited for mitral valve
acquisition.
• Large: large sector more suited for acquisition of the complete LV.
Multi Beat
4D, 4D Color Toggles ECG gated 4D acquisition on and off.
Num Cycles
4D, 4D Color Adjusts the number of heart cycles the multi beat acquisition is based on.
Acquire volume
4D Color Toggles between Prepare mode and 4D Color flow acquisition.

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4D-Mode
Depth/Color maps
4D, 4D Color • Adjusts the volume rendering color from a color map menu.
• Depth color maps: these color maps use colors to improve the perception of
depth. Selecting the Depth bronze/blue color map will display structures that are
close to the view plane with a bronze color. Structures that are farther behind will
be colored with a gray color, while the structures that are farthest behind will be
colored in blue. Very bright colors are almost white, independent of the depth.
4D • Depth Illumination map: this color map creates shadows to improve the
perception of depth. Rotate the Light source rotary on the Touch panel to adjust
the light angle.
Navigation Abs/Rel
4D, 4D Color Abs: rotation of the volume about the probe axis. The volume rendering can be
tilted.
Rel: Rotation of the volume about x and y axis. Left/right movement rotates about
the y-axis, up/down about the x-axis.
Stereo Vision
4D, 4D Color Stereo Vision: 4D Stereo vision is a display technique that enhances the perception
of depth in 3D renderings. This is achieved by mixing two different volume
renderings with slightly separated viewing angles and presenting them separately
to the user’s left and right eyes. Two types of stereo visions are supported:
anaglyph stereo vision and polarized stereo vision (see ‘Stereo vision’ on
page 5-28 for more information).
Up/Down
4D, 4D Color Flips the volume upside-down. Not available when alignment has been approved.
Cine rotate
4D, 4D Color Displays the volume rendering of a cardiac cycle that rotates continuously back
and forth.
Smoothness
4D, 4D Color Affects continuity of structures and image noise in the volume rendering. Too much
smoothness will blur the image, too little will leave too much noise.
Shading
4D, 4D Color Adjusts the shading effect on the volume rendering. Shading may improve three
dimensional perception.

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DDP (Data Dependent Processing)
4D, 4D Color Performs temporal processing which reduces random noise without affecting the
motion of significant tissue structures.
UD Clarity
4D Enables the user to create a personalized appearance of the tissue. A lower setting
creates a smoother image, though keeping boundaries sharp. A higher setting
creates a crisper image.
Volume optimize
4D One touch button that optimizes the volume rendering by adjusting several display
controls simultaneously (e.g Shading, Smoothness... etc.).
Gamma
4D Adjusts the brightness of midtone values. A higher gamma value produces an

overall darker image, a lower gamma value a brighter image.
Laser Lines
4D, 4D Color Enables the visualization of the 2D image locations in the volume rendering. The
2D image locations are shown as overlaying red or color coded lines following the
surface in the volume rendering. The color of the laser lines (white or green)
corresponds to the color coding used for the 2D images.
Biplane prepare
4D Bi-plane prepare is a 4D scanning mode intended to be used for entering bi-plane

from within a 4D acquisition. The trackball is used to position two cut-planes
according to structures that are visualized in the volume rendering. Pressing
Biplane on the Touch panel enters the biplane acquisition mode, keeping the
cut-planes shown in the 4D mode, but with higher resolution and frame rate.
2-Click Crop
4D, 4D Color Crop mode where two parallel crop planes are applied in the volume rendering.
The position and viewing direction are defined by clicking in two locations in the
volume rendering. 2-click crop enables to quickly extract any views for visualization
of 4D structures.
Depth Mode
4D, 4D Color In Slice mode, affect the position of the reference plane in the volume rendering.
• Depth Mode on: when clicking in the volume rendering the reference plane is
moved inside the volume to the corresponding depth.
• Depth Mode off: the reference plane is kept at the current depth.

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Multi-plane mode
Multi-plane mode
Multi-plane mode overview
Bi-plane mode screen
1. Scan plane 1 (yellow): default reference scan plane. This scan plane can be rotated together with scan
plane 2, but it cannot be tilted.
2. Scan plane 2 (white): this scan plane is by default perpendicular to scan plane 1 along the scanning
axis. This scan plane can be tilted and rotated.
3. Navigator: displays the position of both scan planes as seen from the probe. The rotation angle for scan
plane 1 and the rotation and tilt angles for scan plane 2 are indicated in the corresponding view.
Figure 5-21. The Bi-plane imaging mode screen

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Figure 5-22. The Bi-plane mode Touch panel (Transthoracic acquisition)
Figure 5-23. The Bi-plane mode Touch panel (Transesophageal acquisition)

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Multi-plane mode
Tri-plane mode screen
1. Scan plane 1 (yellow): default reference scan plane. This scan plane can be rotated together with scan
planes 1 and 2.
2. Scan plane 2 (white): this scan plane can be rotated separately.
3. Scan plane 3 (green): this scan plane can be rotated separately.
4. Orientation window: displays all the scan planes in a projection.
5. Navigator: displays rotation angle values for the scan planes 1 (A) if rotated, 2 (A1) and 3 (A2).
Figure 5-24. The Tri-plane imaging mode screen

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Figure 5-25. The Tri-plane mode Touch panel

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Multi-plane mode
Using Multi-plane mode

2. Press Multi D on the control panel.
The Bi-plane screen is displayed.
3. Press Tri-plane or Bi-plane on the Touch panel to activate
the corresponding mode.
4. Adjust the angle increment between the scan planes, or the
overall rotation (see page 5-51).
5. If in Bi-plane mode, adjust the scan plane 2 tilt angle (see
page 5-52).
6. To activate another scanning mode:
• Press Color to activate CF mode.
• Press TVI to activate TVI mode.
• In TVI mode, press either TSI, Tissue Tracking, Strain
or Strain rate to activate alternative tissue Doppler
modes.
NOTE: To start 4D acquisition, select one of the 4D acquisition
presets on the Touch panel (Bird’s view, Medium or
Large).
7. Zoom in the structure of interest (see page 5-52).
NOTE: Scan plane rotation or tilting cannot be done when in zoom
mode.
8. Press Img. Store to save the acquisition.
Bi-plane prepare
Bi-plane prepare is a 4D scanning mode intended to be used for
entering Bi-plane from within a 4D acquisition. The trackball is
used to position two cut-planes according to structures that are
visualized in the volume rendering. Pressing Bi-plane on the
Touch panel enters the Bi-plane acquisition mode, keeping the
cut-planes shown in the 4D mode, but with higher resolution and
frame rate.

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Figure 5-26. The Bi-plane prepare screen
1. In 4D live:
• Transesophageal acquisition: press Bi-plane prepare
on the Touch panel.
• Transthoracic acquisition: press Page 2 and Bi-plane
prepare on the Touch panel.
The Bi-plane prepare screen is displayed showing two
perpendicular cut-planes and a smaller volume rendering
with a cross-hair defining the position of the cut-planes.
2. Using the trackball, move the cross-hair in the volume
rendering until the cut-planes of interest are displayed.
Alternatively, adjust Tilt and Rotate rotary controls.
3. Press Bi-plane on the Touch panel (or Multi D on the
Control panel) to start high resolution and high frame rate
bi-plane acquisition.
4. Press Img. Store to save the acquisition.

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Multi-plane mode
Basic operations
Scan plane rotation
Simultaneous scan plane rotation

Transthoracic acquisition
1. Adjust the Rotate rotary on the Touch panel to rotate all
scan planes simultaneously.
2. Press Quick Rotate on the Touch panel to rotate all scan
planes to predefined angles.
Transesophageal acquisition
1. If using the default configuration for the buttons on the
6VT-D probe, use Button 1 and 3 to rotate all scan planes
simultaneously (see Figure 5-27).
NOTE: To configure the 6VT-D probe buttons, see ‘6VT-D TEE
probe configuration’ on page 4-50.
1. Button 1 (closest to the probe tip): counterclockwise scan plane rotation

2. Button 2: Image store
3. Button 3: clockwise scan plane rotation
Figure 5-27. 6VT-D default button configuration (Live mode)
Alternatively, adjust the Rotate rotary on the Touch panel to

rotate all scan planes simultaneously.
2. Press Quick Rotate on the Touch panel to rotate all scan
planes to predefined angles.
Single scan plane rotation

Scan plane 2 and 3 can rotated separately. The rotation is done
around the crossing line between the scan planes. Scan plane
rotation is not available zoom mode.
1. Press Select until the desired trackball function is selected:
• Angle 1: rotation of scan plane 2 (white)
• Angle 2: rotation of scan plane 3 (green, Tri-plane only)

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2. Use the trackball to rotate the corresponding scan plane

around the probe center axis.
NOTE: Rotation of scan plane 2 and 3 can also be done using the
Angle 1 and Angle 2 rotary buttons.
3. In Bi-plane mode only, press V-planes to rotate scan
plane 2, so that it has the same angle as scan plane 1. The
scan plane 2 can then be tilted using the Tilt rotary or the
trackball (see below)
4. To reset the scan planes to the original default position,
press Clear.
Tilting scan plane 2
In Bi-plane mode, the scan plane 2 can be tilted around the top
of the scanning sector using the trackball. Tilting is not available
zoom mode.
1. In Bi-plane mode, press Select until the trackball function
Pos is selected.
2. Use the trackball to tilt the scan plane 2.
Figure 5-28. Tilting of scan plane 2 (Bi-plane mode)
3. To reset the scan planes to the original default position,

press Clear.
Zooming
1. Rotate the Zoom knob clockwise on the control panel.

All scan plane images are zoomed in. A Navigation window
is displayed with a frame highlighting the zoomed area.
The zoomed area can be moved within the sector or resized.
1. In zoom mode, press Select to toggle the trackball function
to Pos and use the trackball to freely move the zoomed area
within the scan plane.
2. Press Select to toggle the trackball function to Size and use
the trackball to adjust the size of the zoomed area (2D mode
only).

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Multi-plane mode
Multi-plane mode controls
Control panel
Multi D
Starts/exits Multi-plane mode.
Zoom
Activated and adjusted by rotating the Zoom rotary ( ). An orientation preview

showing the outlined magnified area is displayed in the upper right corner of the
screen. The position and size of the magnified area are adjusted with the trackball
when in B mode.
HR zoom concentrates the image processing to a magnified user selectable
portion of the image, resulting in an improved image quality in the selected image
portion.
HR zoom is activated and adjusted by pressing and rotating the Zoom rotary
( ). An orientation preview showing the outlined magnified area is displayed in
the upper right corner of the screen. The position and size of the magnified area
are adjusted with the trackball.
Clear
Resets all scan planes to the default position.
Angle
Toggles the position of scan plane 2 between the default position and a pre-defined
angle relatively to scan plane 1.
Layout
• In Bi-plane mode, toggles the display between the default Bi-plane dual screen
and a single screen showing the selected scan plane.
• In Tri-plane mode, toggles the display between the default Tri-plane quad screen,
a quad screen with enlarged Geometric model and a single screen showing the
selected scan plane.

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Trackball
The trackball has multiple functions. The trackball functions are organized in
several functional groups.
The function selected is displayed in the lower right corner of the screen.
• Press Select to toggle between the trackball functions within the active functional
group. Groups with several functions are marked with a + symbol.
• Press Trackball to toggle between the functional groups.
The functions available are:
Group 1 (Live):
• Pos: in Bi-plane, tilts the scan plane 2 (white) around the top of the sector.
• Angle 1: adjusts the angle between the scan planes 2 (white) and scan plane 1
(yellow). Scan plane 2 is rotated around the crossing line between the scan
planes. Scan plane 1 is fixed.
• Angle 2: adjusts the angle between the scan planes 3 (green) and scan plane 1
(yellow). Scan plane 1 is fixed. Available in Tri-plane only.
Group 1 (Zoom):
• Pos: moves the zoom area.
• Size: resizes the zoom area.
Group 2 (Color/TVI modes):
• Pos: moves the color sector. In Bi-plane CFM mode, if scan plane 1 (yellow) is
selected as reference scan plane, both color sectors are moved. If scan plane 2
(white) is selected as reference scan plane its color sector is moved
independently. In Tri-plane CFM mode, all ROI are moved at the same time.
• Size: resizes the color ROI. All sectors are resized at the same time.
Group 1 (Freeze/Replay):
This section describes only the Multi-plane mode controls. See

‘Image controls’ on page 4-30 for 2D, Color and TVI modes
image controls
Bi-plane / Tri-plane
Toggles between Bi-plane and Tri-plane mode.
Reference Plane
Toggles the reference plane between the scan planes. The reference plane may
also be selected using the trackball when the Pointer trackball tool selected.
V-Planes
In Bi-plane mode, rotates scan plane 2, so that it has the same angle as scan
plane 1. The scan plane 2 can then be tilted.

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Multi-plane mode
Quick Rotate
Rotates all scan planes to predefined angles.
Angle 1 / Angle 2
• Angle 1: adjusts the angle between the scan planes 2 (white) and scan plane 1
planes.
• Angle 2: adjusts the angle between the scan planes 3 (green) and scan plane 1
planes.
These controls are identical to the Trackball controls Angle 1 and Angle 2.
Rotate
Rotates all scan planes around the crossing line between the scan planes.
Bird’s View / Medium / Large
Starts 4D Acquisition: sets the volume size for the 4D acquisition (see page 5-5).
4D Zoom prepare
Enables 4D Zoom prepare acquisition displaying a biplane screen with an

adjustable zoom ROI in the azimuth and elevation plans. After adjustment of the
ROI, press 4D to acquire 4D data for the defined ROI (see page 5-13).
Right Invert
In Transesophageal Bi-plane mode Live only: mirrors the image on the right hand
side.

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Chapter 6
Stress Echo
‘Selection of a stress test protocol template’ on

page 6-3
‘Image acquisition’ on page 6-4
‘Stress Echo analysis’ on page 6-15
‘Multi-plane Stress Echo’ on page 6-20
‘4D Stress Echo’ on page 6-28
‘Quantitative TVI Stress echo analysis’ on page 6-37
‘Editing/creating a Stress Echo protocol template’ on

page 6-43
‘Configuration’ on page 6-49.

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Stress Echo
Introduction
The 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), see page 6-37.
A stress echo examination consists of three steps:
• Selection of a stress test protocol template (page 6-3)
• Image acquisition (page 6-4)
• Stress analysis (page 6-15)

Multi-plane acquisition with a 4D probes can be used with
specially designed stress templates (factory or user-defined)
that enables simultaneous acquisition of several projection
planes into each cell in the template (see page 6-20).
4D Stress Echo
4D Stress Echo acquisition with a 4D probe can be used with
specially designed stress templates (factory or user-defined)
that enable 4D data set acquisition. 4D acquisition can be either
ECG triggered (gated) acquisition over two heart cycles or real
time as defined in the stress template (see page 6-28).

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Selection of a stress test protocol template
Selection of a stress test protocol

template
1. Press Protocol on the Control panel and Stress on the

Touch panel to enter the stress echo mode.
The Protocol screen is displayed (see Figure 6-1) showing
the default stress protocol for the current probe and
application.
2. Turn freeze off to initiate scanning using the current
template.
To use another template, press Template and select the
desired template from the template list. Turn freeze off to
initiate scanning.
NOTE: To create or edit a template see page 6-43.
1. Level selection
2. Projection selection
3. Current acquisition
4. Group of views
Figure 6-1. The Protocol screen

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Stress Echo
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 6-2). 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.
1. Current view, level and timers

2. Template matrix view and level
3. Current view (Green cell)
Figure 6-2. The stress mode acquisition screen
Starting acquisition
1. Turn freeze off to initiate scanning.
NOTE: To use the Timer, see page 6-8.
2. Perform a scan that conforms with the view that is
highlighted in the template matrix on the Clipboard window.

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Image acquisition
If the selected template has the option Smart Stress turned

on (see page 6-45), 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.
NOTE: Smart Stress is turned on by default in factory templates.
• 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’ on page 3-18 for
further information). Press Img. 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.
NOTE: For further information on stress test configuration, see
page 6-43.
When storage of the cineloop is completed, the actual
highlighted cell in the template matrix is fill with dark blue
color indicating that the view has been acquired. After
storing the loop, the system automatically highlights the next
view in the matrix to be acquired.
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 6-3).
4. Repeat previous steps until all required views are
completed.
CAUTION If using DICOM Server dataflow for stress-echo

acquisition, images should not be saved to permanent
archive before the complete protocol exam is acquired.
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 6-8 on page 6-17).

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Stress Echo
1. Current acquisition loop

2. Corresponding reference loop
Figure 6-3. Display of the Reference loop during acquisition
Protocol Pause function
During the stress acquisition it is possible to temporarily exit the

protocol acquisition mode to acquire images in any mode
outside the stress protocol.
1. To temporarily exit the protocol mode, press Protocol
Pause on the Touch panel.
2. Acquire the desired images outside the protocol.
3. Press Protocol Pause to restart the protocol acquisition
mode and resume the stress 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
follows.
Manual selection of a view during acquisition

1. Use the arrow keys on the Control panel to highlight the cell
that represents the view that is to be acquired.

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Image acquisition
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. 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.
Replacing an acquired image
1. Use the arrow keys on the Control panel to highlight the cell
that represents the view that is to be replaced.
The selected cell in the template matrix is blinking red,
indicating non-default position.
2. Scan and save the selected loop as explained in the
previous section.
3. Select in the dialog window if you want to Replace or Keep
the existing loop.
• Replace: the original image is deleted from the
examination and replaced by the acquired image.
• Keep: the original image is replaced by the acquired
image, but it is not deleted from the examination.
NOTE: When selecting Keep, both the new and the old image
will be associated with the current protocol cell and you
may later perform Wall Motion Scoring for this level in
the protocol using either the new or the old image. The
new image may be opened from the protocol, while the
old image may be opened manually from the clipboard.
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. in the Protocol screen, press Move image.
2. Trackball to the image to move (source cell).
3. Press Select.
4. Trackball to the destination cell.
5. Press Select.

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Stress Echo
The image is moved from the source 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.
If the destination cell contains an image, the images from the
source and destination cells will be exchanged when moving an
acquired image.
Timers
Two timers can be displayed in the Stress mode acquisition

screen, beside the template matrix.
• T1 displays the elapsed time from the start of the stress
examination.
• T2 starts when entering live scanning on the second stress
level
Press Protocol T2 on the Touch panel to stop/start the T2 timer.
Timers restart always at zero.
The display of T1 and T2 is user-configurable (see page 6-43).
Continuous capture mode

Continuous capture mode enables the user to perform
acquisition continuously for several views at any level
depending on the selected template configuration. Continuous
capture consists of temporarily 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 6-43 about template
configuration).

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Image acquisition
The buffer bar
When entering a cell with Continuous capture enabled, a Buffer

bar is displayed in the Info window (see Figure 6-4). The Buffer
bar displays the following information:
• The 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 filling gauge
• The capturing sessions, reflected by the red lines along the
Buffer bar
3 4 5
1. Scanner's state
2. Capture session
3. Pause session
4. Buffer gauge
5. Percentage of filled buffer
Figure 6-4. The buffer bar in Continuous capture
Controlling the capture process
When entering a cell with Continuous capture enabled, the unit

is automatically set in Pause mode.
1. Press Img. Store 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 6-4).

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Stress Echo
2. Press Image Store 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. The captured recording is stored on disk and the captured
loops are displayed in the Continuous capture selection screen
(see below).
Running Continuous capture
1. Do all your pre-stress acquisitions in the Cardiac

application.
The Protocol screen is displayed (see Figure 6-1 on
page 6-3).
NOTE: The application Exercise_U (or Exercise) should be used
in order to get maximum continuous capture buffer.
3. Press Template.
The template list is displayed.
4. Select the template Exercise 2x4.
NOTE: The Exercise protocol template is automatically selected
when the application Exercise_U (or Exercise) is active.
5. Press Begin/Cont.
If the application Exercise_U, Exercise or LVO Stress was
not previously selected, the Application menu is displayed.
Select Exercise_U or Exercise.
6. Acquire the resting loops in all four views.
7. Once the fourth loop is acquired the system enter into a
waiting mode where Continuous Capture is in pause state
awaiting the patient to exercise.
8. When the patient is back on the bed, press Img. Store or 2D
Freeze. The Continuous capture acquisition is started.
9. Acquire all your views. You may pause the acquisition when
moving the probe between parasternal and apical position.
The memory buffer gauge increases (Figure 6-4). When
memory filling exceeds 90%, the percent number turns red.
10. Press Freeze to finish.
11. Press Select Cycles.
The Continuous capture selection screen is displayed (see

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Image acquisition
If the buffer is filled up the system will automatically display

the Continuous capture selection screen.
Refer to the next section if additional image acquisition is
necessary after the buffer is filled up.
12. Assign the cineloops to the four views (see page 6-13).
The continuous capture acquisition was stored on disk
before the Continuous capture selection screen was
displayed. At end exam, a dialogue is displayed asking
whether this file should be kept or not. To avoid
unnecessary data storage, it is recommended to delete this
file at end exam when the cycles have been selected and
stored.
13. Press Done if you are finished selecting or want to do the
selection later.
OR
Press Select later if you want to reselect any loops (open
the capture again from the Protocol screen). This will set the
scanner in Protocol Pause mode.
OR
Press New capture to start a new Continuous capture
acquisition at this stress level.
14. Perform Analysis and scoring (see page 6-15).
Continuous capture with additional image acquisition

After acquiring Continuous capture, additional images can be
stored to the clipboard before the patient’s heart rate decreases
toward recovery level. These additional images may be acquired
with other scanning modes (using the same probe and
application), before doing image assignment to the views:
1. Perform Continuous capture as described above (steps 1
to 10).
2. If the buffer is not filled up: press Protocol Pause on the
Touch panel. Live scanning is activated outside the stress
protocol.
If the buffer is filled up: press Select later. Scanning is
activated and Protocol Pause is automatically enabled.
Press Freeze to start scanning.
3. Perform the additional acquisition (e.g. Color flow, Doppler).
Images will be stored outside the protocol.
4. In order to resume the stress echo exam and assign loops
for the views from the Continuous capture buffer, press
Protocol.
5. Select the Continuous capture thumbnail on the lower left
corner of the Protocol screen.

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Stress Echo
The Continuous capture selection screen is displayed.

6. Assign the cineloops to the views (see page 6-13).
7. Press Done when you are finished selecting.
Postponed image assignment

The assignment of the cineloops to the views can be done on a
later stage on a stored Continuous capture acquisition.
1. Perform Continuous capture as described in ‘Running
Continuous capture’ on page 6-10 (steps 1 to 11).
2. When entering Continuous capture selection screen
(step 11), the continuous capture acquisition is stored on
disk before the Continuous capture selection screen is
displayed. At end exam, a dialogue is displayed asking
whether this file should be kept or not. To avoid
unnecessary data storage, it is recommended to delete this
file at end exam when the cycles have been selected and
stored.
3. Re-open the examination if necessary.
4. Press Protocol.
The Protocol screen is displayed.
5. Press on the Continuous capture thumbnail on the lower
left corner of the Protocol screen.
The Continuous capture selection screen is displayed.
6. Assign the cineloops to the views (see page 6-13).
7. Press Done when finished.
9. When exiting this patient a dialogue window is displayed
asking whether the remaining continuous capture images
should be deleted.
• Press Yes to delete the remaining continuous capture
images
OR
• Press No to keep the entire continuous capture
acquisition.
The normal procedure is to delete the remaining images as
they take a lot of disk space.
New capture from the Continuous capture selection screen

1. Press New Capture.
A new Continuous capture acquisition on the current stress
level is started.

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Image acquisition
Assigning and storing the loops
The cineloops captured in the buffer are assigned to the stress

protocol views and stored from the Continuous capture selection
screen (see Figure 6-5).
1. Rotate Review Page to display other pages.

2. Cycle number and total number of cycles
3. Highlighted loop
4. Buffer bar: to browse through the acquisition, select an area in the buffer bar to display the
corresponding page or select the first, last, previous or next page buttons.
Figure 6-5. The Continuous capture selection screen
Assigning a cineloop to a view

1. Trackball to the desired loop in order to assign it to a
particular view of the stress template.

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Stress Echo
The frame of the loop is highlighted.

2. Press Select.
A pop-up menu is displayed with the view names of the
template (see Figure 6-6).
3. Trackball to the required view name.
4. Press Select.
The name of the view is displayed above the timers in the
loop window.
5. Repeat steps 1 through 4 to assign loops to the other views
of the level.
6. Press Done when completed.
NOTE: The continuous capture acquisition was stored on disk
before the Continuous capture screen was displayed. At
end exam, a dialogue is displayed asking whether this file
should be kept or not. To avoid unnecessary data storage, it
is recommended to delete this file at end exam if the cycles
have been selected and stored.
1. Assigned loop
2. Highlighted loop
3. Already assigned view
4. Highlighted views
Figure 6-6. Loop assignment in Continuous capture

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Stress Echo analysis consists of viewing previously saved loops

and assigning scores to each cardiac segment, in order to
quantify the function of the muscle, or wall motion.
Depending on the protocol configuration, the analysis stage can
be started automatically after completion of the stress test or it
can be started manually. In this case, the usual procedure
consists of sequentially opening all image groups (if defined)
and perform scoring from image to image.
The quad screen is the standard display for comparing heart
cycles (Figure 6-8). The heart cycle loops in the display are
synchronized to enable comparison. Each loop in the quad
screen can be magnified, using the zoom control.
Image selection for analysis

Images can be selected manually or from a pre-defined group in
the Protocol screen.
Selection of images from a group
If groups of images have been defined in the protocol template

(see page 6-46), the user can select a group of images for
analysis and sequentially analyze all images from all groups
from within the Analysis screen (see Figure 6-8 on page 6-17).
1. In a stress examination, press Protocol.
A preview of the acquisitions is displayed.
2. Trackball to a group in the Group list.
The frame of the images belonging to the group are
highlighted.
NOTE: Pressing Analyze (while no images are selected in Protocol
screen) will automatically open the first group of images in
Analyze screen.
3. Press Select to open images in the Analyze screen (see
page 6-17).

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Stress Echo
1. Select a Projection
2. Select an image
3. Select and open an Image
group
Figure 6-7. Image selection from the Protocol screen
Manual selection of images in the Analysis screen
1. When currently in protocol analysis in the Stress analysis

quad screen (Figure 6-8), hold down Shift while selecting
the images on the clipboard on the stress template matrix.
Manual selection of images in the Protocol screen
1. In a stress examination, press Protocol.

A preview of the acquisitions is displayed.
2. Trackball to the first image to select.
3. Press Select.
The frame of the selected loop is highlighted.
4. Repeat steps 2 and 3 to select other images.
5. Press Analyze to open images in the Analyze screen (see
page 6-17).
NOTE: Alternative: Double click on the last selected image to open
images.

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Wall motion scoring
1. Selected loop (highlighted frame)

2. Highlighted segment name (see pointer)
3. Change page or enter next image group
4. Display Bull’s eye diagram
Figure 6-8. The stress echo analysis screen (Quad screen)
Wall motion scoring is used to evaluate wall motion in each

cardiac segment. The left ventricle myocardium is divided into a
number of segments (e.g. 16 or 18), and each segment is
assigned a score based on visual evaluation/”eye-balling”. The
wall motion scoring results are linked to the stress level of the
image being evaluated. This means that for instance when
scoring a short axis projection and a long axis projection from
the same stress level, then common segments with the same
scoring value will be shown in the respective scoring diagrams.

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Stress Echo
CAUTION The wall motion scoring result is assigned to the stress level of
the image, but will not be updated if the image is moved to
another stress level in the protocol at a later time. Images
should be correctly placed in the protocol when performing wall
motion scoring.
NOTE: The number of segments (WMS segment model), the range of

scoring values (WMS scoring legend) and the initial scoring
value (WMS initial scoring) may be configured in Config/Meas
Text/Advanced under the Cardiac M&A category.
1. In the Stress Echo Analysis screen, trackball to a segment
in one of the scoring diagrams and press Select.
The Score pop-up list is displayed (see Figure 6-9).
2. Trackball to a score.
3. Press Select.
The score is displayed in the relevant segment area in the
diagram (see Figure 6-9).
4. Repeat steps 1 through 3 to score relevant segments.
5. Rotate Review page to display next group of images.
6. Repeat steps 1 through 3 to score relevant segments on the
new loops.

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1. Selected segment
2. Selected score
1. Scored segment
Figure 6-9. Segment scoring

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Stress Echo
Multi-plane Stress Echo requires specially designed stress

templates (factory or user-defined) that enable simultaneous
acquisition of several projection planes into each cell in the
template.
Two factory multi-plane stress templates are available:
• Pharm. 4x2 Multiplane: consists of:
• Four levels: Baseline, Low dose, Peak dose and
Recovery
• Two columns:
- A Tri-plane mode column with simultaneous
acquisition of Apical 4 chamber, Apical 2 chamber and
Apical long axis views.
- A Bi-plane mode column with simultaneous acquisition
of Parasternal long axis and Parasternal short axis
views.
• Pharm. 4x3 Biplane: consists of:
Recovery
• Three columns:
of Apical 4 chamber, and Apical 2 chamber views.
of Apical 4 chamber and Apical long axis views.
views.
NOTE: This template acquires the 5 standard projections using only
biplane acquisition, this results in higher resolution / frame
rate than using tri-plane. The probe is fixed on the
4 chamber projection when acquiring both apical biplane
recordings (only the second plane is changing).
To create user-defined multi-plane stress template, see
page 6-43.

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Multi-plane Stress Echo acquisition
Baseline acquisitions
1. Scan plane 1 (yellow): acquire an Apical 4 chamber view.

2. Scan plane 2 (white): an Apical 2 chamber view is displayed.
3. Scan plane 3 (green): an Apical long axis view is displayed.
4. Active cell
Figure 6-10. The Baseline acquisition screen (Apical acquisition)
1. When in the Protocol screen with the Multi-plane stress

template selected, press Begin/Cont to start the stress test
acquisition.
2. The first Baseline view acquisition screen displays a
Tri-plane mode. The positions of the scan planes are set so
that the acquisition of an Apical 4 chamber view in scan
plane 1 (yellow) displays an Apical 2 chamber in scan

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Stress Echo
plane 2 (white) and an Apical long axis in scan plane 3

(green).
If required, fine tune the angle of scan plane 2 and 3 to get
optimal views in these scan planes and adjust the image
quality.
This template is set to preview cineloop before storing, use
the cineloop controls to select and adjust the most
appropriate heart cycle. Press Img. Store or Select to save
the cineloop.
4. The second Baseline view acquisition screen displays a
Bi-plane mode. The acquisition of a Parasternal long axis
view in scan plane 1 (yellow) displays a Parasternal short
axis in scan plane 2 (white).
If required, fine tune the position of scan plane 2 to display a
mid short axis view (on level with papillary muscles) and
adjust the image quality.

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1. Scan plane 1 (yellow): acquire a Parasternal long axis view.

2. Scan plane 2 (white): a Parasternal short axis view is displayed.
3. Active cell
Figure 6-11. The Baseline acquisition screen (Parasternal acquisition)
5. Press Image Store.

Select and adjust the most appropriate heart cycle. Press
Image Store or Select to save the cineloop.
The acquisition screen for the first Low dose level view is
displayed.

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Low dose and Peak dose level acquisitions

4. Active cell
5. Baseline acquisition corresponding to the current acquisition.
Figure 6-12. The Low dose acquisition screen (Apical acquisition)
1. When Show reference is enabled in the template, the

corresponding Baseline view is displayed on the left side of
the screen during Low dose and Peak dose acquisitions.
Acquire an Apical 4 chamber view in scan plane 1. The
angle and image adjustments done during Baseline
acquisition are automatically set for this acquisition (Smart
stress enabled).

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Img. Store or Select to save the cineloop.
The second Low dose level acquisition view (Bi-plane
mode) is displayed with the corresponding Baseline
acquisition.
1. Scan plane 1 (yellow): acquire a Parasternal long axis view.

2. Scan plane 2 (white): a Parasternal short axis view is displayed.
3. Active cell
4. Baseline acquisition corresponding to the current acquisition.
Figure 6-13. The Low dose acquisition screen (Parasternal acquisition)
3. Acquire a Parasternal long axis view in scan plane 1. The

position/angle and image adjustments done during Baseline
acquisition are automatically set for this acquisition.
Img. Store or Select to save the cineloop.

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The acquisition screen for the first Peak dose level

acquisition view (Tri-plane mode) and corresponding base
line acquisition are displayed.
5. Repeat step 1 to 4 to acquire Peak dose view.
6. The Stress template is set to start analysis automatically.
When the last acquisition is stored a dialogue window is
displayed asking the user to start analysis. Select Yes to
start the protocol analysis.
Multi-plane Stress Echo analysis

This section describes the basic procedure for image analysis
for the current example. Refer to ‘Stress Echo analysis’ on
page 6-15 for additional information.
1. Scan plane 1 (yellow): Apical 4 chamber, Baseline

2. Scan plane 1 (yellow): Apical 4 chamber, Low dose
3. Scan plane 1 (yellow): Apical 4 chamber, Peak dose
4. Corresponding Wall segment diagrams
5. Previous next images/group
Figure 6-14. Multi-plane Stress Echo analysis screen (Apical group, 4 chamber
acquisition)

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1. When starting analysis, the Stress echo analysis screen is

displayed, showing the first scan plane from the images in
the first group (Apical 4 chamber for all levels, acquired in
scan plane 1 (yellow) in Tri-plane mode) and the
corresponding wall segment diagrams.
2. Perform segment scoring.
3. Select the Right arrow in the lower right corner of the
screen to display the next scan planes from the images in
the first group (Apical 2 chamber for all three levels,
acquired in scan plane 2 (white) in Tri-plane mode).
the first group (Apical long axis for all three levels, acquired
in scan plane 3 (green) in Tri-plane mode).
screen to display the first scan plane from the images in the
second group (Parasternal long axis for all three levels,
acquired in scan plane 1 (yellow) in Bi-plane mode).
the second group (Parasternal short axis for all three levels,
acquired in scan plane 2 (white) in Bi-plane mode).
11. Press Patient and select End Exam.
The examination is stored.

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4D Stress Echo
4D Stress Echo requires specially designed stress templates

(factory or user-defined) that enable 4D data set acquisition. 4D
acquisition can be either ECG triggered (gated) acquisition over
two heart cycles or real time as defined in the stress template.
4D Stress Echo is only available on Vivid E9.
The following factory 4D stress templates are available:
• Pharm. 4x1 4D: consists of:
• Four levels with 4D acquisition: Baseline, Low dose,
Peak dose and Recovery
• One column (projection) with 4D acquisition.
• Pharm. 4x5 2D/4D: consists of:
Recovery
• Five columns (projections) as follow:
Four columns with 2D acquisition (PLAX, SAX-PM,
4-Ch and 2-Ch)
One column with 4D acquisition.
• Exercise 2x5 2D/4D: consist of:
• Two levels: Rest and Peak
• Five columns (projections) as follow:
Four columns with 2D acquisition (PLAX, SAX-PM,
4-Ch and 2-Ch)
One column with 4D acquisition.
To create user-defined 4D stress template, see page 6-43.
4D Stress Echo acquisition

The following example is based on the Pharm. 4x1 4D template
described above, with ECG triggered acquisition.

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Starting 4D Stress acquisition
1. When in the Protocol screen with the Pharm. 4x1 4D stress

template selected, press Begin/Cont to start the stress test
acquisition.
2. The Probe selection menu is displayed, if the selected probe
is not a 4D probe, select a 4D probe and a cardiac
application.
3. If the selected stress template is not the default template for
the application selected, a message is displayed asking the
user whether to use the current template as default template
for the selected application or not. Select No.
The Baseline acquisition screen is displayed.

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Baseline acquisition

4. Short axis view
5. Active cell
6. Navigator: displays rotation angle values for the scan planes 2 (A1) and 3 (A2) relative to the scan
plane 1.
Figure 6-15. The Baseline acquisition screen (4D Stress)
1. Acquire an Apical 4 Chamber view. The acquisition plane is

displayed in the upper right pane (Figure 6-15). When using
ECG triggering acquisition make sure that the probe and the
patient are not moving during the acquisition to minimize
spatial artefact. Refer to ‘Real time multi beat 4D acquisition’
on page 5-7 about recommendations for ECG triggered
acquisition.

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4D Stress Echo
The positions of the scan planes are set so that the

acquisition of an Apical 4 chamber view in scan plane 1
(yellow) will display an Apical 2 chamber in scan plane 2
(white) and an Apical long axis in scan plane 3 (green).You
may fine adjust the angle for the scan plane 2 and scan
plane 3 using the trackball assigned to respectively Angle 1
and Angle 2 (Press Trackball/Select to switch between
Angle 1 and Angle 2 assignments).
2. When no artifacts are seen over a few heart cycles, press
Img. Store. Press Img. Store again (or Select) to store the
acquisition.
The acquisition screen for the Low dose level view is
displayed.

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Low dose acquisition
A: Reference acquisition (Baseline)

B: Current acquisition (Low dose)
4. Short axis view
5. Active cell
6. Navigator: displays rotation angle values for the scan planes 2 (A1) and 3 (A2) relative to the scan
plane 1.
Figure 6-16. The Low dose acquisition screen (4D Stress)
1. When “Show reference” is enabled in the template, the

corresponding Baseline view is displayed on the left side of
the screen. Acquire an Apical 4 chamber view in scan
plane 1. The angle and image adjustments done during
Baseline acquisition are automatically set for this acquisition
(Smart stress enabled).

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To get a proper alignment between the Low dose and

baseline acquisitions, compare the current acquisition with
the reference view.
2. When no artifacts are seen over a few heart cycles and the
alignment between the Low dose and Baseline acquisitions
is correct, press Img. Store. Press Img. Store again (or
Select) to store the acquisition.
The acquisition screen for the Peak dose level view is
displayed.
Peak dose acquisition
1. The Peak dose acquisition procedure is similar to the Low

dose acquisition procedure. See procedure described in
‘Low dose acquisition’ on page 6-32.
After storing the Peak dose acquisition, the acquisition
screen for the Recovery level is displayed.
Recovery acquisition
1. The Recovery acquisition procedure is similar to the Low

dose acquisition procedure. See procedure described in
‘Low dose acquisition’ on page 6-32.
The Pharm. 4x1 4D Stress template is set to start analysis
automatically. When the last acquisition is stored a dialogue
window is displayed asking the user to start analysis.
2. Select Yes to start the protocol analysis.
4D Stress Echo analysis

The 4D Stress analysis consists of:
• Apical views analysis: segment scoring from 4 chamber,
2 chamber and Apical long axis views for all stress levels
• Short axis views analysis: segment scoring from apex, mid
and basal Short axis views for all stress levels.

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4D Stress Apical analysis
1. Baseline Apical 4 chamber view

2. Low dose Apical 4 chamber view
3. Peak dose Apical 4 chamber view
4. Recovery Apical 4 chamber view
Figure 6-17. 4D Stress Echo analysis screen (Apical 4 chamber view)
1. When starting analysis, the Stress echo analysis screen is

displayed, showing the Apical 4 chamber for all stress levels
and the corresponding wall segment diagrams.
2. If required, adjust Rotation to rotate the scan plan to get an
optimal Apical 4 chamber view. The rotation is applied
simultaneously in all views.
screen or Review page to display the Apical 2 chamber for
all stress levels. The segment diagrams are updated
accordingly.
5. If required rotate the scan planes and perform scoring.
screen or Review page to display the Apical long axis for all

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stress levels. The segment diagrams are updated

accordingly.
7. If required rotate the scan planes and perform scoring.
screen or Review page, the Short axis apex view and
corresponding segment diagram for all stress levels are
displayed.
4D Stress Short axis analysis
1. Baseline short axis apex view

2. Low dose short axis apex view
3. Peak dose short axis apex view
4. Recovery short axis apex view
5. Indicator window, the green bar indicates the position of the current short axis view. Can be translated
simultaneously in all views.
6. Indicator window, the yellow bars indicate upper and lower slices. Can be adjusted individually in each
stress level view.
Figure 6-18. 4D Stress Echo analysis screen (Short axis apex view)
1. The default position for the short axis apex view is at 17%
from the upper slice toward the lower slice. Adjust Translate
to translate the short axis apex view up or down. The
translation is applied in all stress level views simultaneously.

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NOTE: If the upper slice is placed at the top of the apex and the
lower slice is placed at the bottom of the basal segments,
then the position at 17% from the upper slice will show the
center of the apical segment.
The upper and lower slices may be adjusted individually in
each stress level view. Adjust the corresponding Top and
Bottom controls to set the upper and lower slices.
The positions of the upper and lower slices and the current
view can be visualized in the Indicator window.
screen or Review page to display the short axis mid view
for all stress levels.
The default position for the short axis mid view is at 50%
from the upper slice toward the lower slice. Adjust the short
axis mid view and top/bottom slices as described in step 1
above.
screen or Review page to display the short axis basal view
for all stress levels.
The default position for the short axis basal view is at 83%
from the upper slice toward the lower slice. Adjust the short
axis basal view and top/bottom slices as described in step 1
above.
7. Press Patient and select End Exam.
The examination is stored.

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Quantitative TVI Stress echo

analysis
WARNING QTVI Stress analysis is meant as a guide to wall motion

scoring.
Diagnosis must not be based on results achieved by QTVI
Stress analysis only.
The ultrasound unit provides a Quantitative TVI (QTVI) Stress

analysis package based on Tissue velocity information (TVI).
The TVI data is stored in a combined format with grey scale
imaging during stress examination.
When selecting a template supporting TVI data acquisition, the
ultrasound unit will automatically store TVI information,
generally for the apical views of the stress examination.
The QTVI Stress analysis option currently applies only to
Dobutamine stress-echo.
Wall Motion Scoring remains the basis for the diagnosis of CAD
in stress echocardiography. QTVI Stress may be used as a
guidance tool to check this interpretation.
The current version of QTVI Stress is based on the assessment
of peak velocity at peak Dobutamine stress (see reference 1 on
page 6-42). The normal ranges have been validated in the
“average” patient presenting for stress testing. The velocity
cutoff values for the Vpeak measurement will not work in the
following cases:
• Submaximal stress (<85% predicted max HR)
• Patients at extremes of age (<40 or >70)
• Previous myocardial infarction / revascularization
• Previous heart-failure / cardiomyopathy / hypertrophy /
arrhythmia / aortic regurgitation
The velocity cutoff values are based on placing the sample
volume at center of each cardiac segment at start of systole, the
left ventricle myocardial segments are defined by the American

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Society of Echocardiography 16 segments model. However, the

velocity cutoff model does not cover the apical segments (due to
low velocities and segment orientation), (see note).
NOTE: Velocity measurements in mid and basal segments of the
myocardium will contain contributions from the apical region of
the myocardium. E.g. if measured value in a mid segment is
below the cutoff value for this segment then this might relate to a
reduced function in the mid or apical region.
Tissue Doppler does not have perfect site-specificity because of
tethering by adjacent segments. Thus, although an ischemic
segment has little thickening (and therefore could be expected
to show low velocity), measured velocity may be influenced by
local tethering, reflecting contraction in surrounding segments.
Conversely, a normal segment may have its velocity reduced by
an adjacent segment with reduced velocity. This tethering effect
may decrease the sensitivity for single vessel disease, but
nonetheless the sensitivity and specificity of the cut-offs are
approximately 80% (see reference 1 on page 6-42).
Three different analysis tools based on TVI data are available:
• ‘Vpeak measurement’ on page 6-39, enables the display
of a tissue velocity trace for a selected region of a previously
scored segment through the entire heart cycle. In addition
Vpeak is color-coded on the 2D image. From the velocity
trace, the user can estimate the peak systolic velocity (see
reference 1 on page 6-42).
This tool is available in views from peak levels only and only
when a segment has been scored in one of these views.
• ‘Tissue Tracking’ on page 6-42, enables visualization of
the systolic contraction of the heart by color-coding the
myocardial displacement through the systole.
• ‘Quantitative analysis’ on page 6-42, enables further
quantitative analysis based on multiple tissue velocity
traces.
The quantitative analysis is described in Chapter
‘Quantitative Analysis’ on page 9-1.
Accessing QTVI Stress analysis tools

The three QTVI Stress analysis tools are entered by pressing a
dedicated button on the scoring diagram (see Figure 6-19) of
the selected view. Only views with TVI data acquired will display
QTVI Stress tools buttons on the respective diagrams.

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1. Vpeak measurement (V-peak measurement is 2. Tissue Tracking

displayed in views from peak levels and only 3. Quantitative analysis
after scoring.)
Figure 6-19. QTVI Stress tools buttons
Vpeak measurement
This tool enables the user to generate a tissue velocity profile for
a given wall segment through the entire heart cycle and display
color-coded Vpeak in tissue.
From the velocity trace, the user can determine whether the
systolic Vpeak is over or under a clinically determined velocity
threshold (see reference 1 on page 6-42) to confirm the wall
motion scoring.
CAUTION QTVI Stress can be used only in conjunction with wall motion
scoring analysis, as a guiding tool.
When activating QTVI Stress, the measurement applies only to
the currently highlighted segment for the current level and
projection view.
To display a Vpeak measurement
1. Perform segment scoring as described on page 6-17.

When performing scoring in a view from a peak level, the
Vpeak measurement button (V) is displayed in the
corresponding diagram.
2. In the Scoring diagram, press V.
The cursor is changed to sampling area and the scored
peak views are updated showing:

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• A diagram with the current segment highlighted (scoring

bullet with a ring) and the segment's velocity cutoff (see
Figure 6-20).
• Color-coded velocity in tissue. The color-coding
convention is as follow:
- Green: Velocities above threshold value + 5%
- Yellow: Velocities near threshold (+/- 5% interval)
- White: Velocities below threshold value - 5%
• A result window to display tissue velocity profile, shown
when moving the sampling area in the view.
3. In the 2D sector, place the sampling point over the wall area
corresponding to the current segment (shown as the
highlighted segment in the diagram).
A tissue velocity profile for the actual segment is generated
in the Result window (see Figure 6-20).
4. Use Segment Select to analyze the other segments in the
peak view,
Or
Select another scoring bullet in the diagram in one of the
peak views.

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1. Tissue velocity profile 4. Vpeak threshold for current segment

2. Sampling point 5. Color-coded tissue velocity:
3. Current segment
Color-coding (velocity thresholds and tissue):

• Green: velocities above threshold value
• Yellow: velocities near threshold (0 to -10% interval)
• White: velocities below threshold value - 10%
Figure 6-20. Vpeak QTVI Stress display
Turn-off the Vpeak measurement tool
1. Select the V button in the peak view scoring diagrams.
V-peak measurement interpretation
The systolic Vpeak in the tissue velocity profile is automatically

detected and highlighted by a vertical bar (see Figure 6-20). The
automatically detected Vpeak should be visually verified by the
user. In addition Vpeak thresholds are displayed as color-coded
horizontal lines (see Figure 6-20). These thresholds represent
statistical guideline values for peak velocity at peak stress level
(Dobutamine stress procedure) for the three apical views. Only
threshold values for basal and mid-segments for each apical
view are defined (see reference 1 on page 6-42). The result is
highlighted by a color-coding of the thresholds lines, the

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color-coding in the 2D image and the scoring bullet (see

Figure 6-20).
Tissue Tracking
Tissue Tracking calculates and color-codes the displacement in
tissue over a given time interval. The displacement is found as
the time integral (sum) of the tissue velocities during the given
time interval. The color-coded displacements calculated in the
myocardium are displayed as color overlay in the respective
acquisition window.
By studying the color patterns generated in the different
segments, the user can confirm the standard segmental wall
motion scoring at peak levels.
To display Tissue Tracking
1. Press T in one of the Wall segment diagram field (usually an

apical view at peak level).
The Tissue Tracking color overlay is displayed in the
Acquisition window.
Quantitative analysis
Quantitative analysis enables further analysis based on multiple
tissue velocity traces. Quantitative analysis is performed using
the Quantitative analysis package described in Chapter
‘Quantitative Analysis’ on page 9-1.
To start quantitative analysis
1. Press Q in one of the Wall segment diagram field (usually

an apical view at peak level) to launch the Quantitative
analysis package (see page 9-1).
References
1. Application of Tissue Doppler to Interpretation of
Dubotamine Echocardiography and Comparison With
Quantitative Coronary Angiography. Cain P, Baglin T,
Case C, Spicer D, Short L. and Marwick T H. Am. J. Cardiol.
2001; 87: 525-531

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Editing/creating a Stress Echo

protocol template
The stress package provides protocol templates for exercise as

well as pharmacological stress examinations. The user can
create new templates or modify existing templates to suit the
individual needs. Up to ten projections and fourteen stress
levels can be created in a template.
Multi-plane Stress Echo requires specially designed template,
see page 6-47 for more information.
Templates created may be temporary, used only during the
current examination, or saved as new templates, for future use
and reference. The editions that may be performed include:
• Adding/deleting levels and projections, page 6-44
• Assigning new labels to levels and projections, page 6-45
• Defining level options, page 6-45
• Defining new groups, page 6-46
Templates are edited/created from the Template editor screen.
Entering the Template editor screen

2. Press Template.
The Template menu is displayed.
3. Select Template Editor.
The Template editor screen is displayed (see Figure 6-21).

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Figure 6-21. The Template editor screen
Editing/Creating a template
Selecting a base template to edit
1. From the Template drop-down menu on the upper left corner

of the Template editor screen select a base template to edit.
NOTE: Determine the required number of projections and levels
you need and select the most appropriate foundation
template.
The selected template is displayed in the Protocol template
preview field, showing the levels and projections and their
labels.
Adding/deleting levels and projections
1. Enter the number of levels and projections in the Grid size

field (see Figure 6-21).
The new grid size is displayed in the Protocol template
preview field.
2. Press New Template to create a new template.
Or
Press Save Template to update the base template.

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NOTE: Factory templates cannot be changed.
Scan mode selection
1. From the Scan mode drop-down menu, select a scan mode

(e.g. 4D real time or gated, color... etc.) to be associated to
the actual column (projection).
Display timer(s)
1. Check the box(es) to display timer(s) as specified (see

Figure 6-21).
Start analysis automatically
1. Check Auto start analysis to display the Stress Echo

Analysis screen when the last acquisition is performed.
Smart stress
Check Smart stress to store a subset of the image acquisition

settings (e.g. geometry, zoom, gain, compress, reject,
power...etc) for each view in the protocol. Smart Stress enables
to set image acquisition settings for each view at baseline level
and automatically get the same image settings in the
corresponding views in the next levels. In Continuous capture
acquisition at peak stress, the active cell must be moved
manually through the views using the arrow buttons.
Assigning new labels to levels and projections
1. Select a label from the Label drop-down menu or type a new

label.
Configuring levels
The following options can be set up for each level:
Number of cycles to be stored in the cineloop

1. Enter the desired number in the Cycles field.
Up to four cycles/cineloop can be stored.
Continuous capture
1. Check Continuous capture if continuous image acquisition
throughout the level is desired.

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When Continuous capture is selected, preview of cineloop

and reference display (see below) during acquisition are not
possible.
Preview of store
1. Check Preview of store if review and adjustment of
cineloops before storage is desired.
Show reference
1. Check Show reference if the display of the corresponding
reference loop is desired during acquisition (dual screen
mode).
Adding a group
1. In the Protocol template preview field select the cells to be

part of the group.
2. In the Pre-defined group field, press New group.
A dialogue box is displayed asking the user to enter a name
for the new group.
3. Enter the group name.
4. Press OK.
The new group is displayed in the Pre-defined group field.
Updating an existing group
1. In the Pre-defined group field, select the group to edit.

2. Either select (a) new cell(s) to add to the group or deselect
(an) existing cell(s) to remove from the group.
3. Press Update group in the Pre-defined group field.
The display in the Protocol template preview field is updated
accordingly.
Deleting a group
1. In the Pre-defined group field, select the group to delete.

2. Press Delete group.
The group is removed from the list in the Pre-defined group
field.

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Multi-plane Stress Echo Template setup

The following example describes the creation of a Multi-plane
Stress Echo pharmacological protocol template consisting of:
• Three levels:
• Baseline
• Low dose
• Peak dose
• Two columns:
• A Tri-plane mode column with simultaneous acquisition
of Apical 4 chamber, Apical 2 chamber and Apical long
axis views.
• A Bi-plane mode column with simultaneous acquisition
views.
1. In the Grid size field, adjust the Number of levels to three
and the Number of projection views (columns) to two.
2. From the Label drop-down menu of the first column select
the label Tri Ap 4 2 LAX.
With this setting the system will automatically launch the
Tri-plane mode enabling simultaneous acquisition of Apical
4 chamber, 2 chamber and Long axis views in all levels in
the first column.
3. From the Label drop-down menu of the second column
select the label Bi PLAX SAX-PM.
With this setting the system will automatically launch the
Bi-plane mode enabling simultaneous acquisition of
Parasternal long axis and short axis views in all levels in the
second column.
4. Enter the labels for the three levels.
5. Make sure that Smart stress is checked. This will ensure
that all acquisition settings defined at Baseline will be
preserved in the next levels, including rotation and tilt angle
settings.
6. Delete any existing predefined groups (in case the template
is based on an existing template with groups already
defined).
7. Select all the views from the first column and select New
group.
The Group name window is displayed.
NOTE: You should not mix bi-plane and tri-plane recordings in the
same analysis group.

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8. Give the group a name (e.g. Apical) and press OK.

9. Likewise create a group for all the views from the second
column (e.g. Parasternal).
10. Adjust the other settings as required (see ‘Editing/Creating a
template’ on page 6-44 for additional information.
11. Select Save as template and give the template a name (e.g
Pharm. 3x2 Multiplane).
12. Select OK in the Template editor screen.
The new template is selected and the Protocol screen is
displayed.

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Configuration
Configuration
Each application can have a default stress protocol defined.

• Select a probe and an application.
• Press Utility/Config on the Touch panel and log on if
required.
• Select Imaging/Application.
• In the Application sheet (Figure 4-18 on page 4-47), select
the desired stress protocol in the Templates and Packages
field.

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Chapter 7
Contrast Imaging
‘Left Ventricular Contrast Imaging’ on page 7-5.
‘Contrast Low MI’ on page 7-8
‘Vascular/Abdominal Contrast Imaging’ on page 7-12

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Contrast Imaging
Introduction
The two basic steps of contrast imaging are data acquisition and
quantification. Data acquisition is described in this chapter.
Quantification is described in ‘Quantitative Analysis’ on
page 9-1.
Data acquisition
WARNING Appropriate training

Only physicians or echo technicians who have received
appropriate training can use the Contrast applications.
WARNING Always read and follow carefully the manufacturer instructions

on the contrast agent label.
NOTE: This system is designed for compatibility with commercially

available contrast agents. Because the availability of these
agents is subject to government regulation and approval,
product features intended for use with these agents may not be
commercially marketed nor made available before the contrast
agent is approved for use. Advanced contrast features are only
enabled on systems for delivery in countries or regions where
the agents are approved for use or for investigational or
research use.
CAUTION Cardiac rhythm disturbances during cardiac studies using gas

ultrasound contrast agents have been observed in the
diagnostic range of Mechanical Index (MI) values. See the
specific package insert for the contrast agent being used for
further details.

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Introduction
Cardiac imaging
• Left Ventricular Contrast imaging: The LV Contrast and

LVO Stress applications are optimized for endocardial
border detection and assessment of wall motion and wall
thickening. LVO Stress is optimized for higher heart rates.
Both applications require the LVO Contrast option enabled.
• Contrast Low MI: enables real-time imaging using a MI low
enough to generate little tissue signal whilst generating
sufficient signal from microbubbles. This allows continuous
imaging as the low MI avoids significant bubble destruction.
Microbubbles can be intentionally destroyed by a flash of
high MI ultrasound pulses and contrast replenishment is
then observed to allow qualitative and quantitative
assessment of the myocardium utilizing a contrast agent.
CAUTION The Contrast Low MI application is for research purposes only.

Diagnosis must not be based on results achieved by contrast
analysis alone.
CAUTION The Contrast Low MI application may not be available on your

system. Contrast agents for this application are undergoing
clinical trial and therefore not available in the United States.
Non-cardiac imaging
• Vascular Contrast imaging: optimized to visualize contrast

in larger vessels, e.g. carotid artery. Requires the Vascular/
Abdominal Contrast option enabled.
• Abdominal Contrast imaging: optimized to visualize
contrast agents in abdominal organs.
CAUTION The Vascular and Abdominal Contrast applications may not be

available on your system. Contrast agents for these
applications are undergoing clinical trial and therefore not
available in the United States.

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Quantification
Quantification enables the user to perform the following
analysis:
• Time-Intensity analysis: allows instant time-intensity
calculation from up to eight regions of interest.
• Curve fitting analysis: for research studies of myocardial
perfusion rates using contrast agents.
• Arbitrary Anatomical M-Mode (Curved and Straight):
M-Mode applied to intensity data calculates and color-codes
tissue along a path drawn by the operator vs. time.
WARNING Misdiagnosis based on image artifacts

Misdiagnosis in ultrasound contrast images may be caused by
several artifacts, most importantly:
Motion artifacts: gives rise to signals independently of
contrast presence. This may be caused by patient movement;
including respiration, or by probe movement influenced by the
operator.
Regional drop outs: caused by unintentional destruction of
the contrast agent, too low concentration of contrast agent,
poor acoustic penetration due to rib/lung shadows or system
failing to detect the contrast agent due to erroneous settings
induced by the operator.
Tissue harmonics: gives contrast-like signals independently
of the presence of contrast agent.
Useful link
The Contrast Echo Box: the European Society of Cardiology
provides useful information on contrast echocardiography on the
Internet here: http://www.escardio.org/communities/EACVI/
education/echo-box/contrast-echo-box/Pages/
welcome.aspx.

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Data acquisition
Data acquisition
Left Ventricular Contrast Imaging

The Left Ventricular (LV) Contrast application has an optimized
system preset for optimal resolution of endocardial borders and
for optimal assessment of wall motion and wall thickening.
The LV Contrast application may help to identify LV thrombus
and evaluate wall motion.
1. Parameter window
Figure 7-1. The LV Contrast acquisition screen

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Figure 7-2. The LV Contrast Touch panel
Using LV Contrast
The LV Contrast application works with the M5S-D, M5Sc-D,

3V-D, 4V-D and 6T-D probes.
1. Press Probe on the control panel.
A list of the connected probes is displayed.
2. Trackball to the desired probe supporting the LV Contrast
application.
The Application menu for the selected probe is listed.
3. Trackball to an LV Contrast application.
4. Press Select to launch the application.
5. By default Tissue Visualization is turned on in order to
correctly orient the probe after the application has been
selected.
6. Once oriented, turn off Tissue Visualization on the Touch
panel for optimized contrast detection and perform the
acquisition.
NOTE: If the amount of contrast injected is too high, you may press
Flash to destroy some of the contrast.

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Data acquisition
WARNING Always read and follow carefully the manufacturer instructions

on the contrast agent label.
Optimizing LV Contrast
If a swirling pattern is observed and persists after the LV cavity

has been filled with contrast agent, the power should be reduced
until homogenous opacification is obtained.
CAUTION Too high Power setting will destroy the contrast agent in the LV
cavity.

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Contrast Imaging
Contrast Low MI
Contrast Low MI enables real-time imaging using a MI low
enough to generate little tissue signal whilst generating sufficient
signal from microbubbles. This allows continuous imaging as the
low MI avoids significant bubble destruction. Microbubbles can
be intentionally destroyed by a flash of high MI ultrasound
pulses and contrast replenishment is then observed to allow
qualitative and quantitative assessment of the myocardium
utilizing a contrast agent.
CAUTION This application is intended for clinical research only. Diagnosis

must not be based on results achieved by contrast analysis
alone.
CAUTION This application may not be available on your system. Contrast

agents for this application are undergoing clinical trial and
therefore not available in the United States.
Figure 7-3. The Contrast Low MI Contrast acquisition screen

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Data acquisition
Figure 7-4. The Contrast Low MI Touch panel
Figure 7-5. The Contrast Touch panel
Using Contrast Low MI
The Contrast Low MI application works with the M5S-D, M5Sc-D

and 4V-D probes.
1. Press Probe on the control panel.
A list of the connected probes is displayed.

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Contrast Imaging
2. Trackball to the desired probe supporting the Contrast

Low MI application.
The Application menu for the selected probe is listed.
3. Trackball to the Contrast Low MI application.
4. Press Select to launch the application.
5. By default Tissue Visualization is turned on in order to
correctly orient the probe after the application has been
selected.
6. Once oriented, turn off Tissue Visualization on the Touch
panel for optimized contrast detection and acquire baseline
images.
7. Press Img. Store to save the baseline acquisition.
8. Prepare and administer the contrast agent as described by
the manufacturer.
WARNING Always read and follow carefully the manufacturer

instructions on the contrast agent label.
9. Press Flash on the Touch panel when the contrast agent

has reached a stable level (infusion) or just after peak (bolus
injection). The contrast agent is destroyed in the
myocardium.
NOTE: To flash in a region of interest only, press Color on the
Control panel, position the ROI with the trackball and when
required, press Flash located on the Contrast tab or Color
tab on the Touch panel (Flash on the 2D tab will flash the
entire 2D sector).
10. Wait approximately ten heartbeats observing contrast
wash-in.
11. Press Freeze on the Control panel.
12. Adjust Cycle select and Num cycles to define the cineloop
to store.
13. Press Img. Store to save the contrast acquisition.
NOTE: The application can be preset to automatically save
N cardiac cycles (see ‘Application presets’ on page 4-46).

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Data acquisition
Additional controls
The following controls can be used during the Contrast Low MI

acquisition from the Contrast tab on the Touch panel.
• Flash frames: adjust the length of the Flash specified in
number of frames. The current value is displayed in the info
window. The duration of the Flash depends on the actual
frame rate.
• Flash MI Limit: adjust the maximum desired MI of the
Flash. An MI of 1.0 is default. If the maximum desired MI is
not being achieved during Flash, adjust Focus, Frequency
and/or Depth. The MI Limit is displayed in the information
window. The MI during flash is displayed in the Status bar at
the bottom of the screen.
• Flash Trig: flashing begins after the next detected QRS
complex with a delay relative to a percentage of the heart
cycle. The default value is 70%.
NOTE: If no ECG is present, Flashing will occur instantaneously
without regard to the heart cycle.
• ECG trig: enable intermittent imaging based on the ECG.
The ECG trigging parameters can be adjusted from the
Physio tab on the Touch panel (see ‘ECG Trigging’ on
page 3-16).
• Dual trig: enable intermittent imaging with two ECG
triggered frames (primary and secondary). In this mode the
scanner activates a dual display, where the primary frames
are displayed on the left side, whereas all frames (both
primary and secondary) are displayed on the right side. The
Dual trig parameters can be adjusted from the Physio tab
on the Touch panel.
• Timers T1 and T2: press T1 or T2 once to start a timer,
press again to stop the timer.

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Contrast Imaging
Vascular/Abdominal Contrast Imaging
CAUTION The Vascular and Abdominal Contrast applications may not be

available on your system. Contrast agents for these
applications are undergoing clinical trial and therefore not
available in the United States.
NOTE: This system is designed for compatibility with commercially

available contrast agents. Because the availability of these
agents is subject to government regulation and approval,
product features intended for use with these agents may not be
commercially marketed nor made available before the contrast
agent is approved for use. Advanced contrast features are only
enabled on systems for delivery in countries or regions where
the agents are approved for use or for investigational or
research use.
Vascular Contrast is intended for visualization of ultrasound
contrast agents in large vessels (e.g. carotid artery and femoral
artery).
The Vascular Contrast application works with the 9L-D probe.
Abdominal Contrast optimized to visualize contrast agents in
abdominal organs.
The Abdominal Contrast application works with the C1-5-D
probe.
NOTE: The Vascular and Abdominal Contrast applications require the
Vascular/Abdominal Contrast option enabled.

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Chapter 8
Measurements and analysis
‘Assign and Measure modality’ on page 8-6
‘Measure and Assign modality’ on page 8-8
‘Measurements on protocol images’ on page 8-10
‘Advanced cardiac measurements and analysis’ on

page 8-11
‘4D/Multi-plane LV measurements and analysis’ on

page 8-45
‘4D MV-Assessment’ on page 8-65
‘Advanced vascular measurements and analysis’ on

page 8-66
‘OB measurements’ on page 8-70
‘Measurement package configuration’ on page 8-76
‘Measurement result table’ on page 8-96

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‘Worksheet’ on page 8-97.

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Introduction
Introduction
The ultrasound unit provides functionality for two measurement

conventions:
• Assign and Measure (Measure Protocols): the user
selects a study consisting in a set of pre-labeled
measurements related to the active scanning mode and
clinical application. The user is prompted through the
measurements in the order of the measurement labels. This
convention is started from the Measure button on the
control panel. A set of tools is implemented to make the
measurement process as fast and easy as possible for the
user:
• The user is guided through the study: an auto-sequence
functionality automatically selects the next
measurement in a study.
• The selected measurement is highlighted in the
Measurement menu.
• The performed measurement is indicated in the
Measurement menu.
The studies and their parameters are user-configurable. The
user can create its own studies containing the relevant
measurements (see page 8-76).
• Measure and Assign (Free style): the user performs a
measurement and assigns a label. This convention is
started either from Measure or Caliper button on the
Control panel.
CAUTION Only assigned measurements are saved when ending the

examination.
After doing measurements, the system automatically makes the

calculations related to the measurements performed.
Measurements and calculations are displayed in the
Measurements result table (see page 8-96).

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Assigned measurements and calculations are automatically

gathered into a Worksheet and used to populate the patient
report.
General recommendations about measurements

• When doing time-measurements in Doppler or M-Mode, it is
recommended to freeze the 2D image during acquisition.
• Distance and area measurements should be done on
greyscale 2D images or slice mode images if in 4D, not on
color flow or TVI-based images. Similarly, in M-Mode,
distance measurements should be done on greyscale
M-mode images and not on color M-mode images. If doing
Color M-Mode measurements of propagation of flow, please
refer to your specific laboratory protocols.
About Measurement results display

Be aware of the following:
• Measurement results display
By default the system always displays absolute values for
parameters measured in Doppler. This means that values
from above and below baseline will all be displayed as
positive results.
For Cardiac this behavior cannot be changed. For
non-Cardiac the Absolute Value setting can be turned off in
Config -> Meas/Text -> Advanced, by setting the attribute
Absolute Value to Off.
• Calculated parameters
For calculated parameters the system uses signed values in
calculation formulas, and displays the absolute value of the
result.
• When a parameter is measured several times the individual
values for the parameter will be listed in the m1, m2...
columns in the worksheet. The Value column in the
worksheet will contain a derived value for the parameter,
e.g. the average of the individual values (Figure 8-1).
When calculating formula derived parameters, the m1, m2...
columns in the worksheet contain calculated values based
on the individual input parameter values in the same column
(Figure 8-1). The Value column contains calculated values
based on the input parameter values in the Value column.

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Introduction
Figure 8-1. Measurement result window (A) and Worksheet (B)
The Measurement result window always displays values

from the m1, m2... columns. It is therefore recommended to
consult the worksheet (see page 8-97) to get an overview of
measured and calculated parameters.

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1. Measurement category for the 6. Access to other studies for the current measurement category.
current application 7. Controls for the current measurement
2. Study 8. General controls for the measurement application
3. Opened study
4. Performed measurement
5. Pre-selected measurement
Figure 8-2. Example of a measurement study
1. Press Measure on the control panel.

The Measurement menu is displayed, showing the
measurement category for the current application
(Figure 8-2).
The cursor is in the scanning window, ready for a caliper
measurement.
To change Measurement category:
1. Select the heading in the Measurement menu and choose
another category.
NOTE: This can also be done from the Touch panel (page 2).
To perform measurements from a study:
1. Select a study (folder).

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The study folder is opened and the first measurement is

selected.
NOTE: This can also be done from the Touch panel: press Folder
and select a study.
2. Perform the measurement. Follow the instructions displayed
on screen.
Make sure to follow the current medical practices when
placing the specific points on the image.
If the folder is configured with auto-sequence measurement
(see page 8-77), the next measurement in the study is
pre-selected. To skip a pre-selected measurement, select
another measurement.
Completed measurements are marked with a check mark.

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1. Press Caliper on the Control panel and select the desired

measurement tool.
Or
Press Measure and select the desired measurement tool in
the Generic folder in Measurement menu.
Figure 8-3. Measurement tools
2. Perform the measurement. Follow the instructions displayed

on screen.
Make sure to follow the current medical practices when
placing the specific points on the image.
NOTE: The system supports up to 15 separate measurements per
M&A session. When exceeding this limit the measurements
are still correct but will no longer have unique labelling for
the tool graphics and results.
3. To assign a label, select the measurement in the
Measurement result table and select the required label.

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1. Label menu
Assignment
1. Assigned measurement
Figure 8-4. Measurement assignment
Measurements on volume renderings

Distance and area measurements can be done on 4D volume
renderings from a 4D acquisition.
1. Perform a distance or area measurement on a 4D
acquisition by selecting either Distance (Crop plane) or
Area (Crop plane) measurement tool.
CAUTION When measuring on a volume rendering, the measurement

is actually performed on the displayed crop plane and the
depth information is NOT taken into account.
It is recommended to use parallel crop (see ‘Parallel
cropping’ on page 5-31) with a short distance between the
crop planes.
Be aware that the Gain adjustment (2D and 4D Gain) may
impact the display of the anatomical structures to measure.

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Measurements on protocol images
When performing measurements on images acquired in a

protocol, the measurement results will be associated with the
protocol level of the image. Average values will be calculated for
each protocol level.
For example you may measure LVOT Diam for images acquired
outside protocol and for images on each level of an
Exercise 2x4 protocol, leading to the following results in
worksheet:
Parameter Value Method m1 m2
LVOT Diam 1.0 cm Average 1.1 0.9
LVOT Diam, Rest 1.1 cm Average 1.0 1.2
LVOT Diam, Peak 1.2 cm Average 1.2
CAUTION Measurement results associated with a stress level will not be

updated if the image is moved to another stress level at a later
time. Images should be correctly placed in the protocol when
performing measurements.

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Advanced cardiac measurements

and analysis
Event timing measurements

Event timing enables the time measurement for opening and
closure of the Aortic and Mitral valves, as referred to the
automatically detected QRS marker, which normally is on the
rising slope of the R-wave.
Event timing can be performed on a Doppler spectrum or an
M-Mode acquisition showing the corresponding valves. The
procedure is similar in both modes. In addition event timing can
be done on traces in Q Analysis. The measurements are shown
as dashed lines in the Analysis window and Anatomical M-Mode
window in Q Analysis.
The measurements can be used as default start and end times
for TSI.
1. Generate the spectrum or M-Mode image to be measured.
2. Press Freeze to stop the cineloop.
3. Press Measure on the Control Panel.
4. Select Event Timing in the Measurement menu.
The following event timing measurements are available
(with the first measurement on the list selected):
• AVO: Aortic Valve Opening
• AVC: Aortic Valve Closure
• MVO: Mitral Valve Opening
• MVC: Mitral Valve Closure
5. Place the cursor to the corresponding point on the spectrum
for the selected measurement.
6. Press Select to anchor the point.
The event timing measurement (ms) is displayed in the
Measurement result table.
When an event timing measurement is performed, the QRS
markers are displayed on the ECG trace and correct QRS

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marker position should be verified before the Event Timing

measurements are performed.
TSI Measurements
Each sample in the TSI image represents the time to the
maximum velocity within the chosen TSI search interval from
TSI Start to TSI End. (See page 4-25 on how to set the TSI
search interval.)
There are two automatic TSI time to peak measurement tools:
• Generic TSI Time to peak measurement: displays the TSI
value at the location point set by the user.
• Segmental TSI Time to peak measurement: measures the
time to peak velocity in specific wall segments and gets
automatically calculated TSI indexes based on these
measurements. The measurements may be presented in a
color coded Bull's eye diagram.
Alternatively, time to peak measurement can be done in
Q Analysis by manually measuring the time between the QRS
marker and the peak velocity on the velocity trace.
Generic Time to peak measurement
1. Acquire a TSI apical loop.

2. Press Measure.
3. In the Measurement menu, select Generic and Time to
peak (see Figure 8-5).
The TSI loop freezes at the TSI end frame.
4. Place a point in the middle of a basal or mid-level
myocardial segment in the TSI image.
5. The Time to peak value for the segment is displayed in the
Measurement result window.
NOTE: To judge the quality of your data at the measuring point in
the 2D image the TSI trace may be used (see ‘TSI trace’ on
page 8-15). See also the Caution text on page 8-18.

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Figure 8-5. TSI Generic Time to peak measurement screen
Segment Time to peak measurements
1. Acquire TSI loops from all three apical views.

2. Press Measure and select the TSI time study.
The TSI loop freezes at the TSI end frame.
The first measurement in the study is automatically selected
(see Figure 8-6).
3. Place a point in the middle of the corresponding segment in
the TSI image.
The Time to peak and the Peak velocity for the segment are
displayed in the Measurement result window.
4. Perform a measurement for all basal and mid-level
segments in all three apical views.
In addition to the Time to peak and the Peak velocity for
each segment, the following TSI indexes are calculated:
• Septal lateral delay: difference in Time to peak velocity
in the basal lateral wall and basal septum.

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• Septal posterior delay: difference in Time to peak

velocity in the basal posterior wall and the basal
antero-septum.
• Basal seg. max diff.: difference between the maximum
and minimum time to peak measurements in the six
basal segments. Requires at least four of the six basal
segment measurements.
• Basal standard deviation: the standard deviation of the
time to peak measurements in the six basal segments.
Requires at least four of the six basal segment
measurements.
• All seg. max diff.: difference between the maximum and
minimum time to peak measurements in all the
measured basal and mid level segments. Requires at
least eight of the twelve segmental measurements.
• All segments standard deviation: the standard deviation
of the time to peak measurements in all measured basal
and mid level segments. Requires at least eight of the
twelve segmental measurements.
The TSI indexes indicate degrees of asynchrony in time to
peak velocity
5. Select TSI Bull’s eye report in the Measurement menu.
The measurements are displayed in a color coded bull’s eye
diagram together with a list of the calculated TSI indexes.

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Figure 8-6. Segment Time to peak measurements screen
TSI trace
The TSI Time to peak measurement can be verified and

eventually manually changed from the TSI trace.
1. Double click on the measurement point.
The ROI and the corresponding TSI curve are displayed
(see Figure 8-7).
2. Press Select to anchor the ROI and trace.
3. If required, select a new peak location in the trace.
4. Click in the acquisition window to exit the TSI trace.

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1. TSI ROI
2. TSI trace
3. TSI Time to peak marker
Figure 8-7. TSI trace
Time to peak measurement in Q Analysis
1. From a TSI apical loop, press Q Analysis.

2. Place a sample area in a myocardial segment.
A velocity trace is displayed in the Analysis window (see
Figure 8-8).
3. Press Measure.
4. In the Measurement menu, select Generic and Time.
NOTE: If Time is not available in the Generic folder, Press Active
Mode on the Control panel.
5. In the Analysis window, measure the time from the yellow
QRS marker to the peak velocity of the velocity trace.

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1. Time measurement tool

2. Sample area
3. QRS marker
4. Time to peak measurement
Figure 8-8. Manual TSI Time to peak measurement in Q Analysis
NOTE: It is possible to do a Generic or a Segment Time to peak

measurement from within Q Analysis and compare the result
with a manual Time to peak measurement. To access the
corresponding measurement tool in Q Analysis you may have to
press Active mode to display the relevant Measurement menu.

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CAUTION The Time to peak measurement in Q Analysis may differ from

the TSI Time to peak measurements due to the following
considerations:
• The TSI Time to peak measurements find the maximum
velocity only within the TSI search interval. If the desired
peak on the velocity trace is outside the TSI search
interval, the TSI Time to peak measurements will return a
different result than the manual Time to peak
measurement.
• If the maximum velocity is at one of the ends of the TSI
search interval, the TSI time to peak measurements return
the time of the end of the TSI search interval. In some
cases the falling flank of an iso-volumic contraction peak at
the time of TSI Start or the rising flank of a post-systolic
contraction peak at the time of TSI End may be detected.
In a manual measurement the time to a peak within the TSI
search interval with a lower velocity than the velocity at the
end of the interval may be measured instead. The color
map TSI Trace may be used to identify regions in the
image where the peak detection is near the ends of the TSI
search interval. The TSI Trace tool should be used to verify
TSI measurements in the identified regions.
• If there are two or more peaks of comparable velocity
within the TSI search interval, or a poor signal quality, the
TSI Time to peak measurements may return the time to a
different peak than what a manual method would do.
Typically in these situations, the TSI image will show a
wide range of colors over a small spatial region.

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Automated Function Imaging

Automated Function Imaging (AFI) is a decision support tool for
regional assessment of the LV systolic function. AFI is a tool
derived from 2D Strain, which calculates the myocardial tissue
deformation based on feature tracking on 2D grey scale loops.
AFI is performed on apical views in the following order: apical
long-axis, 4-chamber and 2-chamber view, following an on
screen guided workflow (see also Figure 8-9). The apical views
may be acquired sequentially in 2D mode, or simultaneously in
Tri-plane mode.
AFI is also available for standard apical views acquired with a
TEE probe.
The result is presented as a Bull’s eye display showing color
coded and numerical values for peak systolic longitudinal strain.
The result can also be presented as a Bull’s eye with a score
index (Auto scoring).
All values are stored to the worksheet. In addition, Global Strain
for each view, Average Global Strain for the whole LV and the
Aortic Valve Closure time used in the analysis are stored to the
worksheet.

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APLAX 4-Ch 2-Ch Step
Acquired views
Automatic ROI creation
Tracking validation
AVC timing adjustment
Parametric image result
Trace and Bull’s eye result
Figure 8-9. AFI workflow

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Acquisition
CAUTION AFI is only recommended for adult cardiac images acquired

with the following probes: M5Sc-D, M5S-D, 6T, 6Tc, 3V-D, 4V-D
or 6VT-D. The measurement accuracies of the longitudinal
strain values reported in the Reference manual are verified with
these probes.
1. Create an exam, connect the ECG device and make sure to

obtain a stable ECG trace.
2. Sequential acquisition:
• Acquire 2D grey scale cineloops of an Apical long axis
(APLAX) view, an Apical 4 chamber view and an Apical
2 chamber view.
NOTE: It is recommended to acquire all three apical views
sequentially in order to get similar heart rate in all views.
Simultaneous acquisition:
• Acquire all three planes in Tri-plane mode using a 4D
probe (not available with the 6VT-D probe). See
‘Multi-plane mode’ on page 5-45 for more information
about Tri-plane acquisition.
• The frame rate should be between 40 and 80 frames per
second. A higher frame rate is recommended for high heart
rate.
• The scanner should be configured to store 100 ms before
and after each heart cycle.
• If the acquisition has more than one heart cycle, the
analysis will be done on the second to last heart cycle.
• The entire myocardium should be visible.
• A depth range that includes the entire left ventricle should
be used.
Starting AFI
Starting AFI from sequential acquisition

1. Open an APLAX view and press Measure.
2. In the Measurement menu, select AFI.
The View selection menu is displayed (see Figure 8-10).

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Figure 8-10. Measurement and View selection menus
Starting AFI from simultaneous acquisition (Tri-plane

acquisition)
1. Open a Tri-plane acquisition and press Measure.
2. In the Measurement menu, select AFI.
The AFI application is started displaying the APLAX view.
CAUTION When performing AFI on all three apical views, the user is
asked to start with the APLAX view. This allows manual
adjustment of the Aortic Valve Closure (AVC) event timing that
is used in the calculation of the longitudinal systolic strain in all
apical views.
AFI on the APLAX view
1. Select APLAX in the View selection menu.

A ROI following the endocardium is created and the
Tracking validation screen is displayed.

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1. Display Quick Tips on tracking quality assessment

2. The ROI divided in segments
3. The Scoring table
• : acceptable tracking
• : not acceptable tracking
4. Bull’s eye icon:
• Green sectors with yellow border: views being analyzed.
• Green sectors: views already analyzed.
• Black sectors: views not analyzed.
Figure 8-11. Tracking validation screen
2. Pay attention on the left/right orientation of the image:

compare the LV wall names with a visual inspection of the
image.
If the image orientation is wrong create a new ROI manually
as described in the section ‘To create a new ROI’ on
page 8-26. Make sure to place the basal points correctly
relative to the image landmarks when defining the ROI.
NOTE: You may alternatively exit AFI, invert the image and start
AFI again.
The ROI is divided into segments. The tracking quality for
each segment is automatically evaluated and summarized
in the Scoring table (see Figure 8-11).
The tracking for each segment must be visually controlled
and validated as described below.

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Tracking validation
CAUTION Poor tracking quality may lead to incorrect measurement

results. The tracking for each segment must be visually
controlled and validated.
Poor tracking quality could result from a variety of causes.

Select Quick tips (see Figure 8-11) to get tips on the most
common causes for bad tracking. The common causes for bad
tracking are:
• Erroneous placement of the basal points when defining the
ROI. If the basal points are placed too far from the annular
region, the ROI segments at the annular base will not move
together with the underlying 2D image throughout the entire
heart beat (see example cineloops in the Quick tips).
• Erroneous placement of the apex point when defining the
ROI. The point should be placed so that the resulting ROI
covers mainly the myocardium. If the apex point is placed
too high, the ROI will mainly cover the epicardium resulting
in poor tracking (see example cineloops in the Quick tips).
• Too narrow ROI width. Narrowing the ROI too much will
result in poor tracking due to lack of tissue data in the ROI
(see example cineloops in the Quick tips).
• Too much clutter. Images with too much static clutter will
result in poor tracking (see example cineloops in the Quick
tips).
1. Inspect each segment and make sure that the center line is
moving together with the underlying 2D image.
The tracking quality is automatically evaluated for each
segment and displayed in the Scoring table.
The tracking in each segment is scored as either Acceptable
( ) or Not acceptable ( ).
If the tracking needs to be improved for some segments, the
user can modify the ROI or create a new ROI as described
in ‘ROI adjustment’ on page 8-25.
The user may override the tracking quality evaluation done
by the system by clicking on the evaluation result in the
Scoring table.
2. Once the tracking quality has been controlled for all
segments, press Approve in the Scoring table.
The user is asked to confirm or adjust the AVC timing setting
(see ‘Timing validation’ on page 8-30).

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ROI adjustment
If the automatic ROI is not optimal resulting in poor tracking, the
user can either adjust the ROI or create a new ROI as described
below.
To adjust the ROI

1. Press Recalc.
2. The following adjustments can be done to the existing ROI:
• Adjust ROI Width.
• Adjust the shape of the existing ROI: move the cursor
over the inner ROI border, select an anchor point and
move it to a new location. The shape of the ROI is
updated accordingly.
Figure 8-12. Selected anchor point on the inner ROI border
Data processing is started automatically if the cursor is not

moved for a few seconds.
NOTE: If the ROI needs to be adjusted make sure to make the
changes immediately after the ROI is displayed.
NOTE: The auto processing function is configurable (from Config/
Meas-Text/Advanced/AFI auto processing).

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Figure 8-13. AFI auto processing configuration
The Tracking validation screen is displayed.

3. Perform Tracking validation (see ‘Tracking validation’ on
page 8-24).
To create a new ROI

1. Press Recalc.
2. Press New ROI to re-define the ROI.
The system automatically displays a frame where the
endocardial border is usually clearly visible. To use another
frame, adjust Init frame.
3. To define a ROI, place three points at the endocardial
border; two annular points and one at the apex (see
Figure 8-14). Follow the indications displayed next to the
pointer and on the Status bar when placing the three points.
NOTE: The Yo-yo function is turned on to help find correct location
for the points.

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Figure 8-14. Defining a ROI
After placing the apex point the ROI is displayed.

NOTE: Correct ROI definition is important for an accurate strain
measurement. The system has an adaptive ROI function:
using the endocardial three points as a guide, the system
will analyze the image and automatically adapt the ROI to
an optimal position.
Data processing is started automatically if the cursor is not
moved for a few seconds.
The Tracking validation screen is displayed.
4. Perform Tracking validation (see ‘Tracking validation’ on
page 8-24).
Quick tips when re-creating the ROI

Correct ROI definition is crucial to get good tracking. Refer to
the example displayed in the Tip window for correct point
placements. To display additional guidelines, select Click for

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Tip. Make sure to follow the recommendations when placing the

three points (see below).
Base Correct Wrong
1. Correct position of the base

points.
2. The ROI extends into the
aortic tract.
Apex Correct Wrong
1. Correct position of the Apex

point.
2. The apex point is placed too
high. The ROI is extending
beyond the epicardium.

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Apex Correct Wrong
1. Correct position of the Apex

point.
2. The upper right border of the
ROI is way too much into the
chamber cavity.
Bulges Correct Wrong
1. Correct ROI.
2. ROI should not be bulging or
follow the papillary muscle.
To edit the ROI, see ‘ROI
adjustment’ on page 8-25.

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General Correct Wrong
The left ventricle must be visible

through the entire cycle.
1. End systole frame: the entire
left ventricle is displayed.
2. End diastole frame: the
annulus is not displayed.
Timing validation
Timing information may be crucial to accurate diagnosis. The
most important event timing is the aortic valve closure (AVC),
since it is part of the definition of the end systolic strain
parameter.
Determination of the AVC timing by the system is as follows,
depending on the situation:
• If AVC timing has been measured by the operator (through
an event timing measurement, see page 8-11) prior to
running AFI, the system is using this data.
• If event timing is not available, an automatic AVC estimate is
used, determined by the temporal contraction of all LV
segments (Strain curves).
• From the APLAX view, the user can adjust the estimated
AVC timing. The adjusted AVC timing will then be used in
the other apical views when running AFI on these views.
This option is only available from the APLAX view.
AVC timing adjustment

This procedure is available in the APLAX view only.
1. After validation of the tracking quality, the frame for the
current AVC setting (automatic or event timing
measurement) is displayed and highlighted on the ECG.
2. To keep the current AVC setting, press Select. To change
the AVC setting, use the trackball to display another frame
and press Select.
If the AVC setting was changed, a Confirmation window is
displayed. Select one of the following options:

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• Manual to accept the manual AVC setting.

• Event timing to discard the manual AVC setting (if for
example the AVC setting was not possible to assess
from the APLAX view). The AVC event timing
measurement will then be used.
NOTE: This choice is only visible if AVC event timing has been
done.
• Auto to discard the manual AVC setting and use the
automatic AVC timing.
The Parametric systolic strain APLAX view is displayed (see
Figure 8-15).
Figure 8-15. Parametric systolic strain APLAX view
NOTE: The image will not be saved unless Img. Store is pressed.
Press Quad screen to display a quad screen (see
Figure 8-16) showing:
• 2D image with the ROI
• 2D image with Peak systolic strain parametric data
• Segmental curves with peak marker
• M-Mode image with strain parametric data

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Figure 8-16. Quad screen for the APLAX view
NOTE: The Quad screen will not be saved unless Img. Store is
pressed.
AFI on A4-Ch and A2-Ch views
The procedure for AFI on Apical 4-chamber and 2-chamber

views is similar to the one used in the APLAX view.
For sequential acquisition
1. Open the apical view from the clipboard.
2. Select the corresponding view in the View selection menu
(see Figure 8-10).
3. Validate tracking (see page 8-24).
For simultaneous acquisition (Tri-plane acquisition)

1. Press Next view on the Touch panel to display the next
Apical view.
2. Validate tracking (see page 8-24).
NOTE: The AVC timing setting defined in the APLAX view is used by
the system when running AFI on the other apical views.

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Results
For the APLAX and apical 4-chamber views the following results
are available:
• Single screen (see Figure 8-15) displaying a 2D image with
strain parametric data.
• Quad screen (see Figure 8-16) displaying:
• 2D image with the ROI
• 2D image with Peak systolic strain parametric data
• M-Mode image with strain data
• Segmental curves
CAUTION If auto-AVC is used as AVC timing calculation method

when running AFI (see page 8-30), the strain values
displayed in the Quad screen for the APLAX and
4 Chamber views may differ from the strain values
obtained after the system has performed the final
calculation from all three views. The reason for this is that
the Auto-AVC calculation derived from all three views is
most accurate and may be different from the intermediate
AVC calculations used for each view. The strain values
displayed in the Quad screen on APLAX and 4 Chamber
views are therefor preliminary values (A warning text about
this is displayed on the Quad screen). Only final strain
values should be reported. Note: If you enter Quad screen
again after all three loops have been processed, the strain
values will be correct.
When performing AFI on all three apical views the following

results are also available:
• Bull’s Eye and Traces screen (Figure 8-17) displaying:
• Segmental curves for each three Apical views
• Bull’s eye presentation with segmental Peak systolic
strain color coding and segmental Peak systolic strain
values.
• Bull’s Eye Only screen (see Figure 8-18) displaying:
• Bull’s eye presentation with segmental Peak systolic
strain color coding and segmental Peak systolic strain
values
NOTE: The Bull’s eye can be configured to display either 18 or
17 segments (from Config/Meas-Text/Advanced/AFI
Segment model).

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NOTE: Press BE Maps to select another color map for the

Bull’s eye.
NOTE: The system can be configured so that the user can also
choose to display Post systolic strain index (PSI) color
coding and segmental PSI values in the Bull’s eye (from
Config/Meas-Text/Advanced/AFI).
• Global Strain (GS) values for all three apical views.
In a given view the Global Strain (GS), also called
Global Longitudinal Peak Strain (GLPS), is defined as
the percentage of maximal contraction over the whole
cardiac cycle of the entire myocardial wall relative to its
end diastolic length.
• Averaged Global Strain value from all three apical view
data.
• AVC measurement (either automatic, event timing
measurement or manual, see page 8-30)
Getting the results

When approving the tracking in the Apical 2-chamber the Bull’s
Eye and Traces screen with segmental curves and Bull’s eye is
displayed (Figure 8-17). Select Bull’s eye only to display the
Bull’s Eye Only screen (Figure 8-18).
Figure 8-17. Quad screen

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Figure 8-18. Bull’s Eye Only screen
To save the results, exit AFI and answer yes to the question “Do
you want to store?”. Once the results are saved, the
measurements are available in the Worksheet and can be used
in the report.
If the tracking quality of a segment was scored as Not
acceptable ( ), the colorimetric display on the Bull’s eye
is greyed (see Figure 8-19).

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1. Segment with tracking quality scored as Not acceptable ( ).
Figure 8-19. Colorimetric display
Peak detection
The peak systolic strain detection for each segment can be
verified and eventually manually changed.
To adjust the peak detection:
1. Press BE+Traces.
The Bull's Eye and Traces screen is displayed (see
Figure 8-17) showing:
• Trace plots for all three loops
• Bull's Eye with Peak systolic strain values
2. To change the peak marker position on a curve:
• Press Select on the peak marker (square point) on one
of the curves, move the peak marker to a new position
and press the Select key again to fix the point.
OR
• Place the cursor on a segment in the Bull's Eye. The
corresponding curve is highlighted.
Click on the segment to select the corresponding peak
marker and move it to a new position.
The position of the AVC marker can also be checked in the Bull's
Eye and Traces screen. If needed, the APLAX view should be
reprocessed to change the AVC time.

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About the results

• Clinical assessments should be made based on both color
and segmental Peak systolic strain values.
• The Save As function is intended for research purposes and
should not be used to archive diagnostic data.
• To populate the worksheet and the report the Bull’s Eye
Only screen must be saved.
• All results shown (curves, colors and values) are based on
drift compensated values. Any strain drifting is linearly
compensated throughout the cycle. If the drift compensation
in a given segment is too high, the tracking quality is
automatically set to Not acceptable (X).
• If the tracking quality was scored as Not acceptable (X) in
more than one segment, the Global Strain value is not
calculated.
Reprocessing data
The data from one or several views from a saved AFI analysis
may be reprocessed. When reprocessing an AFI analysis new
result screens are created.
1. Double-click on the Bull’s eye thumbnail.
A quad screen is displayed showing the three apical views
and the Bull’s eye diagram.
2. Select the view to reprocess and perform the analysis as
described on page 8-22.

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AutoEF measurements
Automated Ejection Fraction (AutoEF) is a semi-automatic
measurement tool used for measurement of the global EF
(Ejection fraction). The AutoEF tool is used as an optional
decision support tool.
The AutoEF tool is derived from 2D speckle tracking algorithm,
which tracks and calculates the myocardial tissue deformation
based on feature tracking on 2D grey scale loops.
AutoEF is performed on either one or both apical 4-chamber or
2-chamber views, in any order.
The result is presented as Ejection Fraction value for each view
and average Ejection Fraction for the whole LV. All values are
stored to the worksheet.
Acquisition
CAUTION AutoEF is only recommended for adult cardiac images

acquired with the following probes: M5Sc-D, M5S-D, 3V-D or
4V-D. The measurement accuracies of the 2D Auto EF
measurement values reported in the Reference manual are
1. Create an exam, connect the ECG device and make sure to

obtain a stable ECG trace.
2. Acquire 2D grey scale cineloops of an Apical 4 chamber
view and an Apical 2 chamber view.
• The frame rate should be between 35 and 100 frames
per second. A higher frame rate is recommended for
high heart rate.
• The scanner should be configured to store at least
100 ms before and after each heart cycle.
• If the acquisition has more than one heart cycle, the
analysis will be done on the second last heart cycle.
• The entire myocardium should be visible.
• A depth range that includes the entire left ventricle
should be used.
Starting AutoEF
1. Open any one of the stored views and press Measure.

2. In the Measurement menu, select AutoEF.

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The View selection menu is displayed (Figure 8-20).
Figure 8-20. Measurement and View selection menus
3. Select the name of the current view: 4-ch or 2-ch.

A trace following the endocardial border is created and the
and the EF result screen is displayed (Figure 8-21).
The tracking must be visually controlled and validated as
described below.

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EF results
Figure 8-21. The EF results screen
The running loop is shown on the left. A green dotted line marks
the inner border of the chamber. In case of poor tracking, the
system automatically displays parts of the border in red.
The frames with the maximal area (ED) and minimal area (ES)
are displayed on the right side.
NOTE: Press EF Dual to only display the ED and ES frames.
The End Diastolic volume (EDV), the End Systolic Volume
(ESV) and the resulting Ejection Fraction (EF) are displayed.
Results for each view are summarized in a table on the right
side.

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Tracking Validation
CAUTION Poor tracking quality may lead to incorrect measurement

results. The tracking must be visually controlled and validated.
If the tracking results are visually correct press the red Approve
button on screen. The calculated values are stored and
available in the worksheet and can be used in a report.
The following can be done if tracking needs correction:
• Press EF dual to display ES and ED frames side-by-side.
• Adjust ES frame and ED frame controls if different frames
need to be selected for ES and ED.
• Edit misaligned points on the endocardial border trace as
described on ‘Editing the endocardial border trace’ on
page 8-41.
• Create a new endocardial border trace (see ‘Create a new
trace’ on page 8-42).
Possible causes of poor tracking
• Erroneous placement of the basal points when defining the
border. If the basal points are placed too far from the
annular region, the border segments at the annular base will
not move together with the underlying 2D image throughout
the entire heart beat.
• Erroneous placement of the apex point when defining the
border. The point should be placed so that the resulting
border trace covers mainly the endocardium. If the apex
point is placed too high, the border trace will mainly cover
the epicardium resulting in poor tracking.
• Too much clutter. Images with too much static clutter will
result in poor tracking.
Trace adjustment of the endocardial border

If the automatic endocardial border detection is not optimal the
user can either adjust the trace or create a new trace as
described below.
Editing the endocardial border trace

1. Press Recalc.
The initial endocardial border trace is displayed.
2. If required, use the Left/Right Edge shift controls to
delineate separately the left or right portions of the
endocardial border visually as best as possible. These

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controls are not available if the endocardial border trace is

adjusted.
3. You may adjust the trace by moving the cursor over the
endocardial border trace, select an anchor point and drag it
to a new location. The shape of the endocardial border trace
is updated accordingly.
Figure 8-22. Moving an anchor on the trace
Create a new trace

1. Press Recalc.
The initial endocardial border trace is displayed.
2. Press New ROI.
The system automatically displays a frame where the
endocardial border is usually clearly visible. To use another
frame, adjust Init frame.
3. To trace the endocardial border, place three points at the
endocardial border; two annular points at the base and one
at the apex. Follow the indications displayed on the screen
when placing the three points.
After placing the third point on the Apex an endocardial
border is automatically traced (Figure 8-23).
NOTE: Correct border tracing is important for an accurate EF
measurement. The system has an adaptive border tracing
function: using the endocardial three points as a guide, the
system will analyze the image and automatically adapt the
border tracing to an optimal position.
NOTE: The Yo-yo function is turned on to help finding correct
location for the points.

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Figure 8-23. Tracing the endocardial border
4. Data processing is configured by default to start

automatically if the cursor is not moved for a few seconds. If
the trace needs to be adjusted make sure to make the
changes immediately after the ROI is displayed. See
‘Editing the endocardial border trace’ on page 8-41 for more
information on how to edit the trace.
NOTE: The auto processing function is configurable (from Config/
Meas-Text/Advanced/AFI/AutoEF auto processing).
The data is processed and the EF result screen is displayed.
Exit AutoEF
1. Press Exit on the Touch panel.

A dialog is displayed asking the user about storage of the
loop.
• Press Yes to store the loop.
• Press No to discard the loop.
Pediatric Z score measurement study

Calculated Z Scores are used to normalize pediatric heart
measurements to the patient's body size. Z Score values are
calculated based on "Regression Equations for Calculation
of Z Scores of Cardiac Structures in a Large Cohort of
Healthy Infants, Children, and Adolescents: An

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Echocardiographic Study", M.D. Pettersen et.al. The

parameters defined in this publication are calculated when
present in the Dimension folder both for M-mode and 2D
images.
BSA value must be known. BSA is automatically calculated
when entering the patient's height and weight in the Patient
information window (see Figure 2-15 on page 2-26).
In addition, all Z Score values from the above publication are
found in a separate Z Scores folder. By default this Z scores
folder is hidden in the Measurement menu. To display the
Z scores folder, see ‘Configuration of the Measurement menu’
on page 8-78. Please note that Z Score values from the
Z Scores folder are not averaged together with the values in the
Dimension folder.
1. Open a pediatric cardiac acquisition.
Make sure the height and weight of the patient was entered
in the Patient information window.
2. Press Measure and select the Z Scores folder (only
available from the Pediatric Heart measurement category, if
turned on).
3. In the Z Scores folder select the measurement to perform.
4. Make the measurement.
The Z0 and Z values are displayed in the Measurement
result table.
Figure 8-24. Pediatric cardiac measurement with Z Score

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4D/Multi-plane LV measurements
and analysis
Introduction
Depending on the data set, the following 4D/multi-plane LV
analysis tools are available on the Vivid E9:
Data set
Tool 4D Tri-plane Tri-plane TSI
4D Automated LV Quantification page 8-45 - -
Tri-plane LV Volume page 8-58 page 8-58 -

measurement
Bi-plane LV Volume - page 8-61 -

measurement
TSI surface model - - page 8-63
4D Automated Left Ventricular Quantification

The 4D Automated Left Ventricular Quantification tool enables
the estimation of the left ventricular volumes and the ejection
fraction in 4D data sets based on automatic border detection.
The tool also enables estimation of left ventricular mass and
strain (only with transthoracic 4D acquisitions). The automatic
border detection is created after placing two points in an
end-diastolic apical view, one at the center of the LV base and
one at the apex.
Requirements
The tool is available on 4D tissue data sets in replay mode only.

The 4D Automated Left Ventricular Quantification tool cannot be
used on acquisition with volume rate equal or lower than 12 vps.

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CAUTION Do not use the 4D Automated Left Ventricular Quantification

tool if:
• For volume measurements: The acquisition has a volume
rate lower than 20% of the heart rate, e.g., 12 vps at
60 bpm, 20 vps at 100 bpm and 30 vps at 150 bpm.
• For 4D Strain measurements: The acquisition has a
volume rate lower than 40 percent of the heart rate, e.g.,
24 vps at 60 bpm, 40 vps at 100 bpm and 60 vps at
150 bpm.
• The image quality is poor.
• The acquisition has stitching artifacts (see page 5-7 on
how to avoid stitching artifacts).
• The acquisition has significant reverberation artifacts.
• A significant part (more than 25%) of the left ventricular
wall is outside the ultrasound sector.
The tool must not be used on other chambers than the human
adult left ventricle.
Starting the 4D Automated Left Ventricular Quantification tool
1. Open a Full volume acquisition.

2. Press Measure.
3. Select Volume/4D Auto LVQ (Figure 8-25-A).
The Measurement menu is displayed with the Alignment
tool selected (Figure 8-25-B).
Figure 8-25. Measurement menu
The main screen displays three apical and a short axis

views.

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Figure 8-26. Slice alignment screen
Slice alignment
Slice alignment is used to identify the long axis of the left

ventricle, the three standard apical views and the
atrio-ventricular plane. Slice alignment performed and approved
before running 4D Auto LVQ is used by default, otherwise the
slice alignment is performed automatically. If necessary the auto
alignment can be further adjusted as follows:
1. Tilt and/or translate the apical views using the controls on
the Touch panel or the trackball until the left ventricle is
centered to the center axis.
2. Rotate the apical views using the controls on the Touch
panel or the trackball until the standard views are displayed.
NOTE: Auto alignment is not available with transesophageal
acquisitions, only manual alignment as described in
‘Alignment – Transesophageal acquisition’ on page 5-26.
See page 5-24 for more information on Slice alignment.

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End-diastolic volume contour detection
1. Select EDV (End-Diastolic Volume).

The default screen displays three apical views, three short
axis views and an interactive view (Figure 8-27).
The system automatically displays the loops at the
estimated end diastolic frame.
2. If the automatic end diastolic frame detection is not optimal,
use the Move ED control to set the new end diastolic frame.
3. In one of the apical views, place two points: one at the
center of the LV base and one at the apex.
A contour is automatically drawn in all views (see
Figure 8-27).
NOTE: Alternative methods for doing contour detection: press Auto
on the Control panel to draw the contour automatically
without placing any points, or press Manual on the Touch
panel and place two basal and one apical point in all three
apical views.
NOTE: Erroneous contour detection of the left ventricle may lead to
incorrect measurement results. The contour detection
should be visually checked and edited if required.
The contour detection should be checked in all slices.
NOTE: press Layout several times on the Control panel to display
the apical slices in large size one by one.
The contour detection quality can be visualized by moving
the cursor through the LV and observe the contour detection
in the interactive view. The position of the interactive view
updates according to the cursor position in the other views.
To lock the interactive view, press Lock view. When the
interactive view is locked the position can be controlled
using the Move view control.
Adjust Contour visibility to change the display intensity of
the contour (or hide it).
To run the cineloop, press 2D Freeze on the Control panel
or the rotary button Run on the Touch panel.
To stop the cineloop, press 2D Freeze on the Control panel
or the rotary button Go To ED on the Touch panel. The end
diastolic frame is displayed.
To edit the contours, see ‘Contour adjustment’ on
page 8-50.
To reset the contours and start over, press Reset.
The following measurements are available:

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• End diastolic volume

• Sphericity Index
NOTE: You can press Img. Store at any point during the procedure.
1. Apical views
2. Short axis views
3. Interactive view
Figure 8-27. Left ventricle contour detection (end-diastole)
End-systolic Volume contour detection
1. Select ESV (End-Systolic Volume).

The system automatically displays the loop at the estimated
end systolic frame within the same heart cycle.
2. If the automatic end systolic frame detection is not optimal,
use the Move ES control to set the new end systolic frame.
3. In one of the apical views, place two points: one at the
center of the LV base and one at the apex.
A contour is drawn in all views.

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NOTE: If the Auto or Manual contour detection method was used to

define the EDV contour (see step 3 on page 8-48) the same
method is used for the ESV contour detection.
NOTE: Erroneous contour detection of the left ventricle may lead to
incorrect measurement results. The contour detection
The contour detection should be checked in all slices.
The contour detection quality can be visualized by moving
the cursor through the LV and observe the contour detection
in the interactive view. The position of the interactive view
updates according to the cursor position in the other views.
To lock the interactive view, press Lock view. When the
interactive view is locked the position can be controlled
using the Move view control.
or the rotary button Go To ES on the Touch panel. The end
systolic frame is displayed.
To edit the contours, see ‘Contour adjustment’ on
page 8-50.
To reset the contours and start over, press Reset.
• End systolic volume
• Ejection Fraction
• Cardiac Output
• Stroke Volume
• Heart Rate
Contour adjustment
The contour detection should be checked. If the contour

detection is not optimal, it can be adjusted by adding attracting
points to the contour. An attracting point will pull the contour
toward that point.
1. Place the cursor at the location where to add a point.

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NOTE: Attracting points can be added in any slice. Make sure to

lock the interactive view if adding attractive points in the
interactive view.
2. Press Select.
A point is added and the contour is modified (Figure 8-28).
3. To delete an attracting point, double click on the point or
press Undo.
a. Original contour b. Modified contour
1. Original attracting points 2. Added attracting point
Figure 8-28. Contour adjustment
Volume waveform
Display and adjustment

1. Press Volume waveform.
The data is processed and the Result screen is displayed
(Figure 8-29) showing:
• The four running views with dynamic contours
• A volume waveform curve with end diastolic and end
systolic markers
• A dynamic LV surface model
• The Measurement result table
NOTE: Press Layout on the Control panel to display a large LV
surface model.
2. Press Go to ED on the Touch panel to display the end
diastolic frame.
Press Go to ES on the Touch panel to display the end
systolic frame.
3. The contour detection may still be adjusted:
• Press 2D Freeze or press Select on any view to stop
the cineloops. Scroll to correct frame.

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• Add or remove attracting points to modify the contour as

described in ‘Contour adjustment’ on page 8-50.
• Press Volume waveform to reprocess the data.
4. The end diastolic and end systolic markers on the volume
waveform curve can be adjusted:
• Adjust Move ED and Move ES controls to move the end
diastolic and end systolic markers on the curve.
The measurement results are updated.
• Cardiac Output
• Stroke Volume
• Heart Rate
Figure 8-29. The Volume waveform screen

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LV mass
1. Press LV Mass (Left ventricular mass).

The end diastolic frame is displayed and an epicardial
contour is automatically drawn. The ED mass calculation is
displayed in the Measurement result table.
Figure 8-30. The ED mass screen

To run the cineloop, press 2D Freeze on the Control panel.
or the rotary button Go To ED on the Touch panel. The end
diastolic frame is displayed.
2. The epicardial and endocardial contours may be adjusted
by adding/removing attracting points as described in
‘Contour adjustment’ on page 8-50. Adjustment of the
contours can only be done on the end diastolic frame.
NOTE: Toggle the Contour select. control on the Touch panel to
select the contour to adjust.

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• Cardiac Output
• Stroke Volume
• Heart Rate
• End diastolic mass
• End diastolic mass index (if BSA is known)
4D Strain
4D Strain enables calculation of myocardial deformation

parameters based on tissue tracking in 4D tissue data sets.
Calculation is performed after defining a region of interest (ROI)
that covers the left ventricular myocardium.
NOTE: Poor tracking quality may lead to incorrect measurement results.
The tracking for each segment must be visually controlled
before approving the results.
4D Strain ROI
1. Press 4D Strain ROI.
The end systolic frame is displayed and a ROI based on
endocardial and epicardial contours is automatically
created.
To run the cineloop, press 2D Freeze on the Control panel.
2. The epicardial and endocardial contours may be adjusted
by adding/removing attracting points as described in
‘Contour adjustment’ on page 8-50. Adjustment of the
contours can only be done on the end systolic frame.
NOTE: Toggle the Contour select. control on the Touch panel to
select the contour to adjust.

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• Cardiac Output
• Stroke Volume
• Heart Rate
• End diastolic mass
• End diastolic mass index (if BSA is known)
• End systolic mass
• End systolic mass index (if BSA is known)
4D Strain results
1. Press 4D Strain results.
The 4D Strain result screen is displayed (Figure 8-31)
showing:
• Apical and short axis views with segmented ROI.
• Segmental and global curves showing a graphical
display of the selected parameter as a function of time.
• A 17-segments color coded Bull's eye representation
with tracking quality indication when the loop is running
and segmental values for the selected parameter at
current frame when in Freeze.
NOTE: Segments marked with an “X” are rejected.
2. The tracking for each segment must be visually controlled
before approving the results. Inspect each segment and
make sure that it is moving together with the underlying 2D
image.
Adjust the control Segment on the Touch panel to highlight
each segment individually and assess the tracking quality.
A segment with poor tracking can be removed from the
calculation of the global value for the selected parameter:

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press Reject segment to remove the highlighted segment.

The curve of the rejected segment is removed and the
rejected segment is marked with an “X” on the Bull’s eye
representation. The global value for the selected parameter
is not calculated if more than three segments are rejected.
NOTE: To approve a segment previously rejected, press Approve
segment.
3. Press the Parameter button on the Touch panel to display
the results for other parameters.
The following parameters are available:
• Longitudinal Strain
• Circumferential Strain
• Area Strain
• Radial Strain (assuming Volume Conservation)
• Global Peak Longitudinal Strain (GPSL)
4. Press Export results to save the results in CSV format,
readable in Microsoft Excel, or in HDF format, readable in
HDF viewer. See page 10-10 for more information about
HDF format. Both file types contain the segmental traces,
but the HDF file in addition contains the midwall
quadrilateral strain mesh.
NOTE: Exported data is provided “as is”, without any guarantee of
validity. It used at own risk, and should be manually
cross-checked against the values shown on screen to
ensure correctness. In case of discrepancy between
exported values and values shown on screen, then the
values on screen are the official valid ones that should be
reported. The content and data format of the exported files
are subject to change. GE Healthcare may change the
definitions of the file format given in this document
according to new development needs or by other
circumstances.

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1. Apical and short axis views with segmented ROI.

2. Segmental and global curves
3. Bull’s eye representation
4. Selected parameter
5. Selected segment (ROI, curve and Bull’s eye)
6. Rejected segment
7. Global value for the selected parameter
Figure 8-31. The 4D Strain result screen
Approval
1. Press Approve & Exit to store the measurements shown in

the Measurement result table.
The measurements are transferred to the Worksheet.

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To exit without approving, press Cancel.

NOTE: Measurements that are not approved will not be saved.
CAUTION The measurement should not be approved if a significant part

(more than 25%) of the left ventricular wall or the detected
contours are outside the ultrasound sector.
Calculation formula and measurement accuracy
Refer to the Reference manual for calculation formula and

measurement accuracy information.
Manual left ventricular volume measurements
Tri-plane acquisition
This procedure describes the calculation and reconstruction of

the left ventricular volume from a Tri-plane acquisition. The
Tri-plane acquisition should be a Tri-plane greyscale acquisition,
not a Tri-plane color acquisition.
1. In Tri-plane mode, acquire an Apical 4 chamber view in scan
plane 1 (yellow).
2. Rotate scan plane 2 and 3 to display an Apical 2 chamber
view in scan plane 2 (white) and an Apical long axis view in
scan plane 3 (green).
3. Press Freeze (2D Freeze if on a stored image).
4. Press Measure.
The Measurement menu is displayed.
5. In the Measurement menu select Volume and Tri-plane.
The Measurement screen is displayed with the Ejection
fraction tool selected (see Figure 8-32).
The end diastolic frame of the current cardiac cycle is
displayed and the cursor is moved to the reference scan
plane.

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1. Ejection fraction tool for Tri-plane

2. Scan plane 1 (yellow): Apical 4 chamber view
3. Scan plane 2 (white): Apical 2 chamber view
4. Scan plane 3 (green): Apical long axis view
5. Volume reconstruction
Figure 8-32. The Tri-plane measurement screen
6. If desired, press Layout twice to display the reference scan

plane in a single screen.
7. Place the cursor to the start point for the trace.
8. Press Select and draw a contour of the left ventricle.
To edit the contour while drawing:
• Follow the contour backward to erase it and redraw.
• Press Undo or Backspace to erase the contour
stepwise and redraw.
• Press Delete to remove the entire contour and redraw.
9. Press Select to complete the contour.
The cursor is automatically moved to the next scan plane.
The crossing point of the trace done in the first scan plane is
marked in the second scan plane.
10. Draw a contour of the left ventricle in scan plane 2 and 3
following the same procedure.
When the last end-diastolic contour is drawn, an
end-systolic frame is automatically displayed. The system

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automatically enters scroll mode. Using the trackball, ensure

that the correct end-systolic frame is displayed.
Press Select to leave scroll mode.
11. Repeat steps 7 to 10 to draw a contour of the left ventricle at
end-systole in all the scan planes.
The measurement results, including end-diastolic and
end-systolic volumes and the left ventricular ejection
fraction, are displayed in the Measurement result table.
NOTE: Other measurements may be displayed by configuring the
Measurement menu, refer to the scanner’s or workstation’s
User manual for more information about Measurement
menu configuration.
12. If in single screen mode, press Layout to display the
Volume reconstruction of the left ventricle in the Geometric
model.
13. Press Layout again to display an enlarged Geometric
model.
The Volume reconstruction can be rotated in all directions
(see page 8-61).
Multi beat 4D acquisition
This procedure describes the calculation and reconstruction of

the left ventricular volume from a Multi beat 4D acquisition.
CAUTION ECG gated acquisition may by nature contain artifacts, that

may have impact on the measurements.
See the recommendations on page 5-7 to avoid stitching
artifacts during Multi-beat 4D acquisition.
1. Using the Multi beat 4D acquisition mode (see page 5-7),

acquire a 4D Apical 4 chamber image.
2. Press Freeze.
3. Orientate the reference cut-plane to display an Apical
4 chamber.
4. Press Measure.
5. In the Measurement menu select Volume and Tri-plane.
The Measurement screen is displayed with the Ejection
fraction tool selected.
6. Follow the procedure described in ‘Tri-plane acquisition’ on
page 8-58 from step 7.

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Rotation of the Volume reconstruction
The volume reconstruction displayed in the Geometric model

can be rotated in any directions.
1. Place the pointer in the Geometric model.
2. Press and hold down Select and use the trackball to rotate
the volume reconstruction.
Bi-plane acquisition
This procedure describes the calculations of the left ventricular

volume from a Bi-plane acquisition. The volume calculation is
based on the Method of disk.
1. In Bi-plane mode, acquire an Apical 4 chamber view in scan
plane 1 (yellow).
2. If required, rotate scan plane 2 to display an Apical
2 chamber view.
3. Press Freeze.
4. Using the trackball, scroll through the cineloop to display the
end-diastolic frame.
5. Press Measure.
6. In the Measurement menu select Volume and Bi-plane.
The Trace tool for the Left ventricular end-diastolic volume
for the Apical 4 chamber view is selected (see Figure 8-33).

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1. Trace tools
Figure 8-33. The Volume measurement screen (Bi-plane)
7. In scan plane 1 (yellow), place the cursor to the start point

for the trace.
8. Press Select and draw a contour of the left ventricle.
9. Move the cursor to the apex and press Select to measure
the length.
The trace tool for the Left ventricular end-diastolic volume
for the Apical 2 chamber view is selected.
10. Repeat steps 8 and 9 in the scan plane 2 (measurement in
the Apical 2 chamber view).
The trace tool for the Left ventricular end-systolic volume for
the Apical 4 chamber view is selected.
11. Using the trackball, scroll through the cineloop to display the
end-systolic frame in the same heart cycle.
12. Press Trackball to activate the M&A tool.
13. Repeat steps 7 to 10 to perform the end-systolic
measurements in the Apical 4 chamber and 2 chamber
views.
The Ejection fraction (Bi-plane) and the end-diastolic and
end-systolic left ventricular volumes are calculated.

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TSI surface model

A Surface model representation of the left ventricle with TSI
color coding can be generated from a TSI Tri-plane acquisition
by applying a sampling path in the myocardium. The sampling
path is created by placing control points in the myocardium.
1. In Tri-plane TSI mode, acquire an Apical 4 chamber view in
scan plane 1 (yellow).
2. If required rotate scan plane 2 and 3 to display an Apical
2 chamber view in scan plane 2 (white) and an Apical long
axis view in scan plane 3 (green).
3. Press Freeze.
4. Press Measure.
5. In the Measurement menu select Surface Map.
The Mapping tool is selected (see Figure 8-34).
1. Mapping tool for Geometry model

2. TSI surface model
Figure 8-34. The Measurement screen (Geometry model)
6. In scan plane 1 (yellow), place the cursor to the start point

for the sampling path starting in the myocardium.
7. Move the cursor following the myocardium and press Select
to place new points.

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By creating several control points the sampling path can be

bent to follow the myocardium.
8. Press Select twice to end the sampling path.
9. Create a sampling path in scan plane 2 and 3.
A TSI color coded surface model is displayed in the
Geometric model.
10. To create a dynamic model, scroll to another frame in the
same heart cycle and create a sampling path in each scan
plane.
11. Press 2D Freeze to run the model.
To edit the sampling path
1. Place the cursor over a control point.

2. Press Select twice (double-click) and move the control point
to a new position using the trackball.
3. Press Select to place the control point to its new position.

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4D MV-Assessment
4D MV-Assessment
The morphology and function of the mitral valve can be

assessed in 4D transthoracic and transesophageal acquisitions
using the TomTec 4D MV-Assessment application. This
application is an option to the Vivid E9.
Measurements from the 4D MV-Assessment application are
available in the worksheet after completing the analysis. The
number of parameters displayed in the worksheet may vary
depending on the steps that were completed during the
4D MV-Assessment analysis.
In addition, 4D tissue acquisitions can be stored on a removable
media to a format compatible with the TomTec workstation,
using the Save as function on the Vivid E9 (File format:
VolDicom (*.dcm)).
Starting the 4D MV-Assessment application

1. Open a 4D tissue acquisition.
NOTE: 4D MV-Assessment only works on stored patient data. It
does not work on images that were just acquired and not yet
stored.
2. Press Measure on the Control panel.
3. Select Valve/4D MV-Assessment on the Touch panel.
The 4D MV-Assessment application is started.
Refer to the TomTec User manual for proper use of the
application.
Measurements will only be transferred to the worksheet if
the option to save data is selected when ending the
4D MV-Assessment application.
NOTE: The Vivid E9 is not accessible for scanning while running
this application. In emergency situations, the
4D MV-Assessment analysis can be aborted by pressing the
Probe button on the Control panel. All unsaved
measurements will be lost.
NOTE: The Probe button may be used to exit 4D MV-Assessment
in case of application lock-up.

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Advanced vascular measurements

and analysis
Intima-Media Thickness
The Intima-Media Thickness (IMT) is calculated based on
automatic contour detection of the Intima and Media layers on a
user-defined search region along the vessel wall. Multiple IMT
measurements are made between pairs of intima and adventitia
points along the wall (Figure 8-35). IMT can be measured both
on the posterior and the anterior walls of the vessel. IMT should
be done on 2D mode images, not on Color mode images.
The IMT measurement is available with linear probes only.
NOTE: Due to the physical properties of ultrasound imaging, the
posterior IMT measurement is generally more accurate than the
anterior IMT measurement.
The following parameters are calculated:
• Average IMT
• Maximum IMT
• Minimum IMT
• Standard deviation of IMT measurements
• Number of successful IMT measurements

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1. Vessel lumen 3. Lumen-Intima boundary

2. Vessel wall 4. Media-Adventitia boundary
5. Multiple IMT measurements
Figure 8-35. IMT measurement (Posterior wall)
IMT Measurement procedure
The following procedure describes the posterior IMT

measurement.
1. Acquire a longitudinal scan of the carotid artery and
optimize the image.
2. Press Freeze.
3. Scroll to an end-diastolic frame where the intima layer is
clearly visible.
4. Press Measure.
5. Select the appropriate IMT measurement. If measuring the
IMT of the posterior wall of the right common carotid select
Rt and CCA IMT Post (Figure 8-36).

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Figure 8-36. IMT Measurement menu (Right Common Carotid

Posterior IMT measurement tool)
6. Place the cursor in the artery closer to the posterior wall and
press Select to anchor the start of the search region
(Figure 8-37, left).
7. Move the cursor parallel to the artery to define the end point
of the search region. Make sure the Intima and Media layers
are within the search region (indicated by the lower dotted
line in Figure 8-37, left).
Press Select to anchor the point. For the posterior wall the
contour detector searches for the leading of the edges of the
intima and adventitia layers. The detected contours are
drawn in the image (Figure 8-37, right).
The measurement calculations are displayed in the
Measurement result table.
NOTE: If the Intima and Media layers are not within the search
region, the contour is not drawn. Select (double click) and
move the anchored points closer to the Intima layer.
1. Measurement segment 2. IMT trace
Figure 8-37. IMT Measurement segment and traces

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8. If the contour is not optimal, adjust Trace Fit to modify the

traces according to different threshold values.
If the contour is still not optimal, try to perform the IMT
measurement on another frame, preferably close to the end
diastole.
IMT trace approval
NOTE: Erroneous contour detection of the Intima and Media layers may
lead to incorrect measurement results. The contour detection
Since the IMT measurements are done semi-automatically, the
operator has to approve the detection by visual inspection
before storing the results in worksheet and report.
1. If the traces fit both layers of the posterior wall, approve the
measurement by selecting Transfer in the Measurement
menu.
Once transferred, the calculations can be viewed in the
worksheet and report.
NOTE: Measurements that are not approved will not be saved.
NOTE: Any image adjustments (e.g Gain or zoom) on approved
(transferred) measurements will unassign the
measurements. Press Transfer to approve the
measurements again.

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OB measurements
1. From an obstetric exam on a scan in Freeze, press

Measure.
2. Select the desired study.
3. Perform the required measurements from the selected
study.
Follow the on-screen indications when performing
measurements.
OB graphs
OB Graphs allow you to assess fetal growth compared to a
normal growth curve. When a patient has completed two or
more ultrasound exams, you can also use the graphs to look at
fetal trending. For multi-gestational patients you can show
curves for all fetuses and compare the growth on the graphs.
The Vivid E9 provides the following two basic types of graphs:
• Fetal Growth Curve graphs – show one measurement per
graph. These graphs show the normal growth curve,
positive and negative standard deviations or applicable
percentiles, and ultrasound age of the fetus using the
current measurement. For multi-gestational pregnancies,
you can show curves for all fetuses. If previous exam data is
available, the graph can show fetal trending.
• Fetal Growth Bar graph – shows the ultrasound age and
the gestational age based on patient data. Plots all
measurements on one graph.
CAUTION The system provides calculations (e.g. estimated foetal weight)

and charts based on published scientific literature. The
selection of the appropriate chart and clinical interpretation of
calculations and charts are the sole responsibility of the user.
The user must consider contraindications for the use of a
calculation or chart as described in the scientific literature. The
diagnosis, decision for further examinations and medical
treatment must be performed by qualified personnel following
good clinical practice.

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OB measurements
To view OB graphs
1. Press Worksheet.
2. Press Graph.
The Fetal growth curve graph is displayed (Figure 8-38).
The horizontal axis shows the fetal age in weeks. The
system determines this age from the data entered in the
Patient information window. Depending on the
measurement selected the vertical axis displays
measurements (mm or cm), ratios (%) or fetal weight (g).
The Fetal growth curve graph shows the following
information for the selected measurement:
• The normal growth curve
• The standard deviations or relevant percentiles
• The gestational age of the fetus, using patient data
(vertical dotted line)
• Using the current ultrasound measurement data, where
the fetus is on the growth curve
From the OB graphs screen, the user can enter relevant
information in the Fetus position and Placenta fields.
Figure 8-38. Fetal growth curve graph

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To select the measurement

1. Select the measurement in the Measurement type field.
A list of available measurements is displayed.
2. Select the measurement to display.
To scroll through all Fetal growth curve graphs, adjust
Graph change.
To select the age to use

1. Adjust Select GA.
The plot displays either gestational age (GA) from the LMP,
or the composite ultrasound age (CUA).
When selected, the gestational age may be changed by the
user.
1. Select the GA (LMP) value.
An editing window is displayed.
2. Enter a new value and select OK.
The GA (LMP) label is changed to GA(GA) showing the new
value entered. This information is also updated in the
Patient information window. In addition the EDD (LMP) is
updated to EDD (GA) with new calculated value.
To view single or quad screen

1. Press Quad to display four graphs simultaneously.
2. To select the measurements to display in the quad screen,
select the drop-down button on the left of each graph and
select the desired measurement.
3. Press Single to display single graph screen again.

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OB measurements
Figure 8-39. Fetal growth curve graph: quad screen
Fetal trending
When you have ultrasound data for more than one exam for a
patient, you can use the data to look at fetal trending on the
Fetal growth curve graphs. Fetal trending requires that a LMP
value is entered in the Patient information screen.
1. Press Worksheet.
2. Press Graphs and select the desired measurement to
display.
3. Press Plot both.
The system automatically finds the data from previous
ultrasound exams, and displays it on the graph with the
present data.

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Figure 8-40. Fetal trending graph
Fetal growth bar graph
The fetal growth bar graph shows current exam measurements

and the normal growth range based on the gestational age. It
shows all measurements on one graph.
1. Press Worksheet.
2. Press Graph.
3. Press Bar.
The fetal growth bar graph is displayed.
Figure 8-41. Fetal growth bar graph
• The horizontal axis shows the gestational weeks.

• The red vertical line shows the gestational age using the
patient data.
• The blue dotted vertical line shows the ultrasound age
using the current measurements.

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OB measurements
• The yellow x shows the ultrasound age for each

measurement.
• The green rectangle shows the normal age range for the
measurement.

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There are many more measurements and parameters in the

measurement package than shown in the default Measurement
menu. Use the configuration system to set up the
measurements that should be available in the Measurement
menu and which parameters should be calculated.
A list of all cardiac calculations with needed measurements and
location in the Measurement package can be found in the
Reference manual.
Basic operations
Opening the Measurement configuration package

category Measure/Text.
The Measurement menu sheet is displayed (see
Figure 8-42).
Display of the Measurement categories
1. Press M&A categories in the Configuration window.

The M&A categories are displayed in a pop-up window.
2. Check the categories to be displayed.
Uncheck the categories to hide.
To select a Measurement category in the Measurement menu:
1. Select the heading of the Measurement menu.
The measurement categories are displayed in a sub-menu.
2. Select the Measurement category to display.
Moving an item in the Measurement menu
1. Select an entry in the Measurement menu.

2. Press or to move the selection up or down inside
the Measurement menu.

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Deleting an item in the Measurement menu
Only user-created items can be deleted.

1. Select an entry to delete in the Measurement menu.
2. Press to delete the item.
Display/hide a folder or a measurement in the Measurement menu
The Measurement menu (Folders and Measurements) can be

configured to display only the entries (folders and
measurements) of interest.
To hide a folder or a measurement:
1. Uncheck the actual folder or measurement in the Folder or
Measurement field in the Configuration window.
To display a hidden folder or measurement:
1. Check the actual folder or measurement in the Folder or
Measurement field in the Configuration window.
Auto-sequence of measurements within a folder
1. In the Measurement menu sheet, select a folder in the

Measurement menu.
2. Check Auto sequence.
When performing the first measurement in the folder, the
next measurement is automatically selected.
Creating a user-defined folder
1. If the folder is to be inside another folder, select the actual

folder in the Measurement menu.
2. Press Add folder.
The Measurement menu is updated.
3. Enter the folder name in the Name text field.
Measurement package configuration - example

The following example based on calculation of AV CO (Cardiac
Output by Aortic Flow) describes how to configure the
measurement package so that necessary measurements and
the resulting calculations are displayed on screen.

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Calculation of Cardiac Output by Aortic Flow requires the

measurement of:
• AV diameter located in the folder Dimension (2D mode)
• AV VTI located in the folder Aortic (Doppler AV Trace).
• Heart rate
If a calculated parameter (e.g. AV CO in AV Trace
measurement) requires another parameter to be calculated (e.g.
AV Diam) the user must first measure the required parameter
(e.g. AV Diam) before the dependent parameter (e.g AV CO in
AV Trace) gets calculated.
Configuration of the Measurement menu
If the AV diameter measurement is not present in the folder

Dimension in the Measurement menu, follow the following
procedure:
category Measure/Text.
The Measurement menu sheet is displayed (see
Figure 8-42).
2. AV Diam is a 2D measurement, make sure that 2D is
checked in the Measurement sheet.
3. Select folder Dimension in the Measurement menu.
A list of all available measurements for the selected folder is
displayed in the Measurement menu sheet.
4. Check the box in front of AV Diam.
The AV Diam measurement is displayed in the folder
Dimension in the Measurement menu.
5. For the AV VTI measurement, check Doppler in the
Measurement menu sheet and select the folder Aortic in
6. Check the box in front of AV Trace.
The AV Trace measurement is displayed in the folder Aortic
in the Measurement menu.

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1. Select the scanning mode for the measurement to add to the Measurement menu.
2. Select the folder for the measurement to add.
3. Select the measurement to add.
Figure 8-42. Configuration of the Measurement menu
Configuration of the Measurement result table
If AV CO calculation is not displayed in the Measurement result

table, follow the following procedure:
Config category Measure/Text.
The Measurement menu sheet is displayed.
2. The AV CO calculation is based on Doppler AV Trace
measurement in the folder Aortic, check Doppler in the
Measurement menu sheet and select the folder Aortic.
A list of all available measurements and calculations for the
selected folder is displayed in the Measurement menu
sheet.
NOTE: Entries in green are calculated measurements.
3. In the Measurement menu sheet, double-click on the
AV Trace measurement.
A list of all available output parameters for the AV Trace
measurement is displayed in the Measurement menu sheet.

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4. Check the box in front of AV CO.

The AV CO calculation will be displayed in the Measurement
result table.
User-defined formulas
User-defined formulas can be created using existing
measurements or by defining new measurements. The following
example describes the creation of a formula based on existing
measurements.
CAUTION GE Healthcare does not take any responsibility for the

correctness of the user-defined studies, parameters or
functions.
User-defined formula - example
The workflow for user-defined formula is:

• If the user-defined formula is based on several
measurements of different types, create a user-defined
folder in the Measurement menu so that all measurements
and the formula are grouped together. If the formula is
based on a single measurement you may select an existing
appropriate folder.
• Add the measurement(s) needed for the formula to the
user-defined (or existing) folder.
• Create the formula based on the added measurements.
The following procedure describes the creation of user-defined
LIMP formula as follows: My LIMP = (MCO-AV ET)/AV ET.

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Creation of a user-defined folder
1. Select the appropriate scanning mode.

2. Create a folder in the Measurement menu.
Figure 8-43. The Measurement menu sheet

category Measure.
2. MCO and AV ET are Doppler measurements, select
Doppler in the Measurement menu sheet.
3. Select Add folder.
4. Give the folder a name (e.g. “My Folder”).
Adding measurements
1. Select the user-defined folder.

2. Press Add measurement.
1. Select the user-defined folder (e.g. “My Folder”) in the

Measurement menu.
2. Press Add Measurement in the Measurement menu sheet.
The Add measure window is displayed.

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Figure 8-45. The Add measure window
3. MCO and AV ET are measurements that already exist on

the system, check Use copy of and select MCO from the
drop down menu.
4. Select OK to add the MCO measurement.
5. Repeat steps 2 to 4 to add the AV ET measurement.
Creation of the formula
1. Select the last measurement.

2. Double click and enter the formula name.
3. Select “=” to create the formula.
The formula for this example is as follows:

My LIMP = (MCO-AV ET)/AV ET
1. In the user-defined folder (e.g.”My folder”), select the last
measurement created (e.g. AV ET).
2. Double-click (Name) in the last line in the Parameter list in
the Measurement menu sheet.

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3. Enter the name for the formula (e.g. My LIMP).

4. Select .
The Edit formula window is displayed.
Figure 8-47. The Edit formula window
5. Select “(“from the Operators drop-down menu.

6. In the Doppler drop-down list, select
MCO [My Folder, MCO].
Make sure to select the measurement located in the user
defined folder (e.g. “My Folder”).
7. Select “-“ from the Operators drop-down menu.
AV ET [My Folder, AVET].
9. Select “)“ from the Operators drop-down menu.
10. Select “/“ from the Operators drop-down menu.
NOTE: Operators may also be entered using the alphanumeric
keyboard.
AV ET [My Folder, AVET].
The Formula line should display: ({MCO}-{AVET})/{AVET}.
No units are necessary since the formula is a ratio (see also
‘About units’ on page 8-85).
12. Press Check to make sure that the syntax for the formula is
correct.
User-defined measurements
Some user-defined formula may require measurements that do
not exist on the system. The following example based on a

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generic distance measurement illustrates how to create

user-defined measurements.
1. Select the appropriate scanning mode.

2. Select the appropriate folder.
3. Press Add measurement.

category Measure.
2. In the Measurement menu sheet, select the appropriate
scanning mode for the measurement to be created (e.g.
2D).
3. Select the appropriate folder in the Measurement menu
(e.g. Dimension).
4. Press Add Measurement in the Measurement menu sheet.
The Add measure window is displayed.
Figure 8-49. The Add measure window
5. Check Blank and press OK.

The Measurement menu sheet is updated.

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1. Enter a name for the measurement.

2. Select the appropriate measurement tool.
3. Double click and enter the formula name.
6. In the Measurement menu sheet, enter the name for the

measurement (e.g. My Distance).
7. Select the appropriate measurement tool in the drop-down
menu, next to Tool (e.g. 2D Caliper).
8. Double-click (Name) in the appropriate parameter (e.g
Distance) and enter a name for the parameter (e.g. My
Length).
If desired change the unit and the number of decimals for
the measurement by double clicking the values under Unit
and Precision (see also ‘About units’ on page 8-85).
About units

• All formulas are calculated in SI units (see table below).
• If no unit is specified in the Edit formula window when
defining a formula, the displayed value will be in SI unit.
To define a different unit

1. When creating a formula, enter the unit to use when
displaying the formula output. E.g. if Y in the formula Y=f(x)
is to be displayed in cm, enter cm in the Unit field (see

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The Unit field is case sensitive, make sure to enter the exact
unit as shown in the table below (Alternative unit column).
2. The output of a formula must always be in an SI unit (see
table below). Conversion to the specified display unit is then
done automatically.
Example: an user wants to add a regression formula for
estimating a length B from a measured length A, both in cm.
The formula is: B = 2.4 + 1.1*A.
• As A is a measurement value the system will enter the
formula in the SI unit for length (m). The formula
expects A in cm, and to get that, A must be multiplied by
100:
B = 2.4 + 1.1*A*100
• The formula now gives B in cm. Converting the output
from cm to the SI unit (m), is done by dividing by 100:
B = (2.4 + 1.1*A*100)/100
The output is now in m, and by entering this formula into the
system the user gets the expected result. Measuring an A of
2 cm gives: B = (2.4 + 1.1*0.02*100)/100 = 0.046 m.
Before display of the value it is converted according to the
specified display unit (cm), and the system displays 4.6 cm.
If the selected display unit was set to mm the formula would
give the exact same output, 0.046 m, but the automatic unit
conversion would now instead give a displayed value of
46 mm.
Calculation SI Alternative unit

Time s
Ratio %
Frequency bpm
Angle rad
Distance m
Velocity m/s
Acceleration m/s2
Area m2
Volume m3

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Calculation SI Alternative unit

Volume flow m3/s
Pressure mm Hg*
Pressure/time mm Hg/s
Mass kg
Other
* The correct SI unit for pressure is Pa, but here mm Hg was used as base unit as it is a standard pressure
unit to use in medicine.
Advanced settings
The Advanced sheet
The Advanced sheet enables further configuration of the

Measurement function. The settings are divided into application
specific parameters and global parameters.
Figure 8-51. The Advanced sheet
1. If configuring application specific parameters, select an

application from the M&A category pull-down menu.

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2. Select the configuration value next to the parameter to

configure.
A pull-down menu is displayed.
3. Select a new value from the pull-down menu.
The Modify calculations sheet
The Modify calculation sheet is used to configure the

calculations to be performed when doing a Doppler vascular
measurements.
Figure 8-52. The Modify calculations sheet
The following example describes how to configure the Carotid

Doppler calculations.
1. In the Modify calculations sheet, select Vascular next to
M&A Categories.
The Vascular measurement category is displayed.
2. Select Carotid.
The available calculations are displayed.
3. Check the desired calculations to be performed.
4. Select Save.

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The OB table sheet
The OB table sheet enables the creation and edition of

user-defined OB tables.
Figure 8-53. The OB table sheet
The following example describes how to create a fetal age

OB-2/3 table based on Bi Parietal Diameter measurements.
1. In the Measure/Text category, select the Measurement
menu.
2. In the Measurement menu sheet, select 2D mode.
3. Select the OB table sheet.
4. In the Measurement menu, select the category Obstetrics
and the OB-2/3 measurement study.
5. In the OB table sheet, check New table.
6. Enter or select the following:
• OB Table Template: when creating a new OB table,
select Template (1 - 7) which you want to use as the
basis of the user programmable OB Table (see
page 8-91).
When editing an existing user OB table, select the
desired OB table to edit.
• Tool type: Select the type of measurement (e.g.
Distance)

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• Measure Name: type the name of measurement that

will display in the Measurement menu (e.g. My BPD
Measure).
• Author Name: Type the author’s name (e.g. My Name).
• Table Type: If necessary, select the table type (e.g.
Fetal Age).
• Measure type: select the desired measurement (e.g.
BPD).
7. Select Edit table.
The OB Table spreadsheet is displayed, showing the table
template selected.
8. Enter the Min, Max and Interval values in the Parameters
field.
The system automatically fills in the MEAS column.
9. Enter the input values for the MEAN and SD columns.
10. Select Exit to save.

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The OB table templates
Template 1 (based on Hadlock)
Fetal age format: MEAS MEAN SD
Unit: mm week week
Table range: 1 SD
Graph range: 1 SD
Measurement Value: [cm]

result
GA: [#w#d]
Min: [#w#d]
Max: [#w#d]
Fetal growth Format: AGE MEAN SD
Unit: week mm week
Others are same as above
Template 2 (based on Tokyo)
Fetal age Format: MEAS MEAN SD
Unit: mm day day
Table range: 1 SD
Graph range: 1 SD

result
GA: [#w#d]
SD: [day (+/-)]
Unit: day mm day
Template 3 (based on Osaka)
Unit: mm day mm
Table range: 1 SD
Graph range: 1 SD

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Template 3 (based on Osaka)

result
GA: [#w#d]
SD: [(mv-pv)/sd]
Unit: day mm day
Template 4 (based on several European tables)
Unit: mm weekday mm
Table range: 5%–95%
Graph range: 5%–95%

result
GA: [#w#d]
GP: [%] Calculated by Fetal growth table. If Fetal growth table is not
edited, GP is not calculated.
Unit: weekday mm day
Unit: mm weekday mm
Table range: 1 SD

result
GA: [#w#d]
Unit: weekday mm day

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Fetal age Format: MEAS MIN MEAN SD
Unit: mm weekday weekday weekday
Table range: 10%–90%

result
GA: [#w#d]
Fetal growth Format: AGE MIN MEAN SD
Unit: weekday mm mm mm
Unit: mm weekday mm
Table range: 1 SD

result
GA: [#w#d]
Unit: weekday mm mm
Normal values
Normal values can be defined by the user for all parameters. A
Normal value can be either a range or a threshold. Normal
values entered are grouped by measurement category (e.g.
Cardiac, Pediatrics...etc).
Normal values are displayed in the report if the report template
used is configured to display normal values (see page 11-35).

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To define a Normal value
1. Measurement category
2. Selected measurement
3. Parameters
4. Press to define Normal value
Figure 8-54. Adding Normal value

Config category Measure/Text.
The Measurement menu sheet is displayed (Figure 8-54).
2. In the Measurement menu, browse to the measurement of
interest.
The parameters for the selected measurements are
displayed in the Measurement menu sheet.
NOTE: To change Measurement category, press the Heading in the
Measurement menu and select another Measurement
category.
3. Select in the Normal value column.
The Normal value window is displayed.

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Figure 8-55. The Normal value window
4. In the Normal value window:

• Select the Normal value type (Range, Above or Below).
• Type in the Normal value.
• Optionally enter a reference for the Normal value.
5. Select OK.
The Normal value is displayed in the Measurement menu
sheet.
To display Normal values and references in the Report, the
Report template must be configured to show Normal values (see
‘Normal values’ on page 8-93). Measurements outside the
Normal value are highlighted with an “!” in the report.

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Measurement result table
The display of the Measurement result table can be minimized

and moved to prevent the table obscuring parts of the
ultrasound image.
Minimizing the Measurement result table

1. Select on the heading of the Measurement result table.
The Measurement result table is minimized to the heading
bar.
Repeat step 1 to maximize the Measurement result table.
Moving the Measurement result table

1. Select on the heading of the Measurement result table.
2. Move the table.
3. Press the Left mouse button to anchor the table.
NOTE: Alternative: adjust Move Result Win on the Control panel to
move the Measurement result table around the screen.
Deleting measurements
1. Select the measurement to delete in the Measurement
result table.
2. Select Delete measurement in the context menu.

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Worksheet
Worksheet
The worksheet function enables the user to review, edit, delete

or print data independently of a report. All measurements and
calculations taken during the examination can be viewed at any
time using the worksheet.
Overview
1. Measurement type 4. Measured / calculated values

2. Measurement parameter 5. Value type: Averaging, Max, Min or Last
3. Value calculated according to the value type
selected.
Figure 8-56. Worksheet screen
Using the Worksheet

1. Press Worksheet on the Control panel.
2. Select the Measurement type.
3. To browse through the measurements, select Page Up or
Page Down or adjust Page Change.

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To select a type of value
1. Select the relevant cell in the Method column.

A pop-up menu is displayed showing the different options
available.
1. Average of the measurements taken

2. Maximum measurement
3. Minimum measurement
4. Last measurement that was taken
Figure 8-57. Value options
2. Select the required option.

The value is updated accordingly.
To exclude or include measurements
One or more measurement values from a set of measurements

for a parameter can be excluded when doing average
calculation.
1. Place the cursor over the measurement to exclude.
2. Press Update Menu.
3. Select Exclude value/Include value from the context
menu.
To delete measurements
1. Place the cursor over the measurement to delete.

2. Press Update Menu.
3. Select:
• Delete value to delete the current value
• Delete set to delete the current set of values
• Delete all to delete all values from the Worksheet.
To change a measurement value
1. Select the measurement to change.

2. Enter a new value.

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Worksheet
NOTE: Changed measurements are marked with an asterisk (*).

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Chapter 9
Quantitative Analysis
‘Q Analysis overview’ on page 9-3
‘Using Q Analysis’ on page 9-9.

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Introduction
The quantitative analysis (Q Analysis) software package is

designed for analysis of TVI related (Tissue Tracking, Strain,
Strain rate, TSI) and Contrast related raw data.
CAUTION Q Analysis is only recommended for adult cardiac images

acquired with the following probes: M5Sc-D, M5S-D, 6T, 6Tc,
3V-D, 4V-D or 6VT-D. The measurement accuracies of the
quantitative values reported in the Reference manual are
The main features of these options are:

• Multiple Time-mode specific trace display from selected
points in the myocardium.
• Arbitrary Curved anatomical M-Mode

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Q Analysis overview
Q Analysis overview
Starting Q Analysis
Starting Q Analysis in replay mode
1. Open an examination and select a TVI or a contrast loop.

2. Press Q Analysis.
The Quantitative Analysis screen is displayed (see
Figure 9-1).
Starting Q Analysis in live
1. Press Freeze.
2. Press Q Analysis.
The Quantitative Analysis screen is displayed (see
Figure 9-1).

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Q Analysis screen
Overview
1. Color cineloop window

2. Tissue cineloop window
3. Analysis window
4. Sample area
5. Time and velocity at cursor position
6. Sample area tools
Figure 9-1. Quantitative analysis window (here with TVI data)

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Q Analysis overview
The Color cineloop window
Displays TVI, Tissue Tracking, Strain, Strain rate or

Angio color-coded data.
Sample area (1):
Indicates sampling position of the velocity (TVI),
displacement (Tissue Tracking), percent deformation
(Strain), deformation rate (Strain rate) or intensity
(Contrast) trace. The sample area is color-coded: the first
sample area is yellow, the second blue...etc.
The cineloop windows system menu

This menu is displayed by pressing Update menu when
the cursor is in one of the Cineloop windows.
• Delete all Sample areas: removes all traces at once.
• Disable frameb: the current frame is excluded from the
cineloop display.
• Set Sample area Shapea: enables resizing of a
selected sample area by setting height, width and tilt
angle. The trackball marker must be pointed at an
anchored sample area.
• Label Sample area...a: set a descriptive name to the
sample area. The label is useful for identification of the
sample area when exporting data.
• Delete Sample areac: delete the selected sample area.
a)
• Delete anchorc: remove anchoring from a dynamic
Shown only when a sample area is selected sample area (see also page 9-9 and page 9-10).
(pointed at). • Cancel: exits the System menu.
b)
With Contrast data only.
c)
Shown only when pointing at an anchored
sample area.

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The Tissue cineloop window
Displays 2D data
Sample area (1):
Indicates sampling position of the velocity (TVI),
displacement (Tissue Tracking), percent deformation
(Strain), deformation rate (Strain rate) or intensity
(Contrast) trace. The sample area is color-coded: the first
sample area is yellow, the second blue...etc.
Sample area tools:
• : creates a sample area based on freehand

drawing.
• : creates a sample area with a pre-defined circular/

elliptic shape (configurable, see page 9-14)
The analysis window
TVI:
Displays velocity trace
1. Y axis: velocity scale (cm/s)
2. X axis: Time (s)
3. ECG
4. Time at cursor position
5. Velocity at cursor position
6. Velocity at frame marker position (color coded)
Tissue Tracking:
Displays tissue displacement trace
1. Y axis: displacement scale (mm)
2. X axis: time (s)
3. ECG with Tracking start and Tracking end markers
5. Displacement at cursor position
6. Displacement at frame marker position (color coded)
Strain rate:
Displays Strain rate trace (rate of deformation (s-1))
1. Y axis: s-1
2. X axis: time (s)
3. ECG
5. Strain rate at cursor position
6. Strain rate at frame marker position

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Q Analysis overview
Strain:
Displays Strain trace (extent of tissue deformation (%))
1. Y axis: percent displacement
2. X axis: time (s)
3. ECG with Strain start and Strain end markers
5. % deformation at cursor position
6. % deformation at frame marker position (color
coded)
Contrast:
Displays time-intensity curve
1. Y axis: Intensity scale (logarithmic) (dB) or linear
acoustic units (AU).
2. X axis: Time (s) or dT (s), elapsed time from previous
frame.
3. ECG: displays ECG trace, the current frame marker
and the start and stop markers for the cineloop.
5. Intensity (dB or AU) at cursor position
6. Intensity (dB or AU) at frame marker position (color
coded)
The analysis window System menu:

This menu is displayed by pressing Update menu when the cursor
is in the Analysis window.
• Delete all Sample areas: removes all traces at once.
• Analysis signal: toggles trace display between velocity,
displacement, strain rate, stain or greyscale intensity curves.
• Drift compensation: compensates drifting of strain or Tissue
Tracking curves by either resetting the curve to zero at the
tracking start point (cycle resetting) or by linear compensation
throughout the cycle (linear compensation)
• Vertical auto-scaling: selects between full unit range or a range
according to the maximum and minimum values of the displayed
trace(s).
• Vertical unita: toggles between logarithmic (dB) and linear
acoustical units (AU).
• Line style: selects between solid line only or solid line with
square markers at each data point.
• Smoothing: smooths the trace displayed by applying a filter over
a defined time window. Both the filter type and time window are
user-selectable. The type of filter available is depending on the
a)
With contrast data only. analysis signal displayed.
b) • Export traces: saves trace data in ASCII format, readable in
Shown only in zoom mode.
spreadsheet programs. If present, trace data for physiological
traces are also exported.
• Curve fittinga: toggles between Wash-in, Wash-out and off.
• Unzoomb: restores full analysis window display when in zoom
mode.
• Cancel: exits the System menu.
The Trackball assignments

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QA:
Pointing tool in Quantitative analysis mode.
Scroll/Speed:
• When the cineloop is stopped, enables scrolling through
the cineloop.
• When the cineloop is running, enables control of the cine
replay speed.
Press the Trackball key to toggle the trackball assignment
between QA and Scroll/Speed.

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Using Q Analysis
Using Q Analysis
Generation of a trace
Up to eight traces can be generated.
About the sample area
The sample area can be in three different states:

• Free sample area: freely moving sample area (QA cursor)
before anchoring.
NOTE: The free sample area disappears when the QA cursor is
moved over a static anchored frame.
• Static sample area: the free sample area is anchored by
pressing Select.
• Dynamic anchored sample area: the sample area is
anchored in two or more frames (see Manual tracking
below). In these particular frames, the sample area is
displayed with an anchor. The sample area moves smoothly
between the anchored positions when playing/scrolling the
cineloop.
To generate a trace
Trace from a pre-defined sample area

The shape of the pre-defined sample area is configurable (see
page 9-14).
1. If the Trackball assignment is not on QA, press Trackball
until QA is highlighted.
2. If necessary, select the sample area Shape button .
3. Place the cursor in one of the Cineloop windows.
The cursor is changed to a sample area (white circle).
A preview of the trace is displayed in the Analysis window.
4. Press Select to anchor the sample area.
In this frame the sample area is marked with an anchor.

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If the cineloop has more than one heart cycle a sample area
will also be anchored in the corresponding frame in the next
heart cycles.
The trace is updated accordingly in the Analysis window.
NOTE: The trace and sample area are color-coded. First generated
trace is yellow, second blue...etc.
The Strain cursor

In Strain and Strain rate modes, the sample area displays a
Strain cursor showing the segment along the beam direction that
is used for Strain and Strain rate calculations. Make sure that the
Strain cursor is within the myocardium when anchoring the
sample area.
Trace from a freehand sample area

1. Select the Pencil button .
2. Place the cursor in one of the Cineloop windows.
The cursor is changed to a cross.
3. Press and hold down Select while drawing a sample area
with the trackball.
4. Release Select.
The sample area is automatically closed.
The trace is updated accordingly in the Analysis window.
Manual tracking of the sample area (dynamic anchored sample area)
The sample area can be moved within the loop to ensure that
data in the trace is generated from the same anatomical location
during the cyclic motion of the heart.
1. Freeze the image and place a sample area over a region of
interest.
Note the anatomical location of the sample area.
2. Scroll to a new frame.
3. Press Trackball until the QA trackball assignment is
selected.
4. Place the cursor on the sample area.
5. Press Select.
The sample area is unanchored.
6. Drag the sample area to the corresponding anatomical
location in the new frame.
When the sample area is anchored in more than one frame,
linear interpolation is performed, so that the sample area is

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Using Q Analysis
smoothly moved between the anchored positions in the

selected frames when running the cineloop.
NOTE: In the original frame and this particular frame the sample
area is marked with an anchor.
7. Press Trackball until the Scroll trackball assignment is
selected.
8. Scroll through the cineloop and control that the sample area
follows the moving anatomical structure.
9. Add anchored sample areas in several frames to obtain a
more accurate displacement of the sample area.
To move a dynamic anchored sample area

1. Freeze the image.
2. Press Trackball until the Scroll trackball assignment is
selected.
3. Scroll through the cineloop to display one of the frames
where the sample area was anchored.
NOTE: In these frames the sample area is marked with an anchor.
4. Press Trackball until the QA trackball assignment is
selected.
5. Place the cursor on the sample area to move, in one of the
Cineloop windows.
6. Press Select.
The sample area is unanchored.
7. Drag the sample area to a new location.
8. Press Select to anchor the sample area to the new location.
Zooming in the Analysis window
1. In the Analysis window, press and hold down the Select key
while dragging the trackball cursor to define the zooming
area.
2. Release the Select key.
The selected area is displayed in the Analysis window.
To unzoom
1. In the Analysis window, press Update menu.
The System menu is displayed.
2. Select Unzoom.

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Deletion of a trace
The user can delete all traces at once or one at a time.
To delete all traces

1. If necessary, press Trackball until the QA trackball
assignment is selected.
2. With the cursor in one of the Cineloop windows, press
Update menu.
3. Select Delete all sample areas.
To delete one specific trace

2. Place the cursor on the sample area to delete.
3. Press Update menu.
4. Select Delete sample area.
Saving/retrieving Q Analysis
1. Press Img. Store to save the quantitative analysis session.
2. To recall the Quantitative analysis session, select the icon
on the clipboard, and press Q Analysis.
Frame disabling
Frame disabling excludes the actual frame from the cineloop
display. Frame disabling is available only with contrast data.
Disabling frames
1. Place the cursor on the frame marker of the frame to disable

beneath the Analysis window (see Figure 9-2).
2. Press Select to disable the frame.
The frame marker turns red.
NOTE: To re-enable a frame: Press Select on the corresponding
frame marker.

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Using Q Analysis
Disabling successive frames at a time

1. Press and hold down Select while dragging the cursor over
the frame markers of the frames to disable.
The frame markers turn red.
NOTE: To re-enable successive frames: press and hold down
Select while dragging the cursor over the frame markers.
ECG triggered frame disabling

In a multi-cycle acquisition, the user may deselect all frames in
all heart cycles but a selected one. This function can be used for
example to select a particular systolic frame for each heart
cycle.
1. Scroll through the cineloop to identify the cardiac phase to
analyze or identify the cardiac phase on the ECG trace.
2. Place the cursor on the frame marker of the frame of interest
in one of the heart cycles (see Figure 9-2).
4. Select ECG triggering.
All frames in all heart cycles are disabled except for the
selected and corresponding frames in the other heart
cycles.
Re-enabling all frames
1. Place the cursor on the Frame marker axis.

2. Press Update menu in the trackball area on the control
panel.
3. Select Enable all frames.
All previously disabled frames are re-enabled.

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1. Analysis window
2. Frame marker axis
3. Enabled frame (green marker)
4. Disabled frame (red marker)
5. ECG
6. Current frame
Figure 9-2. Frame disabling
Optimization
Optimizing the sample area
The sample area can be reshaped and labelled.
Reshaping a sample area

2. Place the cursor on the sample area to reshape.
4. Select Set Sample area shape.
A Dialogue window is displayed where the user can adjust
the height, the width and the angle of the sample area (see
Figure 9-3).
Figure 9-3. The sample area reshaping window

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Using Q Analysis
5. Drag the sliders to adjust the shape of the sample area as

desired.
6. Press OK to return to the Quantitative analysis window and
use the settings for the current analysis only.
OR
Press Set as default to return to the Quantitative analysis
screen and keep the settings as default.
Labelling a sample area

The sample area label is used to identify data associated to the
sample area when exporting to a spreadsheet program.
2. Place the cursor on the sample area to label.
4. Select Label Sample area....
A Dialogue window with a free text field is displayed (see
Figure 9-4).
5. Type a name for the sample area.
6. Press OK to return to the Quantitative analysis screen.
Figure 9-4. The sample area labelling window
Trace display
Y-axis
Auto-scaling
The system can be configured to display the full unit range or a
range according to the maximum and minimum values of the
displayed trace(s) (auto-scaling function). In addition, the
auto-scaling function can be set to be live update (updates while
the sample area is moved) or delayed (updated when the
sample area is anchored).

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2. With the cursor in the Analysis window, press Update

menu.
3. Select Vertical auto-scaling.
The Vertical auto-scaling menu is displayed.
Figure 9-5. The Vertical Auto-scaling menu
4. Select the desired option:

• Delayed: auto-scaling takes place after anchoring the
sample area.
• On: auto-scaling while moving the sample area.
• Off: displays full scale.
Vertical units
When analyzing contrast data, the Y-axis can be set to display
either logarithmic scale (dB) or linear, acoustical units (AU) for
both tissue intensity (2D) or Angio intensity data.
menu.
3. Select Vertical unit.
The Vertical unit menu is displayed.
Figure 9-6. The Vertical unit menu
4. Select the desired option.

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Using Q Analysis
Trace smoothing
The system can smooth the traces displayed by applying a filter
over a defined time window. The type of filter available is
depending on the analysis signal displayed.
menu.
3. Select Smoothing.
The Smoothing menu is displayed.
4. Select a smoothing filter.
The trace display is updated.
Cine compound
Cine compound calculates and displays cineloops generated

from a temporal averaging of multiple consecutive heart cycles.
The number of averaged cycles is displayed on the top left
corner.
To apply cine compound:
1. Adjust Cine compound to set the number of heart cycles to
average.
The traces are updated showing averaged data. The
number of heart cycles averaged is displayed on the top left
corner.
2. Press CC Zoom to display the last recorded heart cycle.
3. Press CC Zoom again to unzoom.
Switching modes or traces

The user can toggle between TVI, Tissue Tracking, Strain rate or
Strain modes to access to the mode specific controls or display
alternative traces from within a selected mode.
To switch mode
1. Go to Page 2 on the Touch panel.

2. Select the desired mode (TVI, Tissue Tracking, Strain rate,
Strain or TSI).

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To switch trace

2. Place the cursor on the Analysis window.
4. Select Analysis signal.
The Analysis signal menu is displayed.
Figure 9-7. The Analysis signal menu
5. Select the desired trace.

The Analysis window is updated with the selected trace.
Curve fitting analysis

Curve fitting analysis is used to estimate local myocardial
perfusion rate using ultrasound contrast agents.
The analysis is based on two algorithms:
• Wash-in curve fitting: find and estimate local perfusion
rate using contrast agent.
Exponential wash-in is described by the function:
y(t)=A[1-e-kt]+B, where:
• A (dB or AU) is the intensity from the contrast agent.
• B (dB or AU) is the intensity at time t = 0 (defined as the
time of left marker). This corresponds to the tissue
(baseline) signal if no contrast is present at the selected
starting point.

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Using Q Analysis
Note that A+B = contrast + tissue = plateau level.

• k (1/s) is a time constant.
• Wash-out curve fitting: find and estimate the wash-out rate
of contrast agent locally (e.g. LV or myocardium).
Exponential wash-out is described by the function:
y(t)=Ae-kt+B, where:
• A (dB or AU) is the intensity from the contrast agent.
• B (dB or AU) is the intensity from the tissue = baseline
signal.
Note that A+B is the initial intensity level.
• k (1/s) is a time constant.
1. Intensity (AU)
2. Time (s)
Figure 9-8. Curve fitting examples, A) wash-in, B) wash-out A=900 AU, B=300 AU for
all curves
Wash-in curve fitting analysis
Overview
The purpose of wash-in curve fitting analysis is to find and
estimate local perfusion rate using contrast agent. There are two
methods to obtain this information:
• Use the Real-time CPI application with low transmit power
(MI 0.1). Applying Flash will destroy most or all contrast
within the imaging plane. The period of low power imaging
immediately following the flash will contain the information
on how fast contrast agent washes into different segments
of the myocardium. By storing data 5 to 10 seconds after

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Flash and performing curve fitting to this data set, the user
can explore myocardial perfusion.
• Use the myocardial Contrast application in triggered mode.
This imaging mode is destructive for the contrast agent, and
the interval between each frame determines the image
intensity. Vary the triggering interval to obtain information
regarding how fast the contrast agent washes into the
myocardium after destruction.
Performing wash-in curve fit

From a contrast examination in Quantitative analysis:
1. Disable frames that are significantly different (i.e. because
of respiration or probe movements), see page 9-12.
2. Place the sample area over the myocardium in one of the
Cineloop windows.
NOTE: Up to eight different sample areas may be generated in the
myocardium.
3. If desired, reshape the sample area as described on
page 9-14.
4. Because of heart motion, the sample area in each frame
has to be adjusted manually to be located inside the
myocardium (Manual tracking of the sample area).
The signals originating from the heart cavities are typically
10 to 20 times stronger than the signals from the
myocardium, and will have a major effect on the averaging
of signals in the sample area.
NOTE: Refer to ‘Manual tracking of the sample area (dynamic
anchored sample area)’ on page 9-10 for further details
5. Browse through the cineloop to ensure that the sample area
is in the same anatomical position in all frames.
6. Adjust Horizontal sweep and scroll through the cineloop to
visualize a specific part of the data, typically the region
immediately after Flash.
7. Adjust Left marker and Right marker to apply curve fitting
to a specific region.
menu.
9. Select Curve fitting.
The Curve fitting menu is displayed.

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Using Q Analysis
Figure 9-9. The Curve fitting menu
10. Select Wash-in.

The Wash-in curve is displayed in the Analysis window (see
Figure 9-10).
1. Parameter window
Figure 9-10. Wash-in curve fitting
Wash-in curve fitting using varying triggering intervals

If the data set contains frames with uneven time intervals, e.g.
triggered images with increasing triggering intervals, it is
possible to plot the data using the time interval (dt) on the
X-axis.
1. Disable unwanted frames. Curve fitting will be performed
using all enabled frames.
NOTE: The frame disabling procedure is explained on page 9-12.
Cineloop windows.

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3. Repeat step 2 if other sample areas are desired.

myocardium.
page 9-14.
5. Perform manual tracking of the sample areas on all frames
to ensure that the sample area is inside the myocardium.
NOTE: See page 9-10 for more information on sample area manual
tracking.
menu.
7. Select Horizontal scale.
The Horizontal scale menu is displayed.
8. Select dT scaling.
The X-axis in the Analysis window is updated accordingly.
9. With the cursor in the Analysis window, press Update menu
again.
11. Select Wash-in.

The Wash-in curve is displayed in the Analysis window.

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Using Q Analysis
1. Parameter window
Figure 9-12. Wash-in curve fitting after varying triggering interval
Wash-out curve fitting analysis
Overview
The purpose of wash-out curve fitting analysis is to find and
estimate a local wash-out rate. The analysis may be used for
wash-out of contrast from LV or myocardium.
Performing wash-out curve fitting

From a contrast examination in Quantitative analysis:
1. Disable frames that are significantly different (i.e. because
of respiration or probe movements), see page 9-12.
Cineloop windows.
myocardium.
page 9-14.
4. Because of heart motion, the sample area in each frame
has to be adjusted manually to be located inside the
myocardium (Manual tracking of the sample area).
NOTE: Refer to ‘Manual tracking of the sample area (dynamic
anchored sample area)’ on page 9-10 for further details.

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The signals originating from the heart cavities are typically

10 to 20 times stronger than the signals from the
myocardium, and will have a major effect on the averaging
of signals in the sample area.
5. Browse through the cineloop to ensure that the sample area
is in the same anatomical position in all frames.
6. Adjust Horizontal sweep and scroll through the cineloop to
visualize a specific part of the data.
7. Adjust Left marker and Right marker to apply curve fitting
to a specific region.
menu.
10. Select Wash-out.

The Wash-out curve is displayed in the Analysis window
(see Figure 9-14).

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Using Q Analysis
Figure 9-14. Wash-out curve fit of two sample regions in an

in-vitro experiment
Anatomical M-Mode
Introduction
M-Mode applied to TVI, Tissue Tracking, Strain rate, Strain or

intensity data (Contrast) calculates and color/codes data
accordingly along a path drawn by the operator.
Using Anatomical M-Mode
1. Press Curved AMM.

2. In one of the Cineloop windows, place the first point of the
path.
3. Move the cursor to the location for the next anchoring point
of the path and press Select.
A path with two anchor points will give a straight anatomical
M-Mode profile. By creating more than two anchor points,
the user can bend the path and obtain a curved anatomical
M-Mode profile.
NOTE: To edit a path under construction, move the cursor
backward and retrace the path.
4. To end the trace press Select twice (double clicking).

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The color-coded display of the corresponding data

calculated along the path is shown in the Analysis window.
NOTE: Rotate Horiz. Sweep and scroll through the cineloop to
optimize the display to the portion of interest.
Optimizing Anatomical M-Mode
Edition of the curve

The drawn Anatomical M-Mode path can be edited by moving
the anchor points.
To move an anchor point

1. Select the anchor point to move.
2. Move the anchor point to a new position.
3. Press Select to anchor the point to its new location.

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Chapter 10
Archiving
‘The dataflow concept’ on page 10-3
‘Storing images and cineloops’ on page 10-6
‘Retrieving and editing archived information’ on

page 10-13
‘Review images in archive’ on page 10-25
‘Connectivity’ on page 10-30
‘Export/Import patient records/examinations’ on

page 10-44
‘Disk management’ on page 10-53
‘Data Backup and restore’ on page 10-61
‘Configuration – Archiving’ on page 10-68.

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Archiving
Introduction
During an examination, the operator stores data, images and

cineloops for immediate purposes. The Vivid E9 ultrasound unit
includes an integrated patient archiving system for data and
image storage.
The Vivid E9 ultrasound unit enables also storing of data and
images to external databases (Network Server, removable
media).

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Communication between the Vivid E9 ultrasound unit and other

information providers on the network takes the form of
dataflows. Each dataflow defines the transfer of patient
information and images from an input source to the unit, and
from the unit to one or several output sources.
A dataflow is a set of pre-configured settings. Selecting a
dataflow will automatically customize the unit to work according
to the settings associated with this dataflow.
Dataflows available
A set of pre-defined dataflows is available on the unit as listed in
the table below.
NOTE: Not all dataflow listed below are visible by default. The list of
dataflow available is configurable (see ‘Dataflow adjustments’
on page 10-71).
Dataflow Description
LocalArchive-Int.HD The local database is used for patient archiving.

Images are stored to internal harddrive. The
stored image files will consist of raw data only,
together with a single-frame DICOM preview
image (no DICOM multi-frame is stored).
LocalArchive - Int HD/DICOM Server The local archive is used for patient archiving.
Images are stored to the internal hard drive and to
a DICOM server.
Some of the measurements are stored if
DICOM SR is turned on (see page 10-40).
RemoteArch-RemoteHD A remote database (either on EchoPAC

Software Only or a server) is used for patient
archiving. Images are stored to a network image
volume (either internal HD on EchoPAC
Software Only or a server).
Remote Archive - Remote HD/DICOM Server A remote database is used for patient archiving.
Images are stored to a network image volume and
to a DICOM server.

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Worklist/LocalArchive-DICOMServer/Int.HD Search in the DICOM Modality Worklist, the

patient found is copied into local database. The
patient information and the examination results
are stored to the local the database. Images are
stored to a DICOM Server and to an image
volume on the local harddrive.
Worklist/RemoteArchive-DICOMServer/RemoteHD Search in the DICOM Modality Worklist, the

patient found is copied into a remote database.
The patient information and examination results
are stored to a remote database. Images are
stored to a DICOM Server and to an image
network volume as pure DICOM in both locations.
Worklist/Local Archive - LocalHD Search in the DICOM Modality Worklist, the

patient found is copied into the local database.
The patient information and examination results
are stored to the local database. Images are
stored to the local hard disk.
Worklist/Remote Archive - Remote Storage This dataflow is used in a network environment

that includes Vivid HL7 Gateway. The patient list
in the Search/Create Patient window is coming
from Vivid HL7 Gateway through DICOM Modality
Worklist. All patient data and images are stored to
a server.
DICOM CD/DVD read Read DICOM Media from the CD/DVD-drive.

Read only dataflow, no data can be stored.
DICOM Server Store pure DICOM images to a DICOM device.

Query Retrieve Retrieve images from a DICOM server
LocalArchive-Int.HD/eVue The local database is used for patient archiving.

Images are stored to internal harddrive and a
MPEG exam is created to the configured
destination.
RemoteArch-RemoteHD/eVue A remote database (either on EchoPAC

Software Only workstation or a server) is used for
patient archiving. Images are stored to a network
image volume (either internal HD on EchoPAC
Software Only workstation or a server) and a
MPEG exam is created to the configured
destination.
Worklist - DICOM Server Search in the DICOM Modality Worklist. Images

are stored to a DICOM Server. Some of the
measurements are stored if DICOM SR is turned
on (see page 10-40).

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DICOM USB device read Read DICOM data from an USB device. Read
only dataflow, no data can be stored.
No Archive Enables to perform an examination without

storing the data to any archive.

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Archiving
Images and cineloops that are stored during a current

examination are displayed as thumbnails on the clipboard.
When an image is stored, all the additional information that is
displayed is saved with it (e.i. probe and application selected,
image setting, annotations or measurements).
The image archive is set by the dataflow selected (see
page 10-3 about available dataflows).
CAUTION Do not use the internal harddrive for long-term image storage.
External storage media or network-based server solution is
recommended for image long-term archive.
CAUTION If working off-line with a dataflow pointing to a DICOM server,

the images stored during the examination may have to be
manually resent in the DICOM spooler when reconnecting the
unit. Resend all jobs that are failed or on hold.
In addition, stored images and cineloops can be saved to a

removable media in the standard formats JPEG, MPEG, AVI and
DICOM (see page 10-8).
Storing an image
Images are displayed chronologically on the clipboard.
1. While scanning in any mode, press Freeze.
2. With the trackball, scroll through the cineloop and select the
required image.
The image is stored and a thumbnail is displayed on the
clipboard. The number “1” in the upper right corner of the
image indicates that the image stored is a single frame.

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Storing a cineloop
A cineloop is a sequence of images recorded over a certain time
frame. The time frame can be adjusted to cover one or more
heart cycles. The stored cineloops are displayed chronologically
on the clipboard. Cineloops can be stored at any time during the
scanning session. The user can choose to preview the cineloop
before storage or save the cineloop directly as described below.
Preview and storage of a cineloop
1. While scanning in any mode, press Freeze.

2. Select and adjust the cineloop to store using the cineloop
controls (see ‘Cineloop’ on page 3-18).
3. Press 2D Freeze to run the cineloop.
The cineloop is stored and a thumbnail is displayed on the
clipboard.
NOTE: Cineloop storage can be configured to store heart cycles
with additional time before and after the R-wave (see
‘Global imaging settings’ on page 4-45).
Direct storage of a cineloop
Depending on whether the system has been configured to

enable or disable the Preview Loop before store function (see
‘Configuration – Imaging’ on page 4-45), the following
procedures enable the cineloop to be stored directly.
Storing cineloop without preview

The function Preview Loop before store is disabled (see
page 4-45).
1. While scanning, press Img. Store.
The last valid cineloop is stored in the archive and a
thumbnail is displayed on the clipboard.
Scanning resumes immediately.
Storing cineloop with preview

The function Preview Loop before store is enabled (see
page 4-45).
1. While scanning, press Img. Store.
The last valid cineloop is previewed on the screen (but not
stored).

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Archiving
2. If desired, select and adjust the cineloop to store using the

cineloop controls (see ‘Cineloop’ on page 3-18).
3. Press Img. Store to save the cineloop.
A thumbnail is displayed on the clipboard.
Saving images and cineloops to a standard format

Images and cineloops can be saved to a removable media or a
shared network folder in the following standard formats:
• Still images: JPEG, MPEG, DICOM and RawDICOM (Raw
data + DICOM) and HDF
• Cineloops: AVI, MPEG, DICOM and RawDICOM (Raw data
+ DICOM) and HDF
Images can also be stored as MPEG format on a CD-R using
the Export function as described on page 10-10.
1. In live: press Freeze.
In replay: select an image thumbnail on the clipboard.
2. Press Update menu on the control panel.
Figure 10-1. The System menu
3. Select Save as.

The Save as menu is displayed.

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Figure 10-2. The Save as menu
4. Select the desired destination from the Save in archive

pull-down menu.
5. Enter a file name in the File name field.
If the image or cineloop is saved as DICOM or RawDICOM
the file name is automatically generated to follow the
DICOM standard.
6. Select between:
• Store Image only: saves the active image or cineloop
only.
• Store Secondary capture: creates a screen capture of
the entire screen.
• Store Quad view: saves all images or cineloop when in
quad view.
NOTE: Store Secondary capture and Quad view are not
available when storing RawDICOM.
7. Select the image compression type (JPEG or RIe) or no
compression.
8. Enter in the desired Image quality (between 10 and 100).
A high quality setting will give a lower compression.
9. In the Save as type field select one of the following formats:
• RawDICOM: saves the still image or cineloop in both
GE raw format and DICOM format.

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Archiving
• DICOM: saves the still image or cineloop in pure

DICOM format.
• JPEG: saves a still image in JPEG format.
• MPEG: saves the still image or cineloop in MPEG
format.
• AVI: saves the cineloop in AVI format.
• HDF: saves the image or cineloop in HDF (Hierarchical
Data Format). HDF is a portable data format for
exchange of scientific numerical and graphical data.
More information about HDF format at: http://
www.hdfgroup.org/.
A tool for viewing HDF files can be downloaded from
http://www.hdfgroup.org/hdf-java-html/hdfview/.
10. Press Save.
A file is saved in the selected archive.
MPEGVue/eVue
MPEGVue/eVue enables the user to export or save an exam
(images, measurements and reports) into MPEG format
readable from a regular Windows computer together with a
special MPEG viewer. The measurements performed during the
exams are stored as an Excel file, the saved report as Compiled
HTML format.
MPEG exported exams can be created using the Export function
(MPEGVue) or by using the dataflows Local Archive - Int. HD/
eVue (eVue) or Remote Archive - Remote HD/eVue.
The MPEGVue option is used to create MPEG exported exams
on finished exams. The eVue option is used to create MPEG
exported exams when performing the exam, upon saving the
images.
Creating a MPEG exam using the Export function (MPEGVue)
Refer to ‘Export/Import patient records/examinations’ on

page 10-44.
Creating a MPEGVue exam using a eVue dataflow
The dataflow must be configured before first time use as follow:

administrator.
2. Select the Connectivity category and Dataflow subgroup.

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The Dataflow sheet is displayed.

3. Select the dataflow Local Archive - Int. HD/eVue or
Remote Archive - Remote HD/eVue in the Name
pull-down menu.
Make sure that the option Hidden is unchecked.
Figure 10-3. The Dataflow sheet
4. Select the eVue device in the Selected devices pane and

press Properties.
The eVue properties window is displayed.
Figure 10-4. The eVue properties window
5. Select a removable media or a network volume remote path

as the destination in the Destination Pull-down menu.
NOTE: Remote paths of network volumes must be entered once in
the Remote path field before they can be selected from the
Destination Pull-down menu (see ‘Remote path setting’ on
page 10-73).
6. Check the options as required.

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Archiving
7. Select OK and press Config.
To create an MPEG exam using an eVue dataflow

1. Press Patient.
The Search/Create patient window is displayed.
2. Select the dataflow Local Archive - Int. HD/eVue or
Remote Archive - Remote HD/eVue.
3. Perform an exam.
When saving an image, it is stored as raw data to the local
or remote archive (depending of the dataflow selected) and
an MPEG copy is created and stored to the destination set
during the configuration of the dataflow.
Reviewing a MPEG exported exam
A MPEG exam can be read from any computer with

Windows 98/2000/XP/7, provided that DirectX 8.1 or later and
Windows Media Player 7.1 or later are installed.

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Retrieving and editing archived

information
Searching for a patient record

The Search/Create patient window is displayed
(Figure 10-5).
dataflow.
4. Highlight a patient record in the Patient list filed.
NOTE: You can select [+] in front of the actual patient record to
display the examinations belonging to the patient record.
5. Press Open Exam.
The Examination List window for the actual patient is
displayed (refer to Figure 10-6).

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Archiving
1. Select archive and other pre-defined services. 4. Press one of the headings to sort the list
2. Change user. accordingly (ascending/descending).
3. Advanced search filters, the system can be 5. Expand Patient record to display belonging
configured to display the advanced search examinations
filters as default (see ‘Patient management
presets’ on page 10-69).
The Search/Create patient window may be slightly different depending on the Dataflow selected
Figure 10-5. The Search/Create Patient window

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Advanced search
To restrain the search to a specific patient group, one or more

filters may be applied to the search. The table below shows the
filters applicable to a patient search.
Searching filter
Echolab
Diagnostic code
Born between
Examination date between
Current date
Images: patient records with examinations with images
Stress examinations: patient records with stress echo examinations
No Report: Patient record with examination(s) without stored reports
Category: displays only patient records for the selected category
Diagnosis Physician
NOTE: The list of searching filters may vary depending on the Dataflow
selected
1. If not visible, press More in the Search/Create Patient
window to display the advanced search filters.
The unit can be configured to display the Advanced search
options as default (see ‘Patient management presets’ on
page 10-69)
2. Select the required searching filters.
The matching data is displayed in the Patient list when the
automatic search function is turned on.
Printing patient list
1. Press Print Patients.

A patient list with all patients matching the search criteria is
printed.

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Archiving
Editing data in the archive

After selecting a patient record the Examination List window is
displayed showing previous examinations and diagnosis
information related to the selected patient.
1. The information displayed in the Patient list is 2. Insert pre-defined text.

configurable (see page 10-68). 3. Edit Findings (see page 11-10).
Figure 10-6. The Examination list window
Editing Referral Reasons, Comments and Diagnosis
The user can edit the actual text in the Examination List window
using the alphanumeric keyboard and by inserting pre-defined
text input.

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CAUTION The user is responsible for patient demographic data,

diagnostic information or any other patient related information
entered in the database.
Editing text
1. In the Examination list window (Figure 10-6), place the
cursor in the required field.
2. Using the alphanumeric keyboard, edit the information.
Inserting pre-defined text input

1. In the Examination list window, press the Insert Text button
over the field.
The Insert text window is displayed (see Figure 10-7).
The pre-defined text list is organized in a three level
hierarchy. Selecting one item in the first column displays
pre-defined text entries related to the selected text in the
second and third columns.
2. Navigate through the pre-defined text list by selecting items
in the columns and double-click on the desired pre-defined
text to be inserted. If an entry in the third column is inserted,
the selected text in the second column is also inserted.
Press More>> to display the full text for the selected entry.
Figure 10-7. The Insert text window
Creating, editing and deleting text input

1. Press Utility/Config on the Touch panel to access the
configuration package.
2. In the Configuration package, select the category Report
and the Tab sheet Comment texts.

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Archiving
Figure 10-8. The Comment texts sheet

second and third column.
To create a new text input in the first level:
1. Select the first level and press New.
The Enter new text window is displayed.
Figure 10-9. The Enter new text window
2. Enter a title in the Text field and a pre-defined text in the Full
text field.
3. Select OK.
To create a new text input in the second and third level:

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1. Select an item in the first column, then select either the

second or third column and press New.
The Enter new text window is displayed.
The pre-defined text input to be created in the second and
third column will be related to this selection only.
2. Enter a title in the Text field and a pre-defined text in the Full
text field.
3. Press OK.
To edit a pre-defined text input:
1. Select the term to edit in one of the columns.
2. Press Edit.
The Edit text window is displayed.
3. Edit the text in both the Text and Full text fields.
4. Press OK.
To delete a pre-defined text input:
1. Select the item to delete in one of the columns.
2. Press Delete.
A Confirmation window is displayed.
3. Press Yes.
The selected text input is deleted including the belonging
text inputs in the sub-levels.
Diagnosis code
Adding a Diagnosis code

1. In the Examination list window, select Code (see
Figure 10-6).
The Entered Code window is displayed.
2. Select Add.
The Code list window is displayed.
3. Double-click the code to enter.
4. Select Done to exit.
The Code selected is displayed in the Examination list
window.

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Archiving
1. The Entered code window

2. The Code list window
Figure 10-10. Entering Diagnosis codes
Deleting an entered Diagnosis code

Figure 10-6).
The Entered code window is displayed.
2. In the Entered code window, select the code to delete and
press Delete.
Creating a Diagnosis code

Figure 10-6).
The Entered code window is displayed.
2. Select Add.
The Code list window is displayed.
3. Select New.
4. Enter the new code.
5. Select Done to exit.
Diagnostic codes can also be created and deleted from the
configuration package:
1. Press Verify/Config on the Touch panel to access the
configuration package.
2. In the Configuration package, select the category Report
and the Tab sheet Diag. Codes.

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Figure 10-11. The Diagnostic codes sheet
To create a diagnostic code:

1. Select New code.
2. In the Code field, enter a name for the diagnostic code.
3. In the Full text field, enter the code text.
To delete a diagnostic code:
1. In the Code list field, select the diagnostic code to delete.
2. Select Delete.
Editing Demographic details
1. Press Patient info.

The Patient information window is displayed.
The information available in the Patient information window
is dependent of the examination category (i.e. cardiac,
vascular...etc)
2. Using the alphanumeric keyboard, edit the information.
CAUTION Do NOT use '\' or '^' in patient information fields, as these

characters might cause problems with some DICOM devices.
3. Press either:

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Archiving
• Exam list to display the Examination list window.

• Image list to display the Image browser screen.
Deleting archived information

Only user logged in with full operator rights can delete patient
records (see ‘System users’ on page 3-32 for further
information).
To delete a patient record
1. Press Patient on the Front panel.

The Search/Create Patient window is displayed
(Figure 10-5 on page 10-14).
2. Search and highlight the patient record to delete.
3. Press Delete in the Search/Create Patient window.
A warning message is displayed asking the user to confirm
the action to perform.
4. Select OK.
To delete an examination

2. Search and highlight the patient record with the examination
to delete.
3. Press Select patient.
The Examination list window is displayed (Figure 10-6 on
page 10-16).
4. Highlight the examination to delete.
5. Press Del Exam to delete the examination.
6. Select OK.
An information window is displayed to confirm the operation.
7. Select OK.
To delete an image

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2. Search and highlight the patient record with the image to
delete.
3. Press Select patient.
The Examination list window is displayed (Figure 10-6 on
page 10-16).
4. Highlight the examination with the image to delete.
5. Press Review.
The images for the selected examination are displayed on
the Review screen (Figure 10-13 on page 10-26).
6. Select the image to delete.
7. Press Delete.
8. Select Yes.
To delete an image from the clipboard
1. If in live, press Freeze.

2. Press Trackball until the Pointer tool is selected.
3. Move the pointer over the image to delete in the clipboard.
5. Select Delete clipboard cell from the Update menu.
6. Select Yes.
Moving examinations
An examination can be moved from one patient record to
another. This feature should only be used if an examination was
performed and stored to a wrong patient record.
1. In the Search/Create Patient window press [+] in front of the
patient record containing the examination(s) to move (see
2. Select the examination to move.
3. Press More in the lower, right-hand corner of the Search/
Create Patient window.
4. Press Move Exam.
The Move exam window is displayed.

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Archiving
Figure 10-12. The Move exam window
5. Search and select the target patient record.

6. Press Move Exam.
7. Select OK.
An information window is displayed to confirm the operation.
8. Select OK.

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There are two ways to access to archived images:

• Review the images from a selected examination.
• Select images from the Image list screen displaying all the
images sorted by examination for the actual patient record.
Review the images from a selected examination

1. In the Examination list window (see Figure 10-6 on
page 10-16), highlight the examination with images to
review.
2. Press Review on the Control panel.
The stored images for the selected examination are
displayed in the Review screen (see Figure 10-13).
To analyze images:
1. Select the images to analyze.
2. Press Analyze.

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Archiving
Analyze: analyses selected images. Exam list: displays the Examination list window
Image list: displays the Image browser screen. (Figure 10-6 on page 10-16)
Change page: change page in the Review screen.
Figure 10-13. The Review screen
Select images from the Image list screen

The procedure described below enables the analysis of images
belonging to different examinations for a selected patient record.
If images are stored on multiple removable media, they have to
be restored to the local hard drive prior to review as described
below.

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1. In the Examination list window (see Figure 10-6 on

page 10-16), press Image list.
The Image list screen is displayed (see Figure 10-16)
showing thumbnails of stored images for the actual patient
sorted by examination.
If the images are stored on a removable media that is not
mounted, the image thumbnail is replaced by a symbol.
2. Select the images to analyze or press Analyze to review all
images.
• If all images are available the images are displayed for
review.
• If some of the images are not available locally the
Restore images window is displayed.
Figure 10-14. The Restore images window
3. Select between:
• Restore only the selected images: only selected
images that are not available locally are restored.
• Restore all images of the selected exam: all images
that are not available locally in the exams where an
image was selected are restored.
• Restore current patient: restores all images in all
examinations.
4. Press OK.
The Insert media window is displayed.

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Archiving
Figure 10-15. The Insert media window
5. Insert the required media.

6. Select between:
• OK: the images on the mounted media are restored on
the local hard drive. If not all the required images are on
the inserted media, the user is prompted to insert
another media until all required images are restored on
the hard drive.
• Skip media: the images stored on the inserted media
are not restored. If not all the required images are on
the inserted media, the user is prompted to insert
another media until all required images are restored on
the hard drive.
• Cancel: no images are restored.

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1. Missing image
Figure 10-16. The Image browser screen

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Archiving
Connectivity
This section describes the communication and connection

options for the Vivid E9 ultrasound unit with other devices in the
hospital information system. This section covers the procedures
for configuration and optimal data management from a Vivid E9
in the following scenarios:
• A stand-alone Vivid E9
• A scanner and a workstation in a direct connect
environment
• A scanner and workstation in a network
• A scanner and a DICOM server in a network.

Communication between the Vivid E9 ultrasound unit and other
information providers on the network takes the form of
dataflows. Selecting a dataflow will automatically customize the
ultrasound unit to work according to the services associated with
this dataflow. Each dataflow defines the location and format of
patient information. Patient information can include
demographic data and images, as well as reports, measurement
and analysis data. By utilizing dataflows, the user can configure
the Vivid E9 ultrasound unit to optimally meet the connectivity
needs of the facility, while keeping the user interface
unchanged. The dataflow concept allows the flexibility of data to
be obtained from various sources and allows data to flow to
various output sources.

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Connectivity
Dataflow examples
Stand-alone scanner
Acquisition: Review:
Scanner dataflow: LocalArchive-Int.HD Scanner dataflow: LocalArchive-Int.HD
The local database is used for patient archiving. Images are stored to internal harddrive.
Scanner and Workstation in a direct connect environment
Scanner dataflow: RemoteArch-Remote HD Workstation dataflow: LocalArchive-Int.HD
In this scenario the data is transferred from the Vivid E9 to a dedicated EchoPAC Software Only workstation
over the Ethernet (either in a peer-to-peer connection with a crossover cable, or in a network). The database
from the EchoPAC Software Only is used as the master and images are stored directly to the EchoPAC
Software Only internal harddrive. In this configuration the scanner is just an intermediate acquisition unit
which after completion of a study, will not contain any patient information, measurements or images.
Up to three scanners can be connected to one EchoPAC Software Only if the workstation has the EchoPAC
Share option enabled.

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Scanner and Workstation in a network environment
Scanner dataflow: RemoteArch-Remote HD Workstation dataflow: RemoteArch-Remote HD
In this scenario the Vivid E9 is configured to work with an ImageVault patient demographics and image
server in a network environment. Images are first saved on the local image buffer on the scanner and
transferred to the server when saving the examination.
Scanner and DICOM server in a Network
DICOM Server
PHONO ECG AUX

(pressure/pulse)
Scanner DICOM dataflows:

• DICOM server: images are stored to a DICOM server.
• Local Archive - Int HD/DICOM Server: the local archive is used for patient archiving. Images are stored to
the internal harddrive and to a DICOM server.
• Remote Archive - Remote HD/DICOM Server: a remote database is used for patient archiving. Images
are stored to a network image volume and to a DICOM server.
• Worklist/Local Archive - DICOM Server/Int HD: search in a DICOM Modality Worklist, the patient found
is copied into local database. The patient information and the examination results are stored to the local
database. Images are stored to a DICOM server and to an image volume on the local harddrive.
• Worklist/Remote Archive - DICOM Server/Remote HD: search in a DICOM Modality Worklist, the patient
found is copied into a remote database. The patient information and the examination results are stored to a
remote database. Images are stored to a DICOM server and to an image network volume as pure DICOM
in both locations.
• Query/Retrieve: retrieve images from a DICOM server based on query parameters.

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Dataflow selection
Select a dataflow from the Search/Create Patient window (see
Figure 10-5 on page 10-14) or configure the system with a
default dataflow from the Configuration management package
as described below.
Default dataflow selection

The Dataflow sheet is displayed (see Figure 10-17).
3. Select the desired dataflow in the Name pull-down menu
and check the option Default.
4. Press Config to exit the Configuration management
package.
1. Select a dataflow
2. Default option for the selected dataflow
Figure 10-17. Default dataflow setting
Scanner connectivity configuration
Scanner in a network environment
To be able to use the network functions when connected to a

hospital network, the scanner must have a proper network
address. Typically source for this information is the network
administrator.
Scanner’s TCP/IP settings

administrator.
2. Select the Connectivity category and TCP/IP subgroup.

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The TCPIP subgroup is displayed.
1. Computer name: not editable

2. IP settings
3. Remote archive setup: remote archive IP address and name (EchoPAC Software Only, EchoServer,
ImageVault)
4. Save TCP/IP settings. The changes will be effective after the system is rebooted.
Figure 10-18. TCP/IP setting
3. Select Network settings to configure:

• The IP address for the system
• The subnet mask for the system
• The IP address for the Default Gateway
4. In the Remote archive setup area enter:
• The IP address for the remote archive
• The name of the remote archive
5. Press Save settings and reboot the system.

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Connectivity
Scanner in a network environment with a DICOM server
The scanner’s TCP/IP settings must be configured as described

in ‘Scanner’s TCP/IP settings’ on page 10-33.
In addition, to work against the DICOM server the following
information has to be entered in the scanner:
• The DICOM server IP address
• The DICOM server port number
• The DICOM server AE title (the server’s name)
Typically source for this information is the network administrator.
DICOM dataflow selection

administrator.
3. Select the DICOM dataflow to configure from the Name
pull-down menu (Figure 10-19).
DICOM devices configuration

Depending on the DICOM dataflow selected, one or several
DICOM devices may have to be configured.
1. Select a DICOM device in the Selected devices pane and
press Properties (see Figure 10-19).

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1. Select a DICOM dataflow

2. Select the DICOM device.
3. Press Properties.
The Properties window for the selected DICOM device is

displayed (Figure 10-20).

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Figure 10-20. DICOM worklist properties window
2. Select the DICOM server from the IP-address pull-down

menu.
Follow the steps below if the IP address settings for the
DICOM server need to be modified or created:
• Select <Modify> from the IP-address pull-down menu.
The IPs window is displayed.
• Select the DICOM server and press Modify in the IPs
window (or press Add if creating a new IP address).
The Enter name and IP window is displayed.
• Enter the name and/or IP address of the server and
press OK to return to the Properties window.
Figure 10-21. Modifying/Creating the IP address
3. In the Properties window, enter:

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• The DICOM server AE title. This entry is case sensitive

and must match exactly.
• The DICOM server port
For some DICOM servers, the default Timeout setting may
be too low.
4. When configuring the DICOM storage device, the following
image settings should be entered in the Properties window
(Figure 10-22):
• Check DICOM SR if required (see below).
• Keep Reopen per image unchecked.
• Keep Allow raw data unchecked.
• Set Max Frame rate to 30.
• Keep Only Black and White unchecked.
• Set Compression to JPEG.
• Set Quality to 95.
• Check Allow multiframe.
NOTE: Setting Compression to None may result in long
transfer time and cineloop with more than 500 frames
will be truncated. If Compression is set to None, set
Max frame rate to either 25 or 30 frames per second to
reduce the risk of truncating loops.
Figure 10-22. DICOM storage properties window

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Connectivity
Adjusting the Search criteria

When selecting a DICOM Worklist dataflow or Query/Retrieve,
search criteria can be set for the system to use when searching
the database.
administrator.
The Dataflow sheet is displayed (see Figure 10-19 on
page 10-36).
3. Select a DICOM Worklist dataflow or the Query/Retrieve
dataflow.
4. Select the Worklist or Query/Retrieve device in the Selected
devices pane and press Properties.
The Properties window for the selected DICOM device is
displayed.
5. Press Search criteria.
The Search criteria window is displayed (Figure 10-23).
6. Select a Search criteria from the Select tag pull-down menu.
7. Enter a value if required or leave blank if not to be used.
This entry is case sensitive and must match exactly.
8. Press Add to list.
9. Press OK to close the Search criteria window.
Figure 10-23. The Search criteria window

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DICOM SR
DICOM Structured Reporting (SR) is a standardized format for
medical results. Vivid E9 supports the specialized form for Adult
Echo Ultrasound (“TID 5200 Echocardiography Procedure
Report”) and Vascular Ultrasound (“TID 5100 Vascular
Ultrasound Procedure Report”) for M&A results.
With the DICOM SR support, M&A for an exam can be sent at
the end of the exam or when exported from local archive. The
destination can be either a server on the network (Storage SCP)
or a removable media (DICOM Media) depending on the
DICOM dataflow selected.
“TID 5200 Echocardiography Procedure Report” is sent if the
exam contains M&A from category Cardiac or Pediatric (Heart).
“TID 5100 Vascular Ultrasound Procedure Report” is sent if the
exam contains M&A from category Vascular or Abdominal. If the
exam contains M&A from both Cardiac/Pediatric (Heart) and
Vascular/Abdominal categories, two SR documents are sent.
“TID 5200 Echocardiography Procedure Report” and “TID 5100
Vascular Ultrasound Procedure Report” do not support all M&A
results from Vivid E9. They are limited to the following:
• No unassigned measurement.
Refer to the Vivid E9 Reference manual for a complete list
of supported parameters.
• The following modes: 2D, M-mode, Color Flow, PW Doppler,
CW Doppler, 3D and TDI.
• Not Modified Simpson method or Bullet methods.
Refer to the Vivid E9 Reference manual for a complete list
of supported methods.
• Basic derivations (Average, Last, Min and Max), no
references between the derived measurements and the
ones they were made from.
• Wall Motion Scoring: individual segment scores only
according to 16-segment model, no graded Hypokinesis
(only Hypokinesis is used).
DICOM SR must be activated for each DICOM device.
administrator.
The Dataflow sheet is displayed (see Figure 10-19 on
page 10-36).
3. Select the DICOM dataflow to configure in the Name
pull-down menu.

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4. Select a DICOM storage device in the Selected devices

pane and press Properties.
The Properties window for the selected DICOM storage
device is displayed.
Figure 10-24. DICOM storage properties window
5. Check the option Allow SR to enable DICOM SR.

The following additional options are available:
• Allow SR private data: send the current exam data in a
private format. This option is by default unchecked and
should only be used with DICOM storage devices that
can handle private data format.
• Signed Doppler velocities: send signed Doppler
velocities.
• Use older SR version: when checked a Use older SR
version pull-down menu is displayed. The current exam
data will be sent in the same format as the selected SR
version. Details about format and content of the SR
version can be found in the corresponding user manual
of the selected version.
These settings apply to both “TID 5200 Echocardiography
Procedure Report” and “TID 5100 Vascular Ultrasound
Procedure Report”
6. Select OK.

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DICOM spooler
DICOM spooler displays the current DICOM output jobs. The
jobs may be Storage, Print, Modality Performed Procedure Step
or Storage Commitment. The DICOM spooler is used for
checking the current job's status when a job is saved or when
the total spooler status on the right of the Archive window
displays an error.
From the DICOM spooler the user can also:
• Delete non-active jobs
• Resend a job that has failed or is in hold
• Send a job that has failed or is in hold, to a new destination
• Hold a job that is not active.
The job's status displayed in the DICOM spooler window can be:
• Pending: the job is complete, waiting to be active.
• Hold: the job is complete, but suspended, waiting for an
user action.
• Append: the job is incomplete, waiting for more images
(Direct store function).
• Active: the job is complete and connected to the destination
device.
• Failed: the job is complete but one or more images failed to
transmit to the destination device.
• Done: the job is saved to the destination device. The jobs
that are done are removed from the spooler after a few
minutes.
To start the DICOM spooler:
1. Do one of the following:
• Press Utility and DICOM spooler on the Touch panel
• Press F4 on the alphanumeric keyboard
• Press Alt + S on the alphanumeric keyboard
The DICOM spooler window is displayed (see
Figure 10-25).
The DICOM spooler window is automatically updated. Press
Refresh to update the information displayed at any time.

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Figure 10-25. The DICOM job spooler window
To delete a job:
1. Select the job(s) to delete in the DICOM job spooler window.
NOTE: Only non-active jobs can be deleted.
2. Press Delete.
To resend a job:
1. Select the job(s) to re-send in the DICOM job spooler
window.
NOTE: Only jobs that failed or are in hold can be resent.
2. Press Resend.
To send a job to a new destination:
1. Select the job(s) to send in the DICOM job spooler window.
NOTE: Only jobs that failed or are in hold can be sent to a new
destination.
2. Press Send to....
A dialogue window is displayed.
3. Select the new destination from the Destination pull-down
menu.
4. Press Send.
To hold a job:
1. Select the job(s) to hold in the DICOM job spooler window.
NOTE: Only inactive jobs can be set on hold.
2. Press Hold.
3. To undo hold, press Resend.

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Export/Import patient records/

examinations
Patient records/examinations from the local archive on one

system (Vivid E9) can be exported to the local archive on
another system via a removable media. Patient records/
examinations from the local archive can also be exported
directly to a remote archive (an ImageVault server, a DICOM
server or EchoPAC Software Only). In addition patient records/
examinations from a remote archive (an ImageVault server or
EchoPAC Software Only) can be exported to a removable media
or to a DICOM server.
Similarly, patient records/examinations from the local archive on
one system can be imported to the local archive on another
system via a removable media. No data is deleted from the
source archive when importing data. In addition patient records
from a removable archive can be imported to a remote archive
(ImageVault server).
CAUTION If an examination is opened, it must be closed before

performing Export/Import of patient records/examinations.
Exporting patient records/examinations

1. If exporting to a removable media, Insert the media in the
drive.
2. Press Patient.
The Search/Create Patient window is displayed (see
3. Select the source archive in the Dataflow field:
• LocalArchive-Int.HD: exports data from the local
archive.
• RemoteArch-RemoteHD: exports data from the
configured remote archive.

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4. Press Export.
The Export dialogue window is displayed.
Figure 10-26. The Export Dialogue window
5. Select one of the following available destinations from the

Destination drop-down menu:
• CD/DVD Archive: exports raw and DICOM data to a
CD/DVD.
• DICOM CD/DVD: export DICOM data only to a CD/
DVD-R/W.
• Remote Import/Export Archive: exports raw and
DICOM data to an ImageVault server or EchoPAC
Software Only.
• Excel file: exports demographics, measurements and
reporting data to a spreadsheet. The export destination
must be configured (see page 10-74).
• DICOM Print: prints images to a DICOM printer via
DICOM spooler.
• MPEGVue: exports examinations to MPEGVue format
readable from a regular computer. Ultrasound images
are stored as MPEG, measurements as an Excel file
and saved reports as CHM-files. The export destination
must be configured (see page 10-74).
• USB Harddisk/Memstick Archive: exports raw and
DICOM data to an USB device. Only available when an
USB device is mounted.
• DICOM Storage: export DICOM data only to a DICOM
server via DICOM spooler
6. Press OK.
The following situations may occur:
• The system is checking that the removable media is
inserted. If not, a dialogue window is displayed
prompting the user to insert a media.

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Figure 10-27. Insert media window
Insert the media and select Retry.

• The system is checking if the destination media is
empty and needs to be formatted. If yes an Information
window is displayed asking the user whether or not to
format the media.
Figure 10-28. Media formatting window
Enter a new label and select OK.

NOTE: Only the following characters and signs can be used
when labelling a media: A - Z, a - z, 0 - 9, “_” and “-”. Do
not use more than 11 characters or signs. Do not use
space.
• If the media is not empty, the Add files window is
displayed.
Figure 10-29. Add files windows

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Select Yes.
The system is preparing the media to allow addition of
new files.
NOTE: If Eject is selected, the user is prompted to insert
another media. If No is selected, the Export Dialogue
window is displayed (Figure 10-26), where the user can
select another destination.
The Export patient window is displayed (see Figure 10-30).
Figure 10-30. The Export patient window
7. Search and select the patient records/examinations to

export in the Patient list. All searching criteria can be used to
find the patient records to export.
The following selection methods can be used:
• Press and hold down Shift while selecting patient
records/examinations to select several consecutive
items at a time.
• Press and hold down Ctrl while selecting patient
records/examinations to select several discrete items.
• Press Select all to export all patient records.
• Press Today in the Export patient window to display
today's examinations and select the actual
examinations.

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NOTE: Select More to display the extended Export patient

window if necessary.
• Fill in the Exam between field to display the patient
records done during a specific time period and select
the actual records.
• Fill in the Born between field to display the patient
records of patients born during a specific time period
and select the actual records.
8. Adjust the following settings (if available) as desired:
• Delete selected patient(s) after copy
• Copy images
9. Press Copy.
If one or more patient examination is already present in the
destination archive the Export/Import conflict window is
displayed (see Figure 10-31). For each conflicting item,
select:
• Keep: to keep the existing examination in the
destination archive.
• Replace: to replace the existing examination with the
corresponding item in the source archive.
Figure 10-31. The Export/Import conflict window
Press OK to resume export.

A progress indicator is displayed. When done a status
window is displayed showing the number of patient records
that have been successfully exported.
10. Press OK.
A check mark is displayed in the Copied field in the Export
patient window for each item exported.

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A status message is displayed for each item exported. Make

sure that the operation was successful for each item
exported.
11. Press Done to complete the process.
12. If exporting to a removable media, press Alt + E to eject the
media.
NOTE: Do not eject the CD using the button on the CD drive.
The Eject device menu is displayed.
13. Select the relevant media.
The selected removable media is ejected.

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Importing patient records/examinations

1. Insert the removable media of the source archive in the
corresponding drive.
3. Select destination archive in the Dataflow field:
• LocalArchive-Int.HD: imports data to the local archive.
• RemoteArch-RemoteHD: imports data to an
ImageVault server or an EchoPAC Software Only.
4. Press Import.
The Import dialogue window is displayed (see
Figure 10-32).
Figure 10-32. The Import Dialogue window
5. Select one of the following available source archive from the

Source drop-down menu:
• CD/DVD Archive: imports raw and DICOM data (if
present) from a CD/DVD-R.
• DICOM CD/DVD: imports DICOM data only from a CD/
DVD-R.
• Remote Import/Export Archive: imports raw and
DICOM (if present) data from an ImageVault server or
EchoPAC Software Only.
• Query retrieve: imports data from a DICOM server.
• USB Harddisk/Memstick Archive: imports raw and
DICOM data from an USB device. Only available when
an USB device is mounted.
• DICOM USB Harddisk/Memstick: imports DICOM data
only from an USB device. Only available when an USB
device is mounted.
6. Press OK.
The Import patient window is displayed (see Figure 10-33).

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Figure 10-33. The Import patient window
7. Search and select the patient records to import in the

Patient list. All searching criteria can be used to find the
patient records to import.
The following selection methods can be used:
• Press and hold down Shift while selecting patient
records/examinations to select several consecutive
items at a time.
• Press and hold down Ctrl while selecting patient
records/examinations to select several discrete items.
• Press Select all in the Import patient window to export
all patient records.
NOTE: Select More to display the extended Import patient
window if necessary.
• Press Today to display today's examinations and select
the actual examinations.
• Fill out the Exam between field to display the patient
records done during a specific time period and select
the actual records.
• Fill out the Born between field to display the patient
records of patients born during a specific time period
and select the actual records.
8. Press Copy.

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If one or more patient examination is already present in the

destination archive the Export/Import conflict window is
displayed (see Figure 10-31 on page 10-48). For each
conflicting item, select:
• Keep: to keep the existing examination in the
destination archive.
• Replace: to replace the existing examination with the
corresponding item in the source archive.
Press OK to resume import.
A progress indicator is displayed. When done a status
window is displayed showing the number of patient records
that have been successfully imported.
9. Press OK.
A check mark is displayed in the Copied field in the Import
patient window for each item imported.
A status message is displayed for each item imported. Make
sure that the operation was successful for each item
imported.
10. Press Done to complete the process.

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Disk management
Disk management
The Disk management function allows the user to manage hard

disk space while maintaining the patient database on the
system. The Disk management function can be used to move,
copy or delete images and move or copy reports from the oldest
patient records. The Disk management function has also an
auto-purge feature that will automatically delete images and
reports that have already been copied if the local hard disk is
getting full.
Three different disk management scenarios are possible
depending on the system configuration:
• Disk management is set to move files: the user runs the
Disk management function on a regular basis to move
images and reports from older patient records to removable
media or to a network volume. Using this setting, moved
images and reports are deleted from the local hard drive and
copied to the specified destination. This scenario prevents
the local disk to fill up and keeps images and reports from
the most recent patient records on the local disk. Using this
scenario, the user can control what should remain on the
system while keeping the disk free space at an operational
level.
• Disk management is set to copy files: the user runs the Disk
management function on a regular basis to copy images
and reports from older patient records to removable media
or to a network volume. To prevent the local disk to fill up,
the auto-purge function automatically deletes files that were
previously copied when the disk free space has reached the
minimum allowed limit. This scenario lets the system
automatically manage the disk space on the system.
NOTE: When using this setting, the images location displayed in the
Examination list screen will be the selected destination for
the copy operation, even if the images are still present on
the local hard drive. When reviewing the exam, the original
images will be retrieved from the local hard drive as long as
they are available there. When the images are deleted from

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the local hard drive by the auto-purge function, the copied

images will be retrieved.
• Disk management is set to delete files: the user runs the
Disk management function on a regular basis to delete
images from older patient records.
NOTE: Ensure that you have established a data management protocol
for your office/institution. The user MUST manage the
removable media used when running Disk management by
keeping a log and by creating a media filing system.
A person should be in charge of performing the process. The
Disk management system can be set up so that a reminder is
displayed at regular intervals.
Configuring the Disk management function

Configuration of the Disk management system can only be done
by user with administration rights.
If required log on as administrator.
2. Select the category Admin.
3. In the Admin category, select the sheet Disk management.

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1. Sets the reminder time interval for running Disk management.

2. Sets the files to be managed based on the examination dates.
3. Sets the Disk management to copy, move or delete images.
4. Sets the destination device.
5. Starts Disk management
Figure 10-34. The Disk management sheet
Disk management schedule setting
1. Next to Reminder interval, specify the number of days/

weeks you want the system to prompt you to perform disk
management.
This setting should be set based on the activity of your
office/institution. If None is selected, no reminder will be
displayed.
Data management settings
1. Select a number of days, weeks or months or a specific date

next to Manage files older than. Only files older than the
specified setting will be copied or moved.
If None is selected, all files will be copied or moved.
2. Next to Operation check:
• Copy: the images and reports from the examinations
older than the specified setting defined in step 1 are
copied to the specified destination. Using this setting,

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the files will exist in two locations, the local hard drive
and the destination.
• Move: the images and reports from the examinations
older than the specified setting defined in step 1 are
copied to the specified destination, verified and then
deleted from the local hard drive. Using this setting, the
files will exist in one location, the destination media.
They are removed from the local hard drive.
• Delete: the images from the examinations older than
the specified setting defined in step 1 are deleted from
the hard drive.
Destination device setting
1. Next to Destination device, select a removable media or a

network share folder.
NOTE: To be able to select a network share folder in the Destination
device field, its path must have been entered in the Remote
path field.
CAUTION If using removable media, it is recommended to use dedicated

media to the Disk management process. Removable media
used for data backup must not be used when performing Disk
management.
Do not use the same removable media on several systems.
Running the Disk management function

The Disk management function can be run at any time. In
addition, the user may be prompted to run Disk management if
the time since the last Disk management operation performed
has reached the setting for the Reminder interval (see
page 10-55), or if the local hard drive is about to be full.
Disk management can be run from the Search/Create patient
window (see below) or from Config/Admin/Disk management
Manual start of Disk management
1. Press Patient.
The Search/Create patient window is displayed.
2. Press Disk management.

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Disk management
The Disk management welcome screen is displayed

(Figure 10-35).
Figure 10-35. The Disk management welcome screen
The Disk management operation will either copy, remove or

delete files from the local archives depending on the Disk
management configuration (see page 10-54). Make sure
that the correct configuration is set.
3. Press Next.
The Storage size information window is displayed
(Figure 10-36).
Verify the information displayed. If using removable media,
the operation may require several media as specified on the
screen. Make sure that the specified number of disks are
available.

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Figure 10-36. The Storage size information window
4. Insert a removable media in the specified drive.

The disk does not need to be formatted.
5. Press Next.
The Copying files window is displayed (Figure 10-37).
Figure 10-37. The Copying files window
The system automatically formats and labels new disks. If

the media contains data from an export session, a warning
window is displayed.
Select between:
• Cancel: the Disk management process is stopped.

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• Eject: the media is ejected, a new media must be

inserted to resume the Disk management process.
• OK: the data on the disk is deleted and the Disk
management process is resumed.
The information displayed on the Copying files window is
updated while the files are being copied.
NOTE: If the media contains data from a backup session it is
ejected and the user is asked to use another media.
6. If more than one media is necessary the filled media is
ejected and a dialogue window is displayed asking the user
to label the ejected disk and insert a new media.
Press OK after the new media is inserted.
The operation is resumed.
When all the files are copied, the media is automatically
ejected.
7. The Summary window is displayed (Figure 10-38), showing
a list of the disks used.
• Select Print summary to print the list for archiving
purpose.
• Select Detailed summary to display the list of the
patient records copied.
Figure 10-38. The Summary window
8. Make sure that all media are physically labelled according to

the list displayed in the Summary window. The media label
should also have an identification of the system the Disk
management was run from.

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9. Press Done to complete the Disk management operation

and file the media.

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The Backup/Restore function enables the user to:

• Copy/Restore the patient archive.
• Copy/Restore the system configuration. The Copy/Restore
system configuration feature enables the user to configure
several units with identical presets, providing that the units
have the same software version.
To minimize accidental loss of data, perform backup of the
patient archive stored on the local harddrive at least once a
week.
WARNING GE Healthcare is not responsible for lost data if the suggested

backup procedures are not followed and will not aid in the
recovery of lost data.
There is no backup function for the images or reports (no

creation of a safety copy). For long-term storage, images and
reports should be moved to a USB HD or to a network shared
folder using the Disk management procedure (see page 10-53).
CAUTION DO NOT use the local harddrive for long-term image storage.
Only users with administration rights have access to the backup/

Restore function.
Backup procedure
1. Press Patient.
2. In the Search/Create patient window, select the dataflow
Local Archive - Int. HD.
Figure 10-39. Dataflow selection for backup

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5. Select the Backup sheet.
Figure 10-40. The Backup sheet
6. In the Backup sheet select as needed:

• Patient archive to backup the patient records.
• System configuration to copy system settings and
user presets.
7. Select a removable media or a shared network folder as
destination.
NOTE: To be able to select a network share folder, the path (of type:
\\server-name\share-name) must have been entered in the
Remote path field.
8. If the backup is done to a removable media, insert a
dedicated media in the drive.
9. Select Start backup.
The following situations may occur:
• The system is checking that the removable media is
inserted. If not, a dialogue window is displayed
prompting the user to insert a media.

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Figure 10-41. The Insert media window
Insert the media and select OK.

• The system is checking if the media needs to be
formatted. If yes, a dialogue window is displayed
prompting the user to enter a media label.
Figure 10-42. The Enter media label window
Type in a label for the media and select OK.

NOTE: Only the following characters and signs can be used
when labelling a media: A - Z, a - z, 0 - 9, “_” and “-”. Do
not use more than 11 characters or signs. Do not use
space.
NOTE: If you select Eject you can perform the backup using
another removable media. If you select Cancel the
backup operation is stopped.
• The system is checking if there is already a backup or a
Disk management copy on the media. If the following
error message is displayed, the disk is ejected and the
user is asked to use a new media that does not contain
any backup or Disk management data.

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Figure 10-43. The Replace current media window
Insert a new media and select OK.

NOTE: To reuse a Backup media when performing a new
archive backup, the media has to be re-formatted first.
10. During backup, progress windows are displayed showing
the current operation being performed.
Figure 10-44. The Backup progress windows
11. At the end of the process, the media is ejected and the
Backup completed window is displayed.
Figure 10-45. The Backup completed window
Select OK.
The Backup result is displayed on the Backup sheet.

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12. Make sure to physically label the media. An identification of

the system should also be noted on the media and a backup
log should be kept.
File the media in a safe place.
Restore procedure
1. Press Utility/Config from the Touch panel.
3. Select the Restore sheet.
Figure 10-46. The Restore sheet
4. In the Restore sheet select as needed:

• Patient archive to restore the patient archive.
• System configuration to restore all system settings
and user presets.
OR
• One or several system configuration items to restore
parts of the system settings and user presets (see
Figure 10-46).
5. Make sure that Restore from Source Device is selected.
6. Select the appropriate Source device.

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CAUTION The Restore procedure will OVERWRITE the existing data

on the local harddrive. Make sure to select the correct
source device.
7. If restore is done from a backup on a removable media,

insert the media in the drive.
CAUTION The Restore procedure will OVERWRITE the existing data

on the local harddrive. Make sure to insert the correct
media.
8. Select Restore now.

Depending on the selection, one or two restore confirmation
windows are displayed:
Figure 10-47. The Restore confirmation window
9. Ensure that the correct source is selected an select OK.

The selected items are copied to the systems.
10. If connectivity configuration settings are restored the
following information window is displayed.
Figure 10-48. Information window
11. Select OK.

The System shutdown window is displayed.

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Figure 10-49. The System shutdown window
12. Select OK to shut down the system.

13. Restart the system.
If connectivity configuration settings have been restored,
make sure to save the TCP/IP settings: select Config/
Connectivity/TCPIP and select Save settings. The system
needs to be restarted again.

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Archiving presets
1. Press Utility/Config from the Touch panel and log on as
2. Select the Connectivity category and Formats subgroup.
The Format sheet is displayed.
Figure 10-50. The Formats sheet
Configuration of the Examination list window
1. In the Formats sheet, select the column to edit.

A sub-menu is displayed.
2. Select the action to perform:
• Insert: creates a new column
• Delete: removes selected column
• Select the desired information to be displayed in the
selected column.

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Patient management presets
The following settings related to patient management can be

adjusted:
Setting Description
Use free text addresses In the Patient information window:

: The address information (e.g. street, city...etc.) is
entered in type-specific fields.
: The address information is entered in a single field
(free text).
Use birthdate In the Patient information window, enter either the

patient age or the birthdate:
: Enter age (Birthdate field not available)
: Enter birthdate, the age is calculated.
Use extended patient dialog In the Patient information window:

: The entire patient information data is displayed.
: Patient information data displayed is restricted to a
minimum (i.e. name and Patient ID). When unchecked,
press More to display the entire patient information
data.
Use extended search dialog In the Search/Create Patient window (see Figure 10-5
on page 10-14) and Patient information window,
: All the searching filters are displayed as default.
: The searching criteria are restricted to a minimum.
When unchecked, press More to display all the
searching filters.
Auto search for patient In the Search/Create Patient window (see Figure 10-5
on page 10-14),
: The system searches automatically through the
patient archive selected while entering patient
information.
: The system searches through the patient archive
after pressing Enter on the alphanumeric keyboard.
Examination list on Archive button When a patient is selected, pressing Patient will:
: Open the Examination list window for the selected
patient.
: Open the Patient Information window for the
selected patient.
Automatic generation of patient ID In the Search/Create Patient window (see Figure 10-5
on page 10-14),
: Patient ID is not required when entering a new
patient in the archive. The system generates
automatically an ID number.
: Patient ID is required when entering a new patient
in the archive.

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Setting Description
Request acknowledge of End Exam action : The user is asked to confirm action when ending
an examination.
Go directly to scanning from search: : The unit goes directly to the Scanning screen after
creating a patient record.
: The unit displays the Patient information window
after creating a patient record for further information
entry. The user must press Begin Exam to enter the
Scanning screen.
Save all images on end exam : All images on the clipboard are automatically
saved when ending an examination.
: A dialogue window is displayed when ending an
exam where the user can select between:
• Store all images
• Select images to store
• Store no images.
Exam screen/Report headings Enter user-defined headings for Comments, Diagnosis

and Referral reasons fields in the Examination list
window and report.
DICOM images Select between:

• No extra info
• Add visible patient info in the DICOM images:
displays patient information (name, date of birth and
ID) on DICOM images.
• Add titlebar: adds the Titlebar to the DICOM images.
TCP/IP configuration
To be able to use the network functions when connected to a
hospital network, the system must have a proper network
address. See ‘Scanner’s TCP/IP settings’ on page 10-33 for
more information.
Dataflow
Communication between the Vivid E9 and other information
providers on the network takes the form of dataflows. Each
dataflow defines the transfer of patient information and images
from an input source to the unit, and from the unit to one or
several output sources. Input/output devices cannot be added/
removed to/from the pre-defined dataflows. However the
settings for the devices can be adjusted.
See ‘Dataflows available’ on page 10-3 for a complete list and
description of dataflows available.

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Dataflow adjustments

1. Select a dataflow to configure.

2. Use selected dataflow as default (see page 10-33).
3. Store data directly to archive.
4. Hide selected dataflow from the list of available dataflow.
5. Option for the search function. In the Search/Create patient window
select between None, All patients and Today’s patient.
6. Input/output devices assigned to the current dataflow.
7. Adjust the settings for the selected assigned device.
Adjusting the assigned devices
1. Select the device in the Selected devices field.

2. Press Properties.
The Properties window is displayed.
3. Adjust the device specific parameters as desired (see table
below). Not all the settings listed below apply to all devices.
General settings Definition
Name Free text: give a descriptive name for the device.
IP address Select from drop-down menu
Database Name Automatically selected according to the IP address

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General settings Definition
File destination Automatically selected according to the IP address
Removable Check the entry is the media is removable.
MPPS Modality Perform Procedure Step: send information (typically to a HIS)

that a scheduled exam has been started, performed or interrupted.
Image settings Definition
Allow raw data : Save data in both raw and DICOM format.
: Save data in DICOM format only.
Raw Compression Enables compression of raw data images upon storage and export. Raw
compression is active only if the setting Allow raw data is checked.
Max Frame rate Select 25, 30 or Full (original acquisition) from the pop-up menu.
Compression Select compression type or no compression.
Quality Set picture quality from 1 to 100%. A low picture quality level allows high
data compression, while a high picture quality restrains the
compression.
Allow Multiframe : Allow cineloop storage.
Connection settings Definition
Retry Set maximum number of connection retries, time interval between

tentative and time-out.
DICOM settings Definition
AE Title The Application Entity Title is set during DICOM configuration. Refer to
the network specifications.
Port The Port no. is allocated during DICOM configuration. Refer to your
network specifications.
Verification Verify the connection to another DICOM application
Storage commitment Send a request to a PACS, asking it to permanently archive image(s)
MPPS Modality Perform Procedure Step: send information (typically to a HIS)

that a scheduled exam has been started, performed or interrupted.

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DICOM settings Definition
DICOM SR settings • Allow SR: enable DICOM SR.

• Allow SR private data: send the current exam data in a private
format. This option is by default unchecked and should only be used
with DICOM storage devices that can handle private data format.
• Signed Doppler velocities: send signed Doppler velocities.
• Use older SR version: when checked a Use older SR version
pull-down menu is displayed. The current exam data will be sent in the
same format as the selected SR version. Details about format and
content of the SR version can be found in the corresponding user
manual of the selected version.
See also ‘DICOM SR’ on page 10-40.
Remote path setting

The user can define a default remote path for a network shared
folder (\\server-name\share-name). The remote path can then
be selected as a destination archive for the following operations:
• Export traces function in Q-Analysis
• Export of system error log file
• Export of report templates
• Save as function for images
• Save as function for reports
To define a remote path:
2. Select the Connectivity category and Tools subgroup.
The Tool sheet is displayed.

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Figure 10-52. The Tools sheet
3. Enter a remote path of a shared folder on the network.

To check the connection, press Check.
Export configuration
The destination for Export of patient records to Excel and MPEG
must be configured prior to use. See ‘Exporting patient records/
examinations’ on page 10-44 for a description of the Export
function.
To configure the Export function:
administrator.
The Dataflow sheet is displayed (Figure 10-53).
3. Select the dataflow Misc. Export in the Name pull-down
menu.

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Export to Excel configuration
1. Select the Excel storage device in the Selected devices

pane and press Properties.
The Excel properties window is displayed.
Figure 10-54. The Excel properties window

as the destination in the Destination pull-down menu.
Destination pull-down menu.

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Export to MPEGVue configuration
1. Select the eVue device in the Selected devices pane and

press Properties.
The eVue properties window is displayed.
Figure 10-55. The MPEGVue properties window

as the destination in the Destination pull-down menu.
Destination Pull-down menu.
3. Check the options as required.
Additional outputs
The Additional outputs sheet deals with configuration of the P1,
P2 and Record buttons on the Control panel. Several outputs
(e.g. Video Print, Laser print, DICOM storage...etc.) can be
associated to these buttons (i.e. pressing P1 can result in
printing to a printer and storage to a DICOM media).

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1. Select between P1, P2 and Record buttons.

2. Available output devices that can be assigned to the current button.
3. Output devices assigned to the current button.
4. Add or remove selected device to/from the current button.
5. Adjust the device settings of the selected assigned device.
6. Select the type of images to produce and adjust image settings.
7. Printer configuration (see page 13-7)
Figure 10-56. The Additional outputs sheet
P1 / P2 / Record button configuration
1. In Button field select P1, P2 or Record.

2. Select an output device in the Available output field and
press the Right arrow button to assign the device to the
selected button.
The Properties window for the selected device is displayed,
if configurable.
3. Adjust the device specific parameters and select OK.
4. Adjust the image specific parameters (see table below).
Configuration parameter
Format Select between:

• Raw DICOM
• DICOM
Image compression Select compression mode from the pop-up menu.
Quality When JPEG compression is selected, adjust the picture quality

between 1 and 100%. A low picture quality level allows high data
compression, while a high picture quality restrains the compression.

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Configuration parameter
Image frames Select between:

• Single: stores single frame only
• Multiple: stores cineloop
• Secondary Capture: screen shot
Capture Area Select between:
• Video Area (1)

• Whole Screen (2)
To remove a device, select the device in the Selected devices

field and press the Left arrow button.
Note regarding TomTec application

To be able to store secondary capture from the TomTec
application to the Vivid E9 clipboard, the P2 button must be
configured as follows:
• Output device: Store to clipboard
• Image frames: Secondary Capture
• Capture area: Whole screen

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Unlock patient record

If for any reason an examination is not properly finished, the
patient record is locked and cannot be opened again unless it is
unlocked.
Figure 10-57. The Unlock patient sheet
To unlock patient records:

3. In the Admin category, select the sheet Unlock Patient.
4. In the Unlock Patient sheet, select the patient record(s) to
unlock.
You can search for a specific patient record or a group of
patient record using the searching filters.
5. Select Unlock to unlock the selected patient record(s) or
select Unlock all to unlock all patient records.
6. Select OK.

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Chapter 11
Report
‘Creating a report’ on page 11-3
‘Working with the report function’ on page 11-4
‘Structured Findings’ on page 11-10
‘Direct report’ on page 11-26
‘Report designer’ on page 11-28
‘Report templates management’ on page 11-43.

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Introduction
The system enables the creation of patient and examination

reports containing measurements, images and analysis that
were made during the examination. The layout of the reports is
defined by generic templates delivered with the system. Custom
templates can also be made.
Saved reports are read-only. Therefore it is recommended that
the data is carefully reviewed before the report is saved. Use the
worksheet (see page 8-97) to facilitate the review and
adjustment of data before generating a report. The final report
can be printed on a regular printer.

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Creating a report
Creating a report
Reports summarize data obtained in the examination. They can

contain data and images.
Once generated, the report can be viewed, images can be
added, wall segment diagrams can be assigned and text can be
entered in the free text fields. All other information must be
changed from the Patient information window, the Worksheet
screen or the Structured Findings screen.

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1. Press Report (available from the Patient, Worksheet or

Utility Tab sheet on the Touch panel).
The default template for the current examination is
displayed (see Figure 11-1). The information entered during
the examination is automatically filled in (e.g. demographic,
Diagnosis, Comments...etc.).

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Figure 11-1. The Report screen
To choose another report template

1. Press Template.
The Template selection menu is displayed showing the
available report templates organized by application.
NOTE: The Template selection menu can be configured to display
only the templates of interest (see page 11-43).
2. Do one of the following:

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• Select a template from the current application template

list.
• Select another application and select the desired
template from the sub-menu displayed.
The selected template is displayed on the screen.
NOTE: The five last used templates can be selected directly from the
Touch panel.
To change patient information

1. Select the heading of the information to change.
The Patient information screen is displayed.
2. Change the information as required.
3. Press Report when completed.
The user is asked to confirm the changes.
4. Select OK to confirm or Cancel to abort.
Images in the report

1. To add an image to the report, place the pointer over an
image in the clipboard and double-click the Select key.
The image is inserted into the first free image container in
the report.
2. To move an image in the report, select and drag the image
to move it to a new image container.
3. To replace an image in the report, select and drag an image
from the clipboard over the image to replace in the report.
4. To remove an image from the report, select and drag the
image to remove outside the report page.
To print a report
Only members of the user group “Cardiologist” are allowed to
print a report (see ‘System users’ on page 3-32).
1. Press Print.
The report is printed on the default printer. A status window
is displayed showing the printing process.
For printer configuration, see page 13-7.

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To store a report
store a report (see ‘System users’ on page 3-32).
1. Press Store.
The report is stored in the Report archive.
Alternative storage
Reports can also be saved in a user-defined locations in the

following formats:
• Compiled HTML (.CHM) files: readable from any web
browser.
• Portable Document Format (.PDF) files: readable with
Adobe Acrobat reader.
• Text (.TXT) files: only text data is saved; readable with a
text editor.
1. Press Save as.
The Save as dialogue window is displayed.
2. Select the destination folder from the Save in archive pull
down menu.
NOTE: To configure the default remote path, see ‘Remote path
setting’ on page 10-73.
3. Select PDF, CHM or TXT format.
4. Press Save.
Report sign-off
Report sign-off is used to save a report as read-only. A signed
report cannot be changed unless it is first unsigned.
When signing a report, the examination becomes read-only: the
patient demographic data in the Patient information window and
the diagnostic information in the Examination list window for the
current examination cannot be changed unless the report is first
unsigned.
The signing and unsigning operations require an authorization
(operator name and password). Only members belonging to
both “Cardiologist” and “DiagPhys” user groups are allowed to
sign off or unsign a report.

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To sign off a report
1. Press Sign-off.
The Authorization window is displayed.
Figure 11-2. The Authorization window
2. Enter the operator name and password.

3. Select Authorize.
NOTE: If the operator is not authorized to sign off, an Error
message is displayed. Press Retry to go back to the
Authorization window or Cancel to quit sign-off.
Signed reports display a heading confirming sign-off with the
operator name and the date of signature. In addition the
diagnostic physician name is applied at the end of the
report.
NOTE: The sign-off header is not printed. To get the sign-off
signature inside the report, the report template must contain
the assigned field “Diag.Phys. signoff” (see ‘Inserting
archive information’ on page 11-33).
To unsign a report
1. Press Unsign.
The Authorization window is displayed (see Figure 11-2).
2. Enter the operator name and password.
3. Select Authorize.
Retrieving an archived report

1. Press Retrieve.
A list of the available reports for the actual examination is
displayed.
The default name for a report is of type:
<template type>_<store date>_<store time>.
2. Select the report to retrieve.

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NOTE: To display the current report, select Show active exam.
Deleting an archived report

delete a report (see ‘System users’ on page 3-32).
1. Press Delete.
A list of the available reports for the actual examination is
displayed.
The default name for a report is of type:
<template type>_<store date>_<store time>.
2. Select the report to delete.

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Structured Findings
Structured Findings is a feature that enables the user to insert

pre-configured structured diagnostic statements and codes
(e.g Billing, Accreditation) in the patient report and create a
conclusion based on the inserted statements.
Prerequisite
To be able to insert structured diagnostic statements and create
a conclusion in a patient record, the report template used must
have assigned fields for the structured findings, the codes and
the conclusion.
NOTE: Factory templates have Findings and Conclusion fields.
To create the assigned fields in a user-defined report template:
1. Press Report (available from the Patient, Worksheet or
Utility Tab sheet on the Touch panel).
2. Press Template and select the desired report template.
3. Press Designer.
The Report designer screen is displayed.
4. Select the location in the report template where to insert the
Structured findings fields.
5. Select Insert and Archive Information.
The Archive information box is displayed (Figure 11-3).
6. Double-click on Select All under all three parameter fields
in the Archive information box to deselect all parameters.
7. Select Structured findings, Findings conclusion
Indication codes and Billing codes in the Exam
Information field (Figure 11-3).
8. Select OK.
9. Save the Report template and exit the Report designer.

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Structured Findings
Figure 11-3. The Archive information box
Starting Structured Findings

1. Press Report.
Make sure the current template has a Structured Findings
field and a Conclusion field defined or select another
template if necessary.
2. Press Findings or select the header of the Findings box in
the report.
The Structured Findings window is displayed (Figure 11-6).
Structured Findings structure
The diagnostic statements are organized in tab folders (see

Figure 11-4). Each tab folder may contain:
• Underlying tab folders that contain Tab sheets.
• Tab sheets that contain diagnostic statements.

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1. Tab folder with underlying tab sheets

2. Tab sheet
Figure 11-4. Structured findings structure
There are three types of diagnostic statements (see

Figure 11-5):
• Check box statement: when selected the statement is
included in the report.
• Combo box statement: create a statement by selecting one
alternative text among several choices.
• Statement group: create several statements by selecting
multiple check box statements.

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Structured Findings
1. Check box statement

2. Combo box statement
3. Statement group
Figure 11-5. Diagnostic statement types
Using Structured Findings

1. Start Structured Findings (see page 11-11).
2. Browse to the tab sheet containing the statements of
interest.
3. To insert a statement in the report (Findings field):
• Check box statement: select the statement.
• Combo box statement: select an alternative text in the
combo box next to the statement.
• Statement group: select the statements of interest within
the group.
A preview of the selected statement(s) is displayed in the
Findings preview field (see Figure 11-6). The statement text
in the preview field can be edited. This will apply only for the
current report.
Once a statement is selected an asterisk is displayed on the
tab of the current sheet and folder.
NOTE: Select Normal to select only normal statements from the
current tab sheet (see page 11-19 for more information on
how to define normal statements).
NOTE: Select Clear to deselect all statements from the current tab
sheet.

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To insert a conclusion statement in the report:

• Press the Conclusion button in front of the statement of
interest.
A preview of the selected conclusion statement is displayed
in the Conclusion preview field (see Figure 11-6).
Conclusion statements are displayed in a numbered list.
The list can be reordered: triple-click on the conclusion
statement to move in the Conclusion preview field and use
the Arrow up or Arrow down key to move the statement up
or down.
The conclusion text in the preview field can be edited. This
will apply only for the current report.
To display the changes in the report, select Refresh report.
NOTE: Pressing the Conclusion button in front of a statement that
was not previously selected results in simultaneously
inserting the finding statement and create the conclusion.
4. Press Close.
The report for the current patient is displayed with the
selected findings, conclusion statement(s) and associated
codes (if any).
NOTE: Some diagnostic statements have measurements values in
the body text referred by a tag (e.g the {EF} tag refers to EF
measurement). These statements require that the actual
measurement is done to display correctly in the report.

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Structured Findings
1. Statement inserted in the Conclusion and Findings field.

2. Statement inserted in the Findings field only.
3. Findings preview field
4. Conclusion preview field
5. Remove all selections.
6. Insert normal findings for the current tab sheet.
7. Create and add a statement. The statement will be available only for the current examination.
Figure 11-6. Structured Findings window
Global selection of normal statements
It is possible to select all normal statements from all tab sheets

belonging to the current top tab sheet.
1. Place the cursor in the Statement field, press Update menu
on the control panel and select Normal.
All statements defined as normal are selected from all the
tab sheets. An asterisk is displayed on the tab of all the tab
sheets that contain normal statements.

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NOTE: This operation will remove any other “non-normal”

previously selected statements.
2. To remove all statements at once, place the cursor in the
Statement field, press Update menu and select Clear.
Structured Findings configuration

Structured Findings configuration is used to:
• Create, edit or delete finding statements, conclusion
statements and codes.
• Organize the diagnostic statements in the Structured
Findings screen.
• Define the normal diagnostic statements.
Accessing the Structured Findings configuration screen

Report category.
2. Select the Structured Findings tab.
The Structured Findings configuration screen is displayed
(Figure 11-7).
Or from within Structured Findings:
1. Press Update menu on the control panel and select Config.

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Structured Findings
1. Structured Findings structure tree:

• Tab folder
• Tab sheet
• Check box statement
• Combo box statement
• Statement group
2. Tab or statement label
3. Findings text
4. Conclusion text
5. Codes for the selected statement
6. Create, move, copy or delete statement
7. Create folder, Combo box or statement groups
8. Enter a variable in statement or conclusion text
9. Hide selected tab or statement from the Structured Finding window
10. Set the selected statement as normal
11. Rest factory default findings
12. Export/import findings.
Figure 11-7. Structured Findings configuration screen
Creation of a tab folder
The following procedure describes how to create a new top level

tab folder.

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1. Configuration window
2. Structured findings window
Figure 11-8. New tab folder
1. In the Structured Findings configuration window

(Figure 11-7), select the Structured Findings tab folder.
2. Select Add.
A new entry is created in the Structured Findings tab folder.
The new entry is by default a tab sheet ( ).
3. Select Enable one more tab level to change the new entry
to a tab folder ( ).
A warning message is displayed. Select OK.
4. With the new entry selected, follow the following steps:
• Enter a name in the Label field (tab name).
• Enter a description in the Findings text field. The
description will be displayed in the report as a heading
when selecting a statement from the underlying tab
sheets. The system is always using the Findings text
from the highest item in the structure as a heading for
the selected underlying statements.
• Enter the appropriate codes.
NOTE: To enter several codes separate each code by a space.
5. Press Up or Down to move the tab in the structure tree (or
do drag and drop).
Creation of a tab sheet
The following procedure described how to create a tab sheet in

a tab folder.

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Structured Findings
Figure 11-9. New tab sheet
1. Make sure that the tab folder is selected and press Add.
A new entry is created in the tab folder. The new entry is by
default a tab sheet ( ).
• Enter a name in the Label field (tab name).
• Enter a description in the Findings text field.
If required:
Adding statements in the tab sheet
Check box statement

The following procedure describes how to create a check box
statement.

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Figure 11-10. New check box statement
1. Make sure that the tab sheet is selected and press Add.
A new entry is created in the tab sheet. The new entry is by
default a check box statement ( ).
• Enter a name in the Label field (statement name).
• Enter the full statement in the Findings text field.
• Enter a conclusion in the Conclusion text field (optional).
NOTE: If the Conclusion text field is left empty, the statement
text will be used as conclusion when selected.
If required:
• Check Include findings in normal report to define the
statement as normal.
All statements within the selected tab sheet that have
this option checked will be included in the report when

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Structured Findings
Normal is selected in the Structured Findings window

(see ‘Using Structured Findings’ on page 11-13).
Combo box statement

The following procedure describes how to create a combo box
statement.
Figure 11-11. New combo box statement
1. Create a new statement as described above. A check box

statement is created by default.
2. With the new statement selected, press Add.
A new underlying entry is created and the parent statement
is changed to a Combo box statement ( ).
3. With the new underlying entry selected, follow the following
steps:

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• Enter a name in the Label field.

• Enter a text in the Findings text field.
• Enter a conclusion in the Conclusion text field (optional).
4. Repeat the procedure from step 2 to create as many
underlying statements as necessary. Each underlying
statement will be a selectable entry in the combo box.
Statement group
Statement groups are created by changing a combo statement
to a statement group.
1. Create a combo box statement as described above.
2. Make sure the combo box statement is selected and
deselect the option Enable pull-downs.
The combo box statement is changed to a statement group
( ). Each underlaying entries are changed to check box
statements.
Editing a statement
Tab label, statements and statement alternative texts can be

edited.
(Figure 11-7), select the item to edit.
2. Make the required changes.
Inserting variable parameters in a statement
Variable parameters such as patient name, institution name,

measurement values...etc can be inserted in a statement as
tagged information.
To insert variable parameters in a statement:
1. Place the cursor at the required position in the Findings text
field (or Conclusion text field).
2. Press Insert parameter.
The Insert parameter window is displayed (see
Figure 11-12).

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Structured Findings
Figure 11-12. Insert parameter window
3. Browse and select the actual parameter to insert.

NOTE: For measurement values, select first the scanning mode.
4. Press OK.
NOTE: To display correctly in the report, the actual parameter value
must exist, e.g. if a measurement value is included in a
statement as a variable parameter, a measurement value
must exist for the current patient, otherwise the parameter
name is displayed.
5. If the selected parameter can be measured/calculated by
different methods, the user is asked to select the preferred
parameter to insert (Figure 11-13). Move the preferred
parameter as first item in the list displayed and select OK.
The selected parameter is inserted in the statement as a tag
(e.g the {EF} tag refers to EF measurement)

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Figure 11-13. The parameter list
Copy of a statement
Tab folders, tab sheets and statements can be copied from one
location to another. The word “Copied” is added to the copied
item name.
(Figure 11-7), select the item to copy.
2. Select Copy.
3. Select the item to contain the copy.
4. Select Paste.
NOTE: If the item to copy cannot be copied in the selected location,
the operation is ignored.
NOTE: Copy can be done by drag-and-drop, while holding Ctrl
depressed.
Deletion of a statement
Tab folders, tab sheets and statements can be deleted.
CAUTION Deletion cannot be undone.

(Figure 11-7), select the item to delete.
2. Select Delete.
The selected item is deleted.

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Structured Findings
Factory reset
All statements can be reset back to the factory default.
CAUTION Factory reset cannot be undone.
1. Select Reset.
The Reset statements window is displayed.
2. Select:
• Yes to reset all statement to the factory default (No
undo).
• No to cancel the operation.
Exporting/Importing statements
Diagnostic statements can be exported from one system and

imported on another system.
Exporting statements
(Figure 11-7), select Export.
A browsing window is displayed.
2. Browse to a destination and select Save.
Importing statements
(Figure 11-7), select Import.
A browsing window is displayed.
2. Browse to a destination and select Open.
3. Select one of the following options
• Insert: the statements are imported in a new top tab
sheet, keeping the current statements in place.
• Replace: the imported statements replace the existing
ones.
• Cancel: cancel the import.

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Direct report
Direct report enables the user to insert comments at any time

during the examination that will be part of the final report.
Direct report provides also an overview over the measurements
completed.
Creating comments
1. Press Freeze.
3. Select Direct report.
4. In the Direct report screen, select the comment type.
5. Type your comments in the Text field.
6. To add a measurement in the comment, double-click a
measurement in the Measurement overview field.
1. Select the type of information

2. Create/insert pre-defined text
3. Text field
4. List of measurements completed
5. Exits the Direct report
Figure 11-14. The Direct report

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Direct report
Inserting pre-defined text input
1. Select the insertion point in the Text field.

2. Select Insert text.
The Insert text window is displayed (see Figure 11-15).
Figure 11-15. The Insert text window

second and third column.
3. Navigate through the pre-defined text list by selecting items
in the columns and double-click on the desired pre-defined
text to be inserted. If an entry in the third column is inserted,
the selected text in the second column is also inserted.
Press More>> to display the full text for the selected entry.
Creating pre-defined text inputs

This feature is described in ‘Creating, editing and deleting text
input’ on page 10-17.

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Report
Report designer
The Report designer software package enables the user to

create report templates that best suit its needs.
Designing a report template consists of choosing the information
to display in the report (e.g. header, footer, logo, patient
information, images, measurements...etc.) and arrange it in the
report viewer.
The Report designer function is based on the information
container concept: each type of information is included within a
container with parameters that can be configured (size, color,
font properties, information to display...etc.).
Accessing the Report designer

1. Press Report.
The Report screen is displayed.
2. Press Designer.
The Report designer screen is displayed with the selected
template in the Report template design area (see
Figure 11-16).

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Report designer
Report designer overview
The Report designer screen
1. Menu bar
2. Report template design area
Figure 11-16. The Report designer screen

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The menu bar
Menu Description
File • New: start working on an new template.
• Save: save the template using the same name. Factory report
templates cannot be overwritten.
• Save as: save the template using a new name.
• Page setup: define printing orientation and header/footer for the
printed report.
• Print Preview: display a print preview of the report template.
• Exit: exit the Report designer and returns to the report function. The
user can choose whether to save the updates or restore the original
template.
Menu Description
Edit • Delete: remove the selected object from the report template.
• Undo: restore the previous state of the report template.
Menu Description
Insert • Page Break: insert a new page in the report template.
• Table: configure and insert a table in the report template.
• Logo: select and insert a logo to the report template.
• Archive info: select and insert data from the following categories:
Patient information
Exam information
Site information
• Anatomical graphics: select and insert an anatomical graphic
(cardiac, vascular or TEE).
• Image: create a container for the display of ultrasound images.
• Wall motion analysis: insert a container for the display of Stress
Echo analysis results (cut planes Bull’s eye and scoring table).
• OB/GYN: insert OB graph.
• Measurements: insert a container for the display of measurements
and calculations. When creating a measurement container, the user
is prompted through a configuration procedure enabling the selection
of mode specific measurements and/or calculations.
• Text field: insert a container where the user can write in the report.
• Fixed text: insert a container with static text. The text typed during
the creation of the container will be displayed in the report.
Menu Description
Preferences • Page Color: sets the default background color for the template page.
Designing a report template
Starting template designing

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Report designer
1. Start the Report designer (see page 11-28).

2. Press File and select New to display a blank page or use
the current report template as basis template.
Setting the layout preferences
Adjusting the report page color background

1. Press Preferences and select Page Color.
The Color selection window is displayed.
2. Select the desired color.
3. Press OK.
Header and footer in the printed report

This function is described on page 11-40.
Inserting an information container in the report template body
The different types of information to be included in a report are

grouped in information containers. Designing a report template
consists in inserting and configuring the different information
containers in the template page in an ordered manner.
Information containers can be inserted either:
• Directly into the report template body: this procedure does
not allow side-by-side insertion, the information container
will normally cover the width of the report template page.
• Within a table: this procedure allows side-by-side insertion
of several information containers.
Inserting a table
1. Place the cursor at the desired insertion point in the Report

template design area.
2. Press Insert and select Table.
The Container properties window is displayed (see
Figure 11-17).
3. Adjust the parameters as desired.
4. Press OK.
The table is displayed in the template.
NOTE: To modify an inserted table, double-click in an empty area in
the table. A selection menu is displayed where the user can
add, delete a row or a column or open the Table properties
window.

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Figure 11-17. The Table properties window
Inserting a logo
1. Provide the hospital logo in JPEG or Bitmap format onto a

removable media.
2. Select the location where to insert the logo (a table cell or
directly in the report template).
3. Select Insert and Logo.
The Logo box is displayed.
Figure 11-18. The logo box
4. Select a logo, or if not available, select Import logo.

Browse and select the logo and select OK.
5. Specify the appearance.
6. Select OK.

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Report designer
Inserting fixed text
Fixed text is an entry that cannot be changed in the report (e.g.

hospital information).
1. Select the location where to insert the fixed text (a table cell
or directly in the report template).
2. Select Insert and Fixed text.
The Fixed text box is displayed.
Figure 11-19. The Fixed text box
3. Enter the text and specify the appearance.

4. Select OK.
Inserting archive information
Archive information contains all the objects of the different

information menus (Patient, Exam, Study and Site Information).
You may display the archive information over two columns using
a table container as described below.
1. Insert a table for the archive information to the desired
location (a table cell or directly in the report template).
2. Select the first table cell.
3. Select Insert and Archive information.
The Archive information box is displayed.

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Figure 11-20. The Archive information box
4. If desired, enter a heading and select a heading link from

the pull-down menu.
5. Select the Information parameters to be displayed in the first
cell.
Select Box properties to change the font, alignment,
appearance, etc.
6. Select OK.
7. Select the next table cell and repeat steps 3 to 6 to enter the
remaining archive information.
Inserting an Image container
• Select the location where to insert the fixed text (a table cell
or directly in the report template).
• Select Insert and Image.
The Ultrasound image box is displayed.

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Report designer
Figure 11-21. The Ultrasound image box
• If desired, enter a heading, set the container size and

specify the text appearance.
• Select OK.
Inserting a measurement container
You may display the measurements over several columns using

a table container as described below.
1. Insert a table for the measurements to the desired location.
2. Select the first table cell.
3. Select Insert and Measurements.
The Measurements box is displayed.
Figure 11-22. The Measurements box

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4. Enter a heading (e.g. 2D).

5. Using the Filter criteria, define the type of measurements to
be displayed (e.g. Cardiac, 2D, measured and calculated).
Select Show normal value to display user-defined Normal
value next to the measurements in the Report (see ‘Normal
values’ on page 8-93 for more information).
NOTE: References for the normal values can be displayed in the
report by checking Normal value references from Insert ->
Archive Info (see page 11-33).
The Measurement list on the left side is updated.
6. From the measurement list, select the measurement to
insert and press Add. Both single measurements or a folder
may be added.
7. The list of the inserted measurements is displayed in the
Selected measurement list on the right side.
8. Press OK.
9. Select the next table cell and repeat steps 3 to 8 to insert
several measurements.
Inserting Text fields
Text fields are:

• Containers for Referral reasons, Comments and Diagnosis
information.
• Containers for free text, where the user can type information
in the report.
1. Select the location where to insert the text field container (a
table cell or directly in the report template).
2. Select Insert and Text field.
The Text field box is displayed.

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Figure 11-23. The Text field box
3. Enter a heading.
4. From the Display field, select between:
• Referral reasons: displays the information entered in
the Direct report (see page 11-26) or in the Examination
list window.
• Comments: displays the information entered in the
Direct report (see page 11-26) or in the Examination list
window.
• Diagnosis: displays the information entered in the
Direct report (see page 11-26) or in the Examination list
window.
• Free text 1-8: creates an empty free text container.
5. If desired, adjust the font settings for the header and data.

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Inserting Wall motion scoring analysis containers
Two different containers must be inserted for the Wall motion

scoring analysis:
• A Wall motion scoring diagrams container (Cut planes or
Bull’s eyes)
• A Wall motion scoring table
Inserting Wall motion scoring diagrams container

1. Select the location where to insert the free text container (a
table cell or directly in the report template).
2. Select Insert, Wall motion analysis and select between
Cut planes and Bull’s eye.
The corresponding Wall motion scoring box is displayed.
Figure 11-24. The Wall motion scoring box (Cut planes)
3. Adjust the parameters and select OK:

The scoring diagrams are inserted in the report template
Inserting Wall motion scoring table container

1. Place the cursor right below the Wall motion scoring
diagrams container.
2. Select Insert, Wall motion analysis and select Score table
box.
The Score table box is displayed.

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Figure 11-25. The Score table box
3. Adjust the layout parameters in the Score table box and

select OK.
The Score table is inserted in the report template.
Editing the information container
Resizing the information container

1. Move the cursor over the border of the container to resize.
The mouse cursor is changed to a cross .
2. Press Select.
The container is displayed with anchor squares on the sides
and at the corners.
3. Resize the container by dragging from the anchor points.
Editing the information container properties

1. Double-click in the container to edit and select Properties.
The Properties window is displayed.
2. Adjust the parameters specific to the selected container.
NOTE: Some information containers have additional parameters
that may be adjusted by selecting Box properties.
Inserting a new page
1. Place the cursor at the desired insertion point in the Report

template design area.
2. Press Insert and select Page Break.

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Inserting header and footer
Header and footer may be defined to be displayed in the printed

report. The header and footer are not visible in the on screen
report.
To insert header and footer in the printed report:
1. Select File and Page setup.
The Page setup box is displayed.
Figure 11-26. The Page setup box
2. Adjust the printing orientation.

3. Define the header and footer for the printed report, by typing
text and entering the required variables listed in the table
below.
Check Different on first page and create a specific header/
footer for the first page.
4. Select OK.
To check the display of the header and footer, select File
and Print preview.
Variable Description
{pid} Patient ID
{pnm} Patient name

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Report designer
Variable Description
{pdb} Patient date of birth
{exd} Examination date
{prd} Current date (printing date)
{prt} Current time (printing time)
{cp} Current page
{tp} Page count
{c} Subsequent entries are centered
{r} Subsequent entries are right aligned
Saving the report template
Replace an existing template
Factory templates cannot be overwritten.

1. Press File and select Save.
A dialogue window is displayed asking for confirmation.
2. Select:
• Yes to save the report template
• No to discard the report template
• Cancel to go back to the Report designer without
saving the report template.
Save existing template with a new name
1. Press File and select Save as.

The Save as template window is displayed.
Figure 11-27. The Save as template window
2. Enter a name for the template.

3. Press OK.

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The template is saved.
To exit the Report designer

1. Select File and Exit.
The Exit window is displayed.
2. In the Exit window, select:
• Yes: to save the report template and exit the
application.
• No: to exit the application without saving the changes
made in the report template.
• Cancel: to return to the application.

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This section describes:

• Configuration of the Template selection menu.
• Deletion of user-defined report templates.
• Export/import of user-defined report templates.
The report templates management is done from the Report
templates sheet in the system configuration package.
To access to the Report templates sheet:
Report category.
The Report category sheet is displayed.
Figure 11-28. The Report templates sheet
Configuration of the Template selection menu

The Template selection menu displays the application specific
report templates that can be selected when creating a report.

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The Template selection menu can be configured to display only

the templates of interest.
Inserting a template in the Template selection menu
1. Press Utility/Config on the Touch panel and select Report.

The Report templates sheet is displayed (Figure 11-28)
2. In the Available templates field (left field), select the
template to insert in the Template selection menu.
3. Next to Section, select the appropriate application.
4. Press the Right arrow button .
The selected template is inserted in the Template selection
menu.
NOTE: Double-clicking on a template in the Available template field
will also insert the template in the Template menu.
Removing a template from the Template selection menu
1. In the Report template menu field (right field), select the

template to remove.
2. Press the Left arrow button .
The selected template is removed from the Template
selection menu.
NOTE: Double-clicking on a template in the Report template menu
field will also remove the template from the Template menu.
Sorting the templates in the Template selection menu
1. In the Report template menu field, select the template to

move.
2. Press the Up or Down arrow buttons .
The selected template is moved accordingly in the Template
selection menu.
Deleting a report template from the system
Only user-defined report templates can be deleted from the

system.
1. In the Available templates field (left field), select the report to
delete (Figure 11-28).
2. Press Delete.

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3. Select Yes to delete the report template.
Export/Import of Report templates

User-defined report templates can be exported to a removable
media and imported from the removable media into another
system.
Export of Report templates
1. Insert a removable media in the in the drive.

The Report templates sheet is displayed (Figure 11-28 on
page 11-43).
3. Select Export Templates.
The available user-defined templates are displayed in the
Export templates window.
Figure 11-29. The Export templates window
4. Select the template(s) to export. Multiple selection can be

done using the Shift or Ctrl key.
5. Select the desired removable media under Select target
device.
NOTE: To export to a shared folder on a network, a remote path
must be defined (see ‘Remote path setting’ on page 10-73).
6. Press OK.
7. Press OK.

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The selected template(s) are exported to the removable

media.
8. Press Utility/Eject on the Touch panel and select the media
to eject.
Import of Report templates
1. Insert the removable media with the report template(s) to

import.
The Report templates sheet is displayed (Figure 11-28 on
page 11-43).
3. Select Import Templates.
The Import templates window is displayed.
Figure 11-30. The Import template window
4. Select the source device from the pull-down menu.

5. Press OK.
6. Press OK.
The templates are imported into the system.
7. Press Utility/Eject on the Touch panel and select the media
to eject.

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Chapter 12
Probes
‘Probe overview’ on page 12-2
‘Probe Integration’ on page 12-12
‘Care and Maintenance’ on page 12-16
‘Probe safety’ on page 12-20
‘Biopsy’ on page 12-23.

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Probes
Probe overview
Supported probes
Phased Array Sector probes
Probe Mode Technical data
M5S-D 2D-Mode Frequency: 1.5–4.6 MHz

M-Mode Foot print: 17 x 28 mm
Color Flow
CW Doppler
PW Doppler
M5Sc-D 2D-Mode Frequency: 1.5–4.6 MHz

Color Flow
CW Doppler
PW Doppler
6S-D 2D-Mode Frequency: 2.4–8.0 MHz

Color Flow
CW Doppler
PW Doppler
12S-D 2D-Mode Frequency: 4.0–12.0 MHz

M-Mode Foot print 15 x 12 mm
Color Flow
CW Doppler
PW Doppler
3V-D 2D-Mode Frequency: 1.5–4.0 MHz

Color Flow
CW Doppler
PW Doppler
4D-Mode
4V-D 2D-Mode Frequency: 1.5–4.0 MHz

Color Flow
CW Doppler
PW Doppler
4D-Mode

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Probe overview
Linear Array probes
ML6-15-D 2D-Mode Frequency: 4.5–15.0 MHz

Color Flow
PW Doppler
9L-D 2D-Mode Frequency: 2.4–10.0 MHz

Color Flow
PW Doppler
11L-D 2D-Mode Frequency: 4.5–12.0 MHz

Color Flow
PW Doppler
i13L 2D-Mode Frequency: 5.9–14.1 MHz

M-Mode Foot print 10 x 28mm
Color Flow
PW Doppler
Curved Array (Convex) probes
4C-D 2D-Mode Frequency: 1.6–6.0 MHz

Color Flow FOV: 58 degrees
PW Doppler
C1-5-D 2D-Mode Frequency: 1.6–6.0 MHz

PW Doppler
C2-9-D 2D-Mode Frequency: 2.3–8.4 MHz

PW Doppler
8C 2D-Mode Frequency: 4.0–8.0 MHz

PW Doppler
IC5-9-D 2D-Mode Frequency: 3.3–8.6 MHz

PW Doppler

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Doppler probes
2D (P2D) CW Doppler Frequency: 2.0 MHz
6D (P6D) CW Doppler Frequency: 6.3 MHz
Transesophageal Phased Array probes
6VT-D 2D-Mode Frequency: 3.0–8.0 MHz

M-Mode Operating temperature: 8.5–42.5 °C
Color Flow
CW Doppler
PW Doppler
4D-Mode
6T/6T-RS 2D-Mode Frequency: 3.0–8.0 MHz

Color Flow
CW Doppler
PW Doppler
6Tc/6Tc-RS 2D-Mode Frequency: 3.0–8.0 MHz

Color Flow
CW Doppler
PW Doppler
9T/9T-RS 2D-Mode Frequency: 3.0–10.0 MHz

Color Flow
CW Doppler
PW Doppler

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Probe overview
Probes/Applications overview
The Vivid E9 probes are ONLY approved for use for the
applications listed in the table below.
Probe
ML6-15-D
6T/6T-RS
M5Sc-D
IC5-9-D
C1-5-D
C2-9-D
M5S-D
12S-D
6VT-D
11L-D
4C-D
6S-D
3V-D
4V-D
9L-D
i13L
8C
Application
Abdominal + + + + + + + +
Aorto-Iliac + +
Breast + +
Cardiac1 + + + + + + + + +
Carotid + + + +
Contrast + +
Coronary + + + + + + +
Exercise + + + +
Fetal Heart2 + + + + + + + + +
LEA + + + + + +
LEV + + + + + +
LV Contrast + + + + +
LVO Stress + +
Musculoskeletal + + +
Neonatal3 + +
Neonatal Head + + +
Obstetrics4 + + + +
Pediatric5 + + + +
Pelvic + + + +
Q Stress + +
Contrast Low MI6 + + +
Renal + + + + +
Scrotal + +
Small parts + +

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Probes
Probe
ML6-15-D
6T/6T-RS
M5Sc-D
IC5-9-D
C1-5-D
C2-9-D
M5S-D
12S-D
6VT-D
11L-D
4C-D
6S-D
3V-D
4V-D
9L-D
i13L
8C
Application
Rodent7 + + + +
Transcranial + +
Thyroid + + +
UEA + + + +
UEV + + + +
1. Cardiac can have presets, i.e Cardiac 2, Cardiac 3... etc based on user preferences.
2. Fetal Heart can have presets, i.e Fetal Heart 2, Fetal Heart 3... etc based on user preferences.
3. Neonatal can have presets, i.e Neonatal 2, Neonatal 3... etc based on user preferences.
4. Obstetrics has two presets, OB1 and OB2/3.
5. Pediatric (Cardiology) can have presets, i.e Ped 2, Ped 3... etc based on user preferences.
6. Contrast Low MI is intended for clinical research only. Diagnosis must not be based on results achieved
by contrast analysis alone.
7. Rodent can be split in Mice and Rat specific presets.
Probe
6Tc/6Tc-RS
9T/9T-RS
2D (P2D)
6D (P6D)
Application
Abdominal
Aorto-Iliac
Breast
Cardiac1 + +
Carotid
Contrast
Coronary +
Exercise
Fetal Heart2
LEA +
LEV
LV Contrast

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Probe overview
Probe
6Tc/6Tc-RS
9T/9T-RS
2D (P2D)
6D (P6D)
Application
LVO Stress
Musculoskeletal
Neonatal3
Neonatal Head
Obstetrics4
Pediatric5 +
Pelvic
Q Stress
Contrast Low MI6
Renal
Scrotal
Small parts
Rodent7
Transcranial
Thyroid
UEA
UEV
1. Cardiac can have presets, i.e Cardiac 2, Cardiac 3... etc based on user preferences.
2. Fetal Heart can have presets, i.e Fetal Heart 2, Fetal Heart 3... etc based on user preferences.
3. Neonatal can have presets, i.e Neonatal 2, Neonatal 3... etc based on user preferences.
4. Obstetrics has two presets, OB1 and OB2/3.
5. Pediatric (Cardiology) can have presets, i.e Ped 2, Ped 3... etc based on user preferences.
6. Contrast Low MI is intended for clinical research only. Diagnosis must not be based on results achieved
by contrast analysis alone.
7. Rodent can be split in Mice and Rat specific presets.

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Probes
CAUTION GE recommends dedicated probes for use on humans only or

animals only. Mark probes dedicated for animals only with
special labels.
If probes are interchanged between humans and animals, GE
strongly recommends that the probes are sterilized between
transitions humans / animals. Observe any national rules and
regulations for handling equipment used on both animals and
humans. Such national restrictions may prohibit transfer of
probes used on animals to humans and vice-versa.

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Probe overview
Maximum probe temperature
Max Temp Max Temp

Probe (Simulated use) (Still air)
3V-D 34.4 33.9
4V-D 41.9 45.2
M5S-D 40.8 35.0
M5Sc-D 39.7 42.0
6S-D 41.3 45.2
12S-D 40.9 34.6
ML6-15-D 41.2 37.6
9L-D 40.8 33.1
11L-D 40.3 35.4
i13L 41.1 32.6
C1-5-D 39,8 37,1
C2-9-D 40.0 40.7
4C-D 41.0 38.9
8C 40.5 41.5
IC5-9-D 41.6 37.0
2D (P2D) 35.7 38.4
6D (P6D) 37.0 28.4
6VT-D 42.0 35.0
6T 42.0 24.2
6T-RS 40.8 32.2
6Tc 41.5 32.5
6Tc-RS 42.0 33.4
9T 41.4 31.1
9T-RS 41.9 34.1
NOTE: Lens temperature measured under following conditions per

IEC 60601-2-37:
1. Thermocouple was placed at the geometric center of the
lens.
2. a: Thermal phantom at 37 °C for non-external probes.

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Probes
b: Thermal phantom at 33 °C (or 23 °C) for external probes.

(Temperature rise is measured and added to 33 °C if the
phantom is at 23 °C).
c: P2D and P6D with probe transmitting in air, no phantom.
NOTE: Thermal phantom made with tissue-mimicking material as
referenced in IEC 60601-2-37.
3. Probe placed upright in contact with above thermal
phantom.
4. Auto-freeze capability is disabled.
5. Lens temperature is monitored for 30 minutes.
6. 6VT-D, 6T series, 9T series, M5S-D, M5Sc-D, 3V-D and
4V-D probes are equipped with internal temperature sensor
and mechanism to monitor and limit temperature.
7. a: Measurement uncertainty for probes with temperature
sensor: 0.3 °C.
b: Measurement uncertainty and probe variation for other
probes: 2 °C.
Probe orientation
Some probes are provided with a green light (LED) orientation
marking near their head (see Figure 12-1). Probes which do not
have a LED have an indentation (notch) for orientation on the
probe housing. This LED, or notch, corresponds with the V mark
on the scanning screen. The V mark indicates the orientation of
the probe to the scan.

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Probe overview
1. LED 3. V-mark on screen: indicates the orientation of

2. Notch the probe to the scan.
Figure 12-1. Orientation marking on probe and on screen
Probe labelling
Each probe is labelled with the following information:
• Name of manufacturer
• Operating frequency
• Model number
• Probe serial number
• Year of manufacture
The probe name displayed on both the probe housing and the
connector can be read when the probe is connected.

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Probes
Probe Integration
Connecting the probe

Probes can be connected at any time, whether the unit is on or
off.
The system has two types of probe ports: one PD probe port
and three PDT probe ports (Figure 12-2).
The PD probe port is specific for the TEE probes and the i13L
probe with a Vivid 7 probe connector. The three PDT probe
ports are specific to the Vivid E9 probe connectors.
1. PD Probe port: for TEE probes and i13L probe with a Vivid 7 probe connector.
2. PDT Probe port: for Vivid E9 specific probe connectors.
Figure 12-2. Probe ports
1. Before connecting the probe:

• Verify the probe and the probe cable for any damage.
• Do a visual check of the probe pins and system sockets.
Remove any dust or foam rests from the probe pins.
2. Hold the probe connector vertically with the cable pointing
upward.
3. Turn the connector locking handle counterclockwise.
4. Align the connector with the probe port and carefully push
into place.
5. Turn the locking handle clockwise to the full vertical position
to lock in place.

GB092107 05
Probe Integration
6. Position the probe cable so that it is not resting on the floor.
CAUTION Do not allow the probe head to hang freely. Impact to the probe
head may result in irreparable damage.
CAUTION Take the following precautions with the probe cables:

• Keep free from the wheels.
• Do not bend.
• Do not cross cables between probes.
WARNING Do NOT touch the patient and any of the connectors on the
ultrasound unit simultaneously, including ultrasound probe
connectors.
Connecting the 6T-RS or the 9T-RS probe
CAUTION Transesophageal probes require a special handling. Refer to

the user documentation enclosed with these probes.
The 6T-RS and the 9T-RS probes are equipped with a Vivid i
connector. To connect these probes on the ultrasound unit, an
adaptor must be used (see Figure 12-3).

GB092107 05
Probes
1. Insert the RS adaptor in the system PD Probe port.

2. Lock the adaptor.
3. Insert the RS type probe connector in the adaptor.
4. Lock the probe connector
Figure 12-3. The RS probe adaptor
Activating the probe

When a probe is connected to the unit it is automatically
detected.
Selecting a probe and an application
1. Press Probe on the control panel. A list of the connected

probes is displayed.
2. Select the desired probe.
The Application menu for the probe is displayed.
3. Select the desired application.
CAUTION Make sure that the probe and application names displayed on
the screen correspond to the actual probe and application
selection.
Check that the correct TI category is displayed. TIB must be
displayed when a fetal application is selected.

GB092107 05
Probe Integration
Disconnecting a probe
1. Rotate the lock handle counter-clockwise to the horizontal
position to unlock the connector.
2. Remove the connector from the port.
3. Ensure that the probe head is clean before placing the
probe in its storage case.
Coupling gels
In order to assure optimal transmission of energy between the
patient and probe, a conductive gel or couplant must be applied
liberally to the patient where scanning will be performed.
CAUTION Do not apply gel to the eyes. If there is gel contact to the eye,
flush eye thoroughly with water.
Refer to the Probe Care Card enclosed in the probe case or to

probe_care.html for the latest list of compatible coupling gels.
CAUTION Do not use unrecommended gels. They may damage the

probe and void the warranty.
Precautions
Coupling gels should not contain the following ingredients as
they are known to cause probe damage:
• Methanol, ethanol, isopropanol, or any other alcohol-based
product
• Mineral oil
• Iodine
• Lotions
• Lanoline
• Aloe Vera
• Olive Oil
• Methyl or Ethyl Parabens (para hydroxybenzoic acid)
• Dimethylsilicone
• Polyether glycol based
• Petroleum

GB092107 05
Probes
Planned maintenance
CAUTION Improper handling can lead to early probe failure and electric
shock hazards.
DO follow the specific cleaning and disinfection procedures
provided in this chapter and the germicide manufacturers
instructions.
Failure to do so will void probe warranty.
CAUTION Transesophageal probes require a special handling. Refer to

the user documentation enclosed with these probes.
It is recommended to keep a maintenance log and note all probe

malfunctions. Follow the maintenance schedule below to ensure
optimum operation and safety:
After each use:
• Inspect the probe.

• Clean the probe.
• If required disinfect the probe.
Before each use:
• Inspect the probe.
Inspecting the probe
CAUTION If any damage is found, DO NOT use the probe until it has
been inspected and released for further use by a GE service
representative.

GB092107 05
After each use:
1. Inspect the lens, the probe housing and the cable

(Figure 12-4).
2. Look for damage that might allow liquid into the probe.
Before each use:
1. Inspect the lens, the probe housing and the cable

(Figure 12-4).
2. Look for damage that might allow liquid into the probe.
3. Test the functionality of the probe.
1. Housing
2. Strain relief
3. Seal
4. Lens
Figure 12-4. Probe parts
Cleaning and disinfecting probes
CAUTION Transesophageal and intraoperative probes require a special

handling. Refer to the user documentation enclosed with these
probes.
Cleaning probes
Cleaning procedure
1. Disconnect the probe from the unit.
2. Remove the coupling gel by wiping the probe lens with a
soft cloth.
3. Wipe the probe and cable with a soft cloth moisten in a
warm soap and water solution (<80 oF/27 oC).
4. Wipe the probe and cable with a soft cloth moisten in clean
water (<80 oF/27 oC) until all soap is removed.

GB092107 05
Probes
5. Wipe dry with a soft towel.
Disinfecting probes
In order to provide users with options in choosing a germicide,

GE Medical Systems routinely reviews new medical germicides
for compatibility with the materials used in the transducer
housing, cable and lens. Although a necessary step in
protecting patients and employees from disease transmission,
liquid chemical germicides must also be selected to minimize
potential damage to the transducer.
Refer to the Probe Care Card enclosed in the probe case or to
probe_care.html for the latest list of compatible cleaning
solutions and disinfectants.
Low-level disinfection
1. After cleaning, the probe and cable may be wiped with a
tissue sprayed with a recommended disinfectant.
Use additional precautions (e.g. gloves and gown) when
decontaminating an infected probe.
High-level disinfection
High-level Disinfection destroys vegetative bacteria; lipid &
non-lipid viruses, fungi and, depending highly on time of contact,
is effective on bacterial spores. This is required for endocavity
(TV,TR,TE) probes after contact with mucosal membrane.
1. Prepare the germicide solution according to the
manufacturer's instructions.
NOTE: Follow the manufacturer's instructions for storage, use and
disposal of the disinfection solution.
WARNING Use only germicides that are listed in the Probe Care Card
enclosed with the probe. In addition, refer to the local /
national regulations.
Do not steam autoclave or subject the probe to Ethylene
Oxide (ETO).
2. Place the cleaned dried probe in contact with the germicide

for the time duration specified by the manufacturer.

GB092107 05
WARNING Do not immerse the probe in liquid beyond the level

specified for that probe (see Figure 12-5).
Never immerse the probe connector or probe adapters in
liquid.
The probe should not be exposed to the germicide longer
than specified to achieve the desired effect.
DO NOT soak or saturate probes with solutions containing
alcohol, bleach, ammonium chloride compounds or
hydrogen peroxide.
3. Rinse the part of the probe which was in contact with the
germicide according to the germicide manufacturer's
instructions.
4. Wipe dry with a soft towel or air dry the probe.
WARNING CREUTZFELDT-JACOB DISEASE

Neurological use on patients with this disease must be
avoided. If a probe becomes contaminated, there is no
adequate disinfecting means.
a. 3V-D, 4V-D, M5S-D, M5Sc-D, 6S-D, 12S-D

b. 4C-D, C1-5-D, C2-9-D, 8C
c. 9L-D, 11L-D, ML6-15-D
d. 2D (P2D)
e. 6D (P6D)
f. IC5-9-D
1. Fluid level
2. Contact face with patient environment
Figure 12-5. Probe immersion levels

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Probes
Probe safety
Electrical hazards
Probes are driven by electricity, which can injure the patient or
user when exposed to contact with conductive solution.
WARNING Do not immerse the probe into any liquid beyond the level
shown in Figure 12-5. Never immerse the probe connector or
adaptors into any liquid.
Do not subject the probe to mechanical shock or impact, which
may result in cracks or chips in the housing and degrade
performance.
Inspect the probe before and after each use, as described on
page 12-16, for damage or degradation to the housing, strain
relief, lens and seal.
DO NOT apply excessive force to the probe cable, to prevent
insulation failure.
Electrical leakage checks should be performed regularly by a
GE service representative or qualified hospital personnel,
according to the procedures described in EN 60601-1/
IEC 60601-1 §19.
Mechanical hazards
Take precaution to avoid mechanical hazards.
WARNING Observe immersion levels as displayed in Figure 12-5 on

page 12-19.
Inspect probes for sharp edges or rough surfaces that could
injure sensitive tissue.
DO NOT bend or pull the cable forcefully, to avoid mechanical
shock or impact to the probe.

GB092107 05
Probe safety
Biological hazards
CAUTION Transesophageal and intraoperative probes require a special

handling. Refer to the user documentation enclosed with these
probes.
CAUTION Protective barriers may be required to minimize disease

transmission. Probe sheaths are available for use with all
clinical situations where infection is a concern. Use of legally
marketed, sterile probe sheaths is strongly recommended for
intra-cavity and intra-operative procedures.
CAUTION According to local regulations, the use of sterile sheath is

mandatory when performing intra-cavity procedures in China.
To reorder sheaths, please contact your local distributor or the

appropriate support resource.
Adequate cleaning and disinfection are essential to prevent

disease transmission. It is the responsibility of the user to verify
and maintain the effectiveness of the infection control
procedures in use.
CAUTION Risk of Infection. ALWAYS clean and disinfect the probe

between patients to the level appropriate for the type of
examination and use FDA-cleared probe sheaths where
appropriate.

GB092107 05
Probes
Endocavity Probe Handling Precautions
If the disinfection solution comes out of the endocavity probe,

please follow the cautions below.
CAUTION Disinfectant Exposure to Patient: contact with a disinfectant

to the patient’s skin or mucous membrane may cause an
inflammation. If this happens, refer to the disinfectant’s
instruction manual.
Disinfectant Exposure from Probe Handle to Patient: DO
NOT allow the disinfectant to contact the patient. Only immerse
the probe to its specified level. Ensure that no solution has
entered the probe’s handle before scanning the patient. If
disinfectant comes into contact with the patient, refer to the
disinfectant’s instruction manual.
Disinfectant Exposure from Probe Connector to Patient:
DO NOT allow the disinfectant to contact the patient. Only
immerse the probe to its specified level. Ensure that no solution
has entered the probe’s connector before scanning the patient.
If disinfectant comes into contact with the patient, refer to the
disinfectant’s instruction manual.

GB092107 05
Biopsy
Biopsy
The system supports biopsy capability for the probes listed in

the table below.
Use only the biopsy needle guidance systems from Civco
Medical Solutions listed in the table below.
Probe Civco needle guidance systems Cat #
4C-D Ultra-Pro IITM Needle Guidance System E8385NA
C1-5D Ultra-Pro IITM Needle Guidance System H40432LE
C2-9-D Ultra-Pro IITM Needle Guidance System H4913BA
9L-D Ultra-Pro IITM Needle Guidance System H4906BK
11L-D Ultra-Pro IITM Needle Guidance System H40432LC
ML6-15-D Ultra-Pro IITM Needle Guidance System H40432LJ
M5S-D and M5Sc-D Ultra-Pro IITM Needle Guidance System H45561FC
IC5-9-D Disposable Endocavity Needle Guide E8385MJ, E8385MY
The biopsy option is intended for use by a duly licensed

physician who has received the appropriate training in biopsy
techniques as dictated by current relevant practices, as well as
in proper operation of the ultrasound unit.
Precaution concerning the use of biopsy procedures
WARNING Do not freeze the image during a biopsy procedure. The image
must be live to avoid a positioning error.
CAUTION The use of biopsy devices and accessories that have not been
evaluated for use with the equipment may not be compatible
and could result in injury.

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Probes
CAUTION The invasive nature of biopsy procedures requires proper

preparation and technique to control infection and disease
transmission. Equipment must be cleaned as appropriate for
the procedure prior to use.
• Follow the probe cleaning and disinfection procedures and
precautions to properly prepare the probe.
• Follow the manufacturer’s instructions for the cleaning of
biopsy devices and accessories.
• After use, follow proper procedures for decontamination,
cleaning, and waste disposal.
Improper cleaning methods and the use of certain cleaning and
disinfecting agents can cause damage to the plastic
components that will degrade imaging performance or increase
the risk of electric shock.
Preparing the Biopsy guide attachment - Convex, Sector and Linear

probes
Convex, Sector and Linear probes have an optional biopsy kit
specific for each probe. The biopsy kit consists of:
• A reusable non-sterile bracket
• Disposable sterile Ultra-Pro IITM Needle guide kits (Civco
Medical Instruments Co, Inc.) consisting of:
• Sets with needle inserts covering gauge
size 14 through 23 (2.1 mm to 0.6 mm)
• Sterile sheath
• Rubber bands
• Gel
• A reusable needle guide
• Instructions
In addition sterile Ultra-Pro IITM Needle guide kits can be
ordered as replacement kit.
WARNING Read the following instructions and the user’s guide for the
Ultra-Pro IITM Needle Guide kit before using the biopsy
equipment.

GB092107 05
Biopsy
Bracket attachment procedure
1. Identify the appropriate biopsy guide bracket as shown in

Figure 12-6.
Probe Biopsy bracket
4C-D
C1-5D
C2-9-D
9L-D
11L-D
ML6-15-D

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Probes
Probe Biopsy bracket
M5S-D and M5Sc-D
Figure 12-6. The biopsy brackets
2. Orient the bracket so that the needle clip attachment is on

the same side as the probe orientation mark, see
Figure 12-7.
3. Attach the biopsy bracket to the probe by sliding the bracket
over the end of the probe until it clicks or lock into place.
Make sure the bracket is firmly attached to the probe.
1. Needle clip attachment on the bracket

2. Bracket label
3. Probe label
4. Probe orientation mark
Figure 12-7. Probe/bracket alignment (representative examples)
Placing the probe and bracket into the sterile sheath
Refer to the Ultra-Pro IITM Needle Guide user manual.

GB092107 05
Biopsy
Attaching the needle guide to the bracket
Refer to the Ultra-Pro IITM Needle Guide user manual.

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Probes
Preparing the Biopsy guide attachment - endocavity probe

The endocavity probe IC5-9-D has an optional specific biopsy kit
The biopsy kit consists of:
• Disposable sterile needle guide
• Sterile sheath
• Rubber bands
• Gel
• Reference Guide for the Disposable Endocavity Needle
Guide
In addition disposable sterile endocavity needle guide can be
ordered as replacement kit.
WARNING Read the instructions in the Reference Guide for the

Disposable Endocavity Needle Guide from Civco Medical
Solutions before using the biopsy equipment.
Needle guide attachment
Refer to the “Disposable Endocavity Needle Guide” Reference

Guide.
Placing the probe and needle guide into the sterile sheath
Refer to the “Disposable Endocavity Needle Guide” Reference

Guide.

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Biopsy
Displaying the Guide zone

1. Select the desired probe with biopsy support.
2. Press Biopsy on the Touch panel (Page 2).
3. If the needle multi-angle is supported, select the correct
angle from the Biopsy menu.
Figure 12-8. The Biopsy menu
The biopsy guide zone is displayed on the screen.
1. Biopsy guide zone The first red mark is at 5 cm from the top of the
• 5 cm between the red marks needle guide.
• 1 cm between the large yellow marks
• 0.5 cm between two consecutive marks
Figure 12-9. Biopsy guide zone
Biopsy needle path verification

Perform the Needle path verification once a year or whenever
there is a suspicion of malfunction.
To verify that the path of the needle is accurately indicated within
the guide zone on the system monitor, perform the following:

GB092107 05
Probes
1. Properly install the bracket and biopsy guide (see

page 12-25 and page 12-28).
2. Scan in a container filled with a glycerol solution (6% in
water).
3. Display the biopsy guide zone on the monitor (see
page 12-29).
4. Ensure that the needle echo falls within the guide zone
markers.
Starting the biopsy procedure

1. Press Biopsy on the Touch panel (Page 2). When using
multi-angle guides, select the correct angle from the Biopsy
menu.
2. Place sterile coupling gel on the scanning surface of the
probe/sheath.
3. Scan to locate the target. Center the target in the electronic
guidezone path.
NOTE: Enabling color flow would allow for visualization of the
vascular structure around the area to be biopsied.
4. Place the needle in the guide between the needle barrel and
needle clip. Direct it into the area of interest for specimen
retrieval.
Cleaning, disinfection and disposal

1. Refer to the Ultra-Pro IITM Needle Guide user manual for
cleaning and disinfection of the bracket.
2. Perform cleaning and disinfection of the probe as described
in page 12-17.
3. Dispose the sheath, bands and needle guide after use,
according to medical regulations for biohazardous waste.
CAUTION When the biopsy needle guide kit is opened, all parts must be
discarded after the procedure whether they have been used or
not.

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Chapter 13
Peripherals
‘DVR’ on page 13-3
‘Printing’ on page 13-7.

GB092107 05
Peripherals
Introduction
This chapter provides information on peripherals that can

operate with the ultrasound unit, as follows:
• Digital Video Recorder (DVR)
• Color Thermal Video Printer
CAUTION Use only GE Healthcare approved internal equipment when

replacing an internal peripheral.
External peripheral equipment must be in compliance with
related IEC standards for safety. The electrical medical
systems conformance to IEC60601-1-1: 2000 or
IEC60601-1: 2005 must be verified.
All devices meeting IEC60950 must be kept outside of the
patient environment, as defined in IEC60601-1-1, unless it,
according to IEC60601-1-1, is equipped with additional
protective earth or extra isolating transformer. Commercial
devices such as laser cameras, printers, VCRs and external
monitors, usually exceed allowable leakage current limits and,
when plugged into separate AC outlets, are in violation of
patient safety standards. Suitable electrical isolation of such
external AC outlets, or providing the device with extra
protective earth, will be required in order to meet IEC60601-1
standards for electrical leakage.
WARNING Any devices or cables, other than those sold with the
ultrasound unit, connected to the Peripheral /accessory
connector panel or to an USB port on the unit may result in an
increase of the electromagnetic emission from the unit, or a
decrease of the electromagnetic immunity of the unit.
CAUTION When using peripheral device, observe all warnings and

cautions given in peripheral operator manuals.

GB092107 05
DVR
DVR
DVR Overview
The DVR is operated from the ultrasound unit control panel. The
DVR status displayed on the screen indicates the current DVR
function.
1. DVD time counter 7. Fast Forward

2. Title number 8. Rewind
3. Recording 9. Eject
4. Stop 10. Search
5. Play
6. Pause (red while recording)
Figure 13-1. The DVR status area on the Title bar

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Peripherals
Using the DVR
Recording
Data recording can be done in two ways depending on the

configuration of the DVR:
• Direct recording (streaming): data is stored directly on DVD.
Only DVD+RW is supported using Direct recording.
• Indirect recording: data is stored on an internal dedicated
hard disk. The stored data can then be burned to any
writable DVD.
Configuration of the DVR recording mode is done in Config
(F2)/Service.
NOTE: Changing the recording mode requires a reboot of the system.
Direct recording
1. Create a patient record or open an existing one.
2. Insert a DVD+RW in the DVR drive.
3. Press Record on the Control panel.
A blinking red dot is displayed in the DVR status area on the
Title bar to indicate that recording has begun.
The amount of used space on the disk is indicated by the
DVR filling gauge on the status bar.
NOTE: A new title is created for each recording session.
4. Press the Record key to toggle between pause and record.
NOTE: When recording is resumed after pause a new chapter is
created.
5. To stop recording, press Stop recording on the Touch
panel.
6. To delete recorded data, press Clear DVR on the Touch
panel.
NOTE: When pressing Clear DVR the disk is formatted.
7. To eject the DVD, press Eject DVR on the Touch panel.
Indirect recording
1. Create a patient record or open an existing one.
2. Press Record on the Control panel.
A blinking red dot is displayed in the DVR status area on the
Title bar to indicate that recording has begun. The data
recorded is stored on an internal dedicated hard disk.

GB092107 05
DVR
The amount of used space on the disk is indicated by the

DVR filling gauge on the status bar.
NOTE: A new title is created for each recording session.
3. Press the Record key to toggle between pause and record.
NOTE: When recording is resumed after pause a new chapter is
created.
4. To stop recording, press Stop recording on the Touch
panel.
5. To write the recorded data on a DVD, insert a writable DVD
in the DVR and press Burn to DVD on the Touch panel.
A blinking yellow dot is displayed in the DVR status area on
the Title bar to indicate that writing to DVD is in progress.
The DVD is ejected when completed.
6. To delete recorded data on the internal dedicated disk,
press Clear DVR Disk on the Touch panel.
Play back from the internal disk or DVD
1. If playing back from a DVD, insert the DVD to play back in

the CD/DVD drive (not the DVR) and wait while it is loading.
2. Press Utility and Play on the Touch panel.
3. Use the buttons on the Touch panel to perform actions on
the played back session, such as stop, pause, rewind or fast
forward. Press the dedicated Prev and Next buttons to
change title or chapter.
Figure 13-2. DVR playback Touch panel
4. To find a patient record, press Go to/Search on the Touch

panel.

GB092107 05
Peripherals
The Video Counter/Search window is displayed.
Figure 13-3. The Search window
• Select a title from the Recording title drop-down menu

and press Search counter.
Playback of the selected title is started.

GB092107 05
Printing
Printing
The ultrasound unit can support a thermal video printer. The

printer device is controlled from the P1 or P2 key on the control
panel (see Figure 13-4).
the P1 and P2 keys can also be configured to perform
alternative storage (i.e. storage to DICOM media or secondary
capture). See page 10-76 for configuration of the P1 and P2
keys.
Figure 13-4. The printer controls on the Control panel
To print an image
1. Press P1 or P2 on the Control panel (see Figure 13-4).
The image displayed on the screen is printed on the printer,
depending on the key assignment configuration (see
page 10-76).
NOTE: For details on the Thermal video printers operation, consult
the manufacturer operator manual provided with the printer.
Printer configuration
The following procedure describes how to configure and select a
printer as the default printer.
2. Select Connectivity and Additional output.
The Additional output screen is displayed.

GB092107 05
Peripherals
3. In the Additional output screen select Advanced in the

Printer setup field.
The Printer properties window is displayed.
4. Press Configure.
The Print setup window is displayed.
5. In the Print setup window, select the printer and adjust the
parameters for the printer. Additional settings may be
adjusted by selecting Properties.
6. Select OK to close the Print setup window.
The Standard printer properties window is displayed.
To choose the configured printer as the default printer:
1. Select Open in the Printer properties window.
The Printer status window for the opened printer is
displayed.
2. Select Printer and Set as default printer.
3. Close the Printer status window and select OK in the
Standard printer properties window.

GB092107 05
Chapter 14
Maintenance
‘System Care and Maintenance’ on page 14-2
‘System self-test’ on page 14-13.
‘Software upgrade’ on page 14-15

GB092107 05
Maintenance
CAUTION The user must ensure that safety inspections are performed at
least every 12 months according to the requirements of the
patient safety standard IEC 60601-1. Refer to the Service
manual, Chapter 10.
Only trained persons are allowed to perform the safety
inspections mentioned above.
Technical descriptions are available on request.
To ensure that the unit constantly operates at maximum

efficiency we recommend that the following procedures be
observed as part of the customer’s internal routine maintenance
program.
Inspecting the system
CAUTION If any defects are observed or malfunctions occur, DO NOT

operate the equipment, and inform a qualified service person.
Examine the following on a monthly basis (or whenever there is

a reason to assume that any issue may have occurred):
• Connectors on cables, for any mechanical defects
• Entire length of electrical and power cables, for cuts or
abrasions
• Equipment, for loose or missing hardware
• Control panel and keyboard for defects
• Wheels for proper locking operation
WARNING To avoid electrical shock hazard, do not remove panels or

covers from the unit. This servicing must be performed by
qualified service personnel. Failure to do so could cause
serious injury.

GB092107 05
Cleaning the unit

The ultrasound unit requires regular care and maintenance to
function safely and properly. The following components should
be cleaned.
Weekly:
• LCD monitor and Touch screen
• Control panel
• Keyboard
• Probe holders
• System cabinet
• Footswitch
Biweekly:
• Air filters
CAUTION When performing cleaning procedures, to prevent the risk of

system damage, always observe the following precautions:
• Use only cleaning materials and solutions as
recommended in the procedures described below.
• Never use thinner, benzene, ethanol or methanol alcohol,
abrasive cleaners, or other strong solvents, as these may
cause damage to the cabinet or LCD panel. Only use
isopropyl alcohol, when instructed to do so.
• Do not spray any liquid directly onto the Vivid E9 covers,
LCD Display or keyboard.
• Do not allow any liquid to drip or seep into the system.
• DO NOT scratch or press on the panel with any sharp
objects, such as pencils or pens, as this may result in
damage to the panel.
• Make sure not to spill or spray any liquid on the controls,
into the system cabinet, or in the probe connection
receptacle.
• Prior to cleaning, turn OFF power to the system and
disconnect the mains cable.

GB092107 05
Maintenance
Appropriate cleaning agents
LCD monitor (glass)
Touch panel (glass)

LCD frame (panel)
Operator controls
System cabinet
Footswitch
Cleaning agent
Mild, Non-Abrasive Soap and Water X X X X X X
Ammonia X X X
Bleach (10 to 1 Ratio of 5% Home X X X

Bleach)
Hydrogen Peroxide / Hydrogen X X X

Peroxide Wipes
Other T-Spray II
Sani-Cloth HB
Diluted Cidex
Cleaning procedures
Prior to cleaning any part of the system:

1. Turn off the system power. If possible, disconnect the power
cord.
LCD Monitor and Touch panel

NOTE: Never use thinner, benzene, ethanol or methanol alcohol,
abrasive cleaners, or other strong solvents, as these may cause
damage to the cabinet or LCD panel.
NOTE: DO NOT scratch or press on the panel with any sharp objects,
such as pencils or pens, as this may result in damage to the
panel.
To clean the LCD frame
1. Moisten a soft, non-abrasive folded cloth with a mild,
general purpose, non-abrasive soap and water solution. The
cloth should be damp, not dripping wet.
NOTE: Other acceptable cleaning agents are: Ammonia, Bleach
(10 to 1 ratio of 5% home bleach), Hydrogen Peroxide or
Hydrogen Peroxide wipes.
2. Wipe down the top, front, back, and both sides of the LCD
frame. Do not spray any liquid directly onto the LCD.

GB092107 05
3. Wipe off excess cleaning agents.

4. In the event that disinfection is required or any stubborn
stains remain, absorb a small quantity of isopropyl rubbing
alcohol on a soft, dust-free cloth. Wipe the cabinet and allow
to dry.
To clean LCD monitor and Touch panel (glasses):
2. Gently wipe the surface of the LCD monitor and Touch
panel.
3. Wipe off excess cleaning agents.
4. If necessary, stubborn stains can be removed by moistening
part of a cloth with water or a 50-50 mixture of isopropyl
alcohol and water that does not contain impurities. Wring
out as much of the liquid as possible then wipe the LCD
surface. Do not let any liquid drip into the system.
Control panel and keyboard

NOTE: Diligent cleaning of the console reduces the risk of spreading
infection from person to person, and also helps to maintain a
clean working environment.
Only use the following cleaners on the Control panel:
• A non-abrasive soap and water solution (e.g. Palmolive
Dishwashing Liquid, manufactured by Colgate-Palmolive)
• Sani Wipes Alcohol-free (manufactured by Micorgen Inc.)
• T-Spray II (manufactured by Pharmaceutical Innovations,
Inc.)
• Ammonia
• Bleach (10 to 1 ratio of 5% home bleach)
• Hydrogen Peroxide or Hydrogen Peroxide wipes
DO NOT USE:
• T-Spray I (Original T-Spray)
• SaniCloth Plus (red cap)
To clean the Control panel:
1. Moisten a soft, non-abrasive folded cloth with water or a
mild, non-abrasive soap and water solution.
2. Gently wipe the surface of the console.
3. Use a cotton swab to clean around keys or controls. Use a
toothpick to remove solids from between keys and controls.

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Maintenance
When cleaning the operator control panel, make sure not to

spill or spray any liquid on the controls, into the system
cabinet, or in the probe connection receptacle.
alcohol on a soft, dust-free cloth. Wipe the surface of the
console. Make sure no liquid drips on or between the keys.
Allow to dry.
To clean the keyboard:
1. Clean the keyboard as described above for the Control
panel.
key caps. Make sure no liquid drips on or between the keys.
Allow to dry.
To clean the trackball:
Clean the trackball only when required.
1. Rotate the top locking ring counter-clockwise around the
trackball.
2. Lift off the top locking ring, the rubber dust filtering ring and
the trackball from the Control panel.
3. Wipe the trackball with a soft dry cloth.
4. Wipe the trackball housing, rollers, etc. with a soft dry cloth
or a cotton swab.
5. Insert the trackball into the housing.
6. Place the dust filtering ring and the top locking ring.
7. Rotate the top locking ring clockwise to lock it in place.
Probe holder
1. Clean the probe holders with warm water and a damp cloth
to remove all traces of gel.
probe holder. Make sure no liquid drips into the system.
Allow to dry.
System cabinet

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NOTE: Other acceptable cleaning agents are: Ammonia, Bleach

(10 to 1 ratio of 5% home bleach), Hydrogen Peroxide or
Hydrogen Peroxide wipes.
2. Wipe down the top, front, back and both sides of the
cabinet. Do not spray any liquid directly onto the unit.
alcohol on a soft, dust-free cloth. Wipe the system cabinet
and allow to dry.
Footswitch
To clean the footswitch:
2. Wipe the external surfaces of the unit then dry with a soft,
clean, cloth.
alcohol on a soft, dust-free cloth. Wipe the footswitch and
allow to dry.
Air filters
Clean the unit’s air filters to ensure that a clogged filter does not
cause the unit to overheat and reduce system performance and
reliability.
A message is displayed on screen on a regular basis to remind
the user about the need to clean the filters.
CAUTION Be sure to lock the wheels before cleaning the air filters to
avoid injury by any unexpected movement of the system.
DO NOT operate the unit without the air filters in place.
The Vivid E9 has two air filters which need to be cleaned. The
top air filter is located on the back of the unit below the power
cord and the bottom air filter is located underneath the system.

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Maintenance
1. Top air filter

2. Bottom air filter
Figure 14-1. Location of the air filters
Removing the air filters

1. Turn off the power of the system to prevent any loose or
knocked-off debris from entering the fan tray.
2. Walk the Vivid E9 forward until the wheel is in position to
access the filter handle. The right rear wheel must be in-line
and away from the Vivid E9.
Figure 14-2. Positioning the wheels

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3. Lock the brakes
Figure 14-3. Lock the brakes
4. Top air filter:

Remove the cover and then remove the filter.
Figure 14-4. Top air filter removal
5. Bottom air filter:

Remove the filter assembly by lowering the handle situated
behind the right rear wheel.

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Maintenance
Figure 14-5. Bottom air filter removal
Cleaning the air filters

1. Top air filter:
Remove the lint or dust from the soiled side. Vacuum if
necessary.
Figure 14-6. Cleaning the top air filter

Remove the lint or dust from the soiled side. Use a soft
brush or vacuum if necessary.
Figure 14-7. Cleaning the bottom air filter
Reinstalling the air filters

1. Top air filter:

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Tuck the edges of the filter under the rear bumper and
reinstall the cover.
Figure 14-8. Reinstalling the top air filter

Position the filter under the system. Place the handle into
the stowed position. The filter is drawn to the mounting
magnets.
Figure 14-9. Reinstalling the bottom air filter
Cleaning the probes

Refer to the Probes chapter, section for probe cleaning and
disinfecting instructions.

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Maintenance
Prevention of static electricity interference

Interference from static electricity can damage electronic
components in the system. The following measures help to
reduce the likelihood of electrostatic discharge:
• Wipe the alphanumeric keyboard and monitor with lint-free
tissue or a soft cloth dampened with anti-static spray on a
monthly basis.
• Spray carpets with anti-static spray because constant
walking on carpets in or near the scanning room may be a
source of static electricity.

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System self-test
System self-test
The ultrasound unit is designed for reliable operation and

consistent, high-quality performance. Automatic self-testing
facilities are provided to monitor system operation and to detect
malfunction as soon as possible, thereby eliminating
unnecessary downtime. The detection of any serious
malfunction may result in immediate interruption of the unit
operation.
System malfunction
In the event of error or system malfunction the user may save
locally or export a log file to a removable media as described
below and contact authorized service personnel.
In addition, system malfunctions can be bookmarked, enabling
creation of a log file specific to that event.
Bookmarking a system malfunction
1. If a system malfunction is observed, press Alt - B.

A bookmark will be created when creating a log file.
Generating a log file
1. Press Alt - D on the alphanumeric keyboard.

The Problem description dialogue window is displayed (see
Figure 14-10).
2. Type in a description of the problem. Notes should be made
regarding the selected probe, the imaging mode and the
application that was being used at the time of malfunction. If
applicable, try to describe the button or key pushing
sequence that immediately preceded the problem.
Check the mention System lockup if applicable.
3. Select the destination where to save or export the log file.
If Store locally is selected, the log file is saved to the local
hard disk.

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Maintenance
If a removable media is selected, the current and previously

saved log files are exported to the selected media.
NOTE: To export to a shared folder on a network, a remote path
must be defined (see ‘Remote path setting’ on page 10-73).
4. Press Save and Export.
A Zip file (named “logfile_<date>_<time>.zip”) is created.
Figure 14-10. The Problem description dialogue window
Advanced log options
Extensive Log
Extensive Log enables the creation of a log file containing
additional information for the selected functionality.
Options
Options enables creation of a log file based on a selected
bookmark or for a user configurable time frame. Different type of
information can be selected to be part of the log file.

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Software upgrade
Software upgrade
Software upgrade for the unit may become available for

download and installation through the GE Service platform.
When a software upgrade is available a message icon is
displayed on the status bar.
Users must have administrator rights to perform the software
download. If a user is not logged in as ADM (administrator) he/
she will not be prompted for initiating SW Download.
CAUTION Please backup up presets and database before installation of

the software (see ‘Data Backup and restore’ on page 10-61).
Remote software download should not change user presets or
affect customer database; however, it is always best practice to
ensure patient data and preset are backed up before
proceeding with any software installation.
NOTE: Please allow approximately one hour for complete software

download and installation. (Times may vary due to network
connection speed).
NOTE: Software upgrade through the GE service platform may not be
available in all markets.
To ensure TCP/IP settings are retained after software upgrade,
save the TCP/IP settings as described in section ‘Save TCP/IP
settings’ on page 14-20 prior to downloading the software.
Software download and installation

1. Press the on/off button on the top left of the control panel.
The Exit dialogue window with software download is
displayed.

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Maintenance
Note: the SW Download section (lower part of the window) may take a few
seconds to be displayed.
• Automatically install after download: it is recommended that the user
checks this option. This selection allows the software to start loading
automatically after the software has been downloaded. If not selected the
user will be given the opportunity after download to install the software.
• More Info: displays a window with information about the software to
download.
• Decline: the software is not downloaded, no upgrade will be performed.
Note: If you choose Decline, you will not be prompted to install this
software update again unless you contact GE Service.
• Download: starts software download.
Figure 14-11. The Exit dialogue window
2. Press Download.
The download process is started. The progression of the
download process is displayed.
NOTE: A typical software update of about 600 Mb may take up to
60 minutes to download.
Please allow the software to fully download and only stop or
suspend in case of emergency.

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Software upgrade
• Stop: the download process is stopped, no software upgrade is performed.

• Suspend/Resume: the download process is paused, press Resume to
continue download.
Figure 14-12. Software download in progress
3. If the user did not check the option Automatically install

after download in step 1 the following message is
displayed.
• Decline: the downloaded software will not be installed; software upgrade

will not be performed.
Note: If you choose Decline, you will not be prompted to install this
software update again unless you contact GE Service.
• Install: the downloaded software will begin installation.
Figure 14-13. Software ready to be installed
4. Press Install.
The system will reboot automatically and the installation
process will begin Do not power off the system during the
software installation. The system will reboot during
installation. Please allow the system to completely install the
software.
NOTE: A typical installation may take up to 20 minutes.
when installation is complete, reboot the system. Perform
TCP/IP Save Settings (see page 14-20) and reboot. After a
few minutes the New software verification window is
displayed (see Figure 14-14).

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Maintenance
Figure 14-14. Software verification
5. Perform a check for all features listed. Press to get

information on how to check each feature.
NOTE: You can press to minimize the Software verification
window and move it out of the way when testing.
Select Passed or Failed for each feature. If all features are
“Passed” the signature field is enabled.
CAUTION If for any reason the user fails a test the system will roll
back to the original software version. Please call your local
service immediately.
Figure 14-15. Signature field enabled
6. Enter your signature (minimum three characters) and press

OK.
7. Create an Insite permanent user as described in the next
section.

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Software upgrade
Create an Insite permanent user

An Insite permanent user is required for automatic system error
reporting to the GE digital service network.
1. Select the Contact GE icon on the status bar.
The Insite service menu is displayed.
Figure 14-16. The Insite service menu
2. Select Request for service.

The Contact GE screen is displayed.
Figure 14-17. The Contact GE screen
3. Select Users on the top menu.

The Permanent users screen is displayed.
4. Press Add user (see arrow in Figure 14-18).

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Maintenance
Figure 14-18. The Permanent users screen
5. Fill in the required information and press the Add user

button (see arrow in Figure 14-19).
Figure 14-19. The Permanent users screen
The permanent user is created.

6. Close the window.
Save TCP/IP settings

The TCP/IP settings of the system need to be saved after a
software upgrade.
2. Select the Connectivity category and TCP/IP subgroup.
The TCP/IP settings window is displayed (Figure 14-20).

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Software upgrade
Figure 14-20. TCP/IP settings
3. Press Save settings.

Figure 14-21. Confirmation window
4. Press OK and reboot the system.

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Maintenance
5. The software upgrade is complete. If you have any

questions or concerns, please call your GE service
organization.

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Chapter 15
Safety
‘Owner responsibility’ on page 15-3
‘Acoustic output’ on page 15-4
‘Important safety considerations’ on page 15-10
‘Device labels’ on page 15-23.

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Safety
Introduction
This chapter describes the important safety measures which

should be taken before operating the ultrasound unit.
Procedures for simple care and maintenance of the unit are also
described.
Various levels of safety precautions may be found on the
equipment, and different levels of severity are identified by one
of the following icons that precede precautionary statements in
the text.
The following icons are used to indicate precautions:
DANGER Indicates that a specific hazard exists that, given inappropriate

conditions or actions, will cause:
• Severe or fatal personal injury
• Substantial property damage
WARNING Indicates that a specific hazard exists that, given inappropriate

conditions or actions, will cause:
• Severe or fatal personal injury
• Substantial property damage
CAUTION Indicates that a potential hazard may exist that, given

inappropriate conditions or actions, can cause:
• Minor injury
• Property damage

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CAUTION For USA only:

Federal law restricts this device to use by, or on the orders of, a
physician.
It is the responsibility of the owner to ensure that anyone

operating the system reads and understands this section of the
manual. However, there is no representation that the act of
reading this manual renders the reader qualified to operate,
inspect, test, align, calibrate, troubleshoot, repair or modify the
system. The owner should make certain that only properly
trained, fully-qualified service personnel undertake the
installation, maintenance, troubleshooting, calibration and repair
of the equipment.
The owner of the ultrasound unit should ensure that only
properly trained, fully qualified personnel are authorized to
operate the system. Before authorizing anyone to operate the
system, it should be verified that the person has read, and fully
understands, the operating instructions contained in this
manual. It is advisable to maintain a list of authorized operators.
Should the system fail to operate correctly, or if the unit does not
respond to the commands described in this manual, the
operator should contact the nearest field GE Ultrasound Service
Office.
For information about specific requirements and regulations
applicable to the use of electronic medical equipment, consult
the local, state and federal agencies.
Notice against user modification

Never modify this product, including system components,
software, cables, and so on. User modification may cause safety
hazards and degradation in system performance. All
modification must be done by a GE qualified person.

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Safety
Acoustic output
Definition of the acoustic output parameters
Thermal Index
TI is an estimate of the temperature increase of soft tissue or

bone. There are three thermal index categories:
• TIS: Soft tissue thermal index. The main TI category. Used
for applications that do not image bone.
• TIB: Bone thermal index (bone located in a focal region).
Used for fetal application.
• TIC: Cranial bone thermal index (bone located close to the
surface). Used for transcranial application.
Mechanical Index
MI is the estimated likelihood of tissue damage due to cavitation.

The absolute maximum limits of the MI is 1.9 as set by the FDA
510(k) guidance of September 9, 2008.
Ispta
The Ispta is the Spatial Peak Temporal Average Intensity. The

absolute maximum limit of Ispta is 720 mW/cm2 as set by the
FDA 510(k) guidance of September 9, 2008.

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Acoustic output
Acoustic output and display on the Vivid E9

In the title bar, two fields are allocated for the display of power
values as shown in Figure 15-1.
1. Title bar
2. MI
3. TI
Figure 15-1. The display of MI and TI on the screen
The Vivid E9 chooses the correct category based on mode of

operation and chosen application, and presents the relevant TI
category to the operator. It is therefore important that the
operator chooses the right application. The system also
provides the ability to select the display of any of the TI
categories regardless of the current application.
The Vivid E9 has an internal limit of 3.0 on TI for the chosen
index category.
The British Medical Ultrasound Society has suggested some
maximum scanning times relative to displayed TI as follows:
Obstetric scanning
TI time Note
0.0–0.7 Unlimited Monitor TIS up to 10 weeks post LMP, TIB thereafter
0.7–1.0 < 60 min
1.0–1.5 < 30 min
1.5–2.0 < 15 min
2.0–2.5 < 4 min
2.5–3.0 < 1 min

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Safety
Neonatal trans-cranial & spinal scanning
TI time Note
0.0–0.7 Unlimited Monitor TIC. MI>0.7 should be used with caution in the presence of
contrast agents.
0.7–1.0 < 60 min
1.0–1.5 < 30 min
1.5–2.0 < 15 min
2.0–2.5 < 4 min
2.5–3.0 < 1 min
Neonatal general and cardiac scanning
TI time Note
0.0–1.0 Unlimited Monitor TIB. MI>0.7 should be used with caution in the presence of
contrast agents.
1.0–1.5 < 120 min
1.5–2.0 < 60 min
2.0–2.5 < 15 min
2.5–3.0 < 4 min
Adult trans-cranial scanning
TI time Note
0.0–1.0 Unlimited Monitor TIC. MI>0.7 should be used with caution in the presence of
contrast agents.
1.0–1.5 < 30 min
1.5–2.0 < 15 min
2.0–2.5 < 4 min
2.5–3.0 < 1 min
General Abdominal, Peripheral Vascular and other scanning (excluding the eye)
TI time Note
0.0–1.0 Unlimited Monitor TIB or TIC if bone closer than 1 cm, TIS if no bone is in the
image. MI>0.7 should be used with caution in the presence of
1.0–1.5 < 120 min contrast agents.
1.5–2.0 < 60 min
2.0–2.5 < 15 min
2.5–3.0 < 4 min

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Acoustic output
NOTE: The Vivid E9 does not monitor the thermal exposure time.
References
• The British Medical Ultrasound Society. Guidelines for the
safe use of diagnostic ultrasound equipment.
• American Institute of Ultrasound in Medicine Consensus
Report on Potential Bioeffects of Diagnostic Ultrasound.
The maximum possible MI and Ispta on the Vivid E9 is within the
limits set in Track 3 in the FDA 510(k) guide of September 9,
2008, MI < 1.9 and Ispta < 720 mW/cm2.
ALARA
Ultrasound procedures should be performed using output levels
and exposure times As Low As Reasonably Achievable
(ALARA) while acquiring clinical information.
Training
During each ultrasound examination the user is expected to

weigh the medical benefit of the diagnostic information that
would be obtained against the risk of potential harmful effects.
Once an optimal image is achieved, the need for increasing
acoustic output or prolonging the exposure cannot be justified. It
is recommended that all users receive proper training in
applications before performing them in a clinical setting. Contact
the GE Healthcare sales representative for training assistance.
Safety statement
GE Vingmed Ultrasound safety statement
Although no harmful biological effects have been demonstrated

for ultrasound frequencies, intensities and exposure times used
in examination with the GE Vingmed system, GE Vingmed
Ultrasound recommends using the lowest acoustic output
settings which will produce diagnostically acceptable
information.
System controls affecting acoustic output

The operator controls that directly affect the acoustic output are
discussed in the Acoustic Output Data Tables in the Reference
Manual. These tables show the highest possible acoustic

GB092107 05
Safety
intensity for a given mode, obtainable only when the maximum

combination of control settings is selected. Most settings result
in a much lower output. It is important to note the following:
• The duration of an ultrasound examination is as important
as the acoustic output, since patient exposure to output is
directly related to the exposure time.
• Better image quality yields faster clinical results, making it
possible to complete the relevant ultrasound examination
more rapidly. Therefore, any control that improves the
quality of the examination can help to reduce patient
exposure, even though it may not directly affect acoustic
output.
Probe selection
As long as the appropriate application is available, any probe

can be used with the knowledge that the intensities fall at, or
below, those stated in the Acoustic Output Data Tables. The
duration of patient exposure is most likely minimized with the
use of a probe that is optimized to provide resolution and focal
depth, appropriate to the examination.
Application selection
Selecting the probe and application preset appropriate to a

particular ultrasound examination automatically provides
acoustic output limits within FDA guidelines for that application.
Other parameters which optimize performance for the selected
application are also set automatically, and should assist in
reducing the patient exposure time. See page 12-14, for
information on selecting probes and application presets.
Changing imaging modes
Acoustic output depends on the imaging mode selected. The

choice of mode (2D, M-Mode, Doppler or Color Flow)
determines whether the ultrasound beam is stationary or in
motion. This greatly affects the energy absorbed by the tissue.
See ‘Scanning Modes’ on page 4-1, for complete information on
changing imaging modes.
When operating in a combined mode, such as 2D and M-Mode,
the total acoustic output comprises contributions from each
individual mode. Depending on the modes in use, either or both
output indices may be affected.

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Acoustic output
The user can override the default settings, but care should be
taken to observe the displayed MI and TI values.
Power
It is possible to change the power in all operating modes so that

the operator can use the ALARA principle.

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Safety
This section includes considerations for the following:

• Patient safety
• Personnel and equipment safety
The information contained in this section is intended to
familiarize the user with the hazards associated with the use of
the unit, and to alert them to the extent to which injury and
damage may occur if the precautions are not observed.
Users are obligated to familiarize themselves with these safety
considerations and to avoid conditions that could result in injury
or damage.
Patient safety
Patient identification
WARNING The concerns listed in this section can seriously affect the
safety of the patient undergoing a diagnostic ultrasound
examination.
Always include proper identification with all patient data and

verify the accuracy of the patient's name and/or identity number
when entering such data. Ensure that the correct patient ID is
provided on all recorded data and hard copy prints. Identification
errors could result in an incorrect diagnosis.
Diagnostic information
The images and calculations provided by the system are

intended for use by competent users, as a diagnostic tool. They
are explicitly not to be regarded as the sole, irrefutable basis for
clinical diagnosis. Users are encouraged to study the literature
and reach their own professional conclusions regarding the
clinical utility of the system.

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CAUTION The system provides calculations (e.g. estimated foetal weight)

and charts based on published scientific literature. The
selection of the appropriate chart and clinical interpretation of
calculations and charts are the sole responsibility of the user.
The user must consider contraindications for the use of a
calculation or chart as described in the scientific literature. The
diagnosis, decision for further examinations and medical
treatment must be performed by qualified personnel following
good clinical practice.
The user should be aware of the product specifications and of

the system accuracy and stability limitations. These limitations
must be considered before making any decision based on
quantitative values. If in doubt, the nearest GE Ultrasound
Service Office should be consulted.
Equipment malfunction or incorrect settings can result in
measurement errors or failure to detect details in the image. The
user must become thoroughly familiar with the operation of the
unit in order to optimize its performance and to recognize
possible malfunctions. Application training is available through
the sales representative.
CAUTION Be certain to ensure privacy data of patient information.
Mechanical hazards
Damaged probes or improper use and manipulation of the

transesophageal probe may result in injury or increased risk of
infection. Inspect probes frequently for sharp, pointed or rough
surface damage that could cause injury or tear protective
barriers (gloves and sheaths).
Transesophageal probe safety
Never use excessive force when manipulating the

transesophageal probe. The detailed operator manual enclosed
with the transesophageal probe must be read carefully.

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Safety
Safe and efficient data storage is crucial when doing

transesophageal examination. To ensure optimal image storage
during a transesophageal examination the user should consider:
• To create a new examination when using the TEE probe in
order to limit the size of the examination.
• To store the images on the local archive. Storage on a
remote archive may be affected by network instability and
traffic.
Electrical Hazard
A damaged probe may increase the risk of electric shock if

conductive solutions come in contact with internal live pads.
Inspect probes often for cracks or openings in the housing and
holes in and around the acoustic lens, or other damage that
could allow moisture to enter. Become familiar with the probe's
use and care precautions outlined in ‘Probes’ on page 12-1.
The scanner and Electrosurgical units
WARNING This equipment provides no special means of protection from

high frequency (HF) burns that may result from using an
electrosurgical unit (ESU). To reduce the risk of HF burns,
avoid contact between the patient and ultrasound transducer or
ECG electrodes while operating the ESU. Where contact
cannot be avoided, as in the case of TEE monitoring during
surgery, make sure the transducer or ECG electrodes are not
located between the ESU active and dispersive electrodes and
keep the ESU cables away from the transducer or ECG cables
Personnel and equipment safety
DANGER The hazards listed below can seriously affect the safety of
personnel and equipment during a diagnostic ultrasound
examination.
General hazard
CAUTION Do not use this equipment if a safety problem is known to exist.

Have the unit repaired and performance verified by qualified
service personnel before returning to use.

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CAUTION Only approved and recommended peripherals and accessories

should be used.
All peripherals and accessories must be securely mounted to
the Vivid E9.
Explosion hazard
Never operate the equipment in the presence of flammable or

explosive liquids, vapors or gases. Malfunctions in the unit, or
sparks generated by fan motors, can electrically ignite these
substances. Operators should be aware of the following points
to prevent such explosion hazards.
• If flammable substances are detected in the environment,
do not plug in or turn on the system.
• If flammable substances are detected after the system has
been turned on, do not attempt to turn off the unit, or to
unplug it.
• If flammable substances are detected, evacuate and
ventilate the area before turning off the unit.
Electrical hazard
WARNING The internal circuits of the unit use high voltages, capable of
causing serious injury or death by electrical shock.
NOTE: Any rest energy within our scanners or their components will be
below 60 V DC or 2 mJ.
To avoid injury
• Do not remove the unit's protective covers. No
user-serviceable parts are inside. If servicing is required,
contact qualified technical personnel.
• Connect the attachment plug to a hospital-grade grounding
outlet to ensure adequate grounding.
• Do not place liquids on or above the unit. Conductive fluids
seeping into the active circuit components may cause short
circuiting, which could result in an electrical fire.
• An electrical hazard may exist if any light, monitor or visual
indicator remains on after the unit is turned off.

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Safety
Fuses blown within 36 hours of being replaced may indicate a

malfunctioning electrical circuit within the system. In this event,
the unit must be checked by GE Ultrasound service personnel.
No attempt should be made to replace the fuses with others of a
higher rating.
Moving hazard
CAUTION The ultrasound unit weighs approximately 128 Kg (283 lb.).
Special care must be used to avoid injury when moving or

transporting the unit.
• Always be sure the pathway is clear.
• Limit the speed of movement to a careful walk.
• Use at least two people when moving the unit on inclines.
Ensure that the unit is well prepared before transporting. Refer
to ‘Moving and transporting the unit’ on page 2-11 for more
information.
Biological hazard
For patient and personnel safety, beware of biological hazards

while performing transesophageal procedures. To avoid the risk
of disease transmission:
• Use protective barriers (gloves and probe sheaths)
whenever necessary. Follow sterile procedures as required.
• Thoroughly clean probes and reusable accessories after
each patient examination and disinfect or sterilize as
needed. Refer to Chapter ‘Probes’ on page 12-1, for probe
use and care instructions.
• Follow all in-house infection control policies as they apply to
personnel and equipment.
Pacemaker hazard
The possibility of the system interfering with pacemakers is

minimal. However, as this system generates high frequency
electrical signals, the operator should be aware of the potential
hazard this could cause.

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Electrical safety
Device classifications
The ultrasound unit is a Class I device, type CF, according to
IEC 60601-1.
Internally connected peripheral devices

The system, together with peripheral devices, such as DVR and
printers, meets UL60601-1 and IEC 60601-1 standards for
electrical isolation and safety. These standards are applicable
only when the specified peripheral devices are plugged into the
AC outlets provided in the unit.
External Connection of other peripheral devices
CAUTION External devices can be used only if CE marked and in

compliance with related standards (EN 60601-1 or EN 60950).
Conformance to EN 60601-1-1 must be verified.
Accessory equipment connected to the analog and digital
interfaces must be certified according to the respective IEC
standards (e.g. IEC60950 for data processing equipment and
IEC 60601-1 for medical equipment). Furthermore all complete
configurations shall comply with the valid version of the system
standard IEC 60601-1-1. Anybody connecting additional
equipment to the signal input part or signal output part of
ultrasound unit configures a medical system, and is therefore
responsible that the system complies with the requirements of
the valid version of IEC 60601-1-1. If in doubt consult the
technical service department or your local representative for
GE Healthcare.
Other external devices, such as laser cameras, printers, VCRs

and external monitors, usually exceed allowable leakage limits
and, when plugged into separate AC outlets that are then
connected to the unit, are in violation of patient safety standards.
Suitable electrical isolation of such external AC outlets may be
required in order to meet UL60601-1 and IEC 60601-1
standards for electrical leakage.

GB092107 05
Safety
Allergic reactions to latex-containing medical devices
CAUTION Contact with natural rubber latex may cause a severe

anaphylactic reaction in persons sensitive to the natural latex
protein. Sensitive users and patients must avoid contact with
these items.
Due to reports of severe allergic reactions to medical devices

containing latex (natural rubber), the FDA advises health-care
professionals to identify latex-sensitive patients, and be
prepared to treat allergic reactions promptly. Latex is a
component of many medical devices, including surgical and
examination gloves, catheters, incubation tubes, anesthesia
masks and dental dams. Patient reaction to latex has ranged
from contact urticaria, to systemic anaphylaxis.
For more details regarding allergic reaction to latex, refer to FDA
Medical Alert MDA91-1, March 29.
Electromagnetic Compatibility (EMC)

NOTE: This unit carries the CE mark. It complies with regulatory
requirements of the European Directive 93/42/EEC concerning
medical devices. It also complies with emission limits for a
Group 1, Class A Medical Device as stated in EN 60601-1-2
(IEC 60601-1-2).
Electrical medical equipment needs special precautions
regarding EMC and needs to be installed and put into service
according to the EMC information provided in this manual.
AII types of electronic equipment may characteristically cause
electromagnetic interference with other equipment, transmitted
either through air or connecting cables. The term
Electromagnetic Compatibility (EMC), indicates the capability of
the equipment to curb electromagnetic influence from other
equipment, while at the same time not affecting other equipment
with similar electromagnetic radiation.
Radiated or conducted electromagnetic signals can cause
distortion, degradation, or artifacts in the ultrasound image
which may impair the ultrasound unit’s essential performance
(see page 15-21).
There is no guarantee that interference will not occur in a
particular installation. If this equipment is found to cause or

GB092107 05
respond to interference, attempt to correct the problem by one

or more of the following measures:
• Re-orient or re-locate the affected device.
• Increase the separation between the unit and the affected
device.
• Power the equipment from a source other than that of the
affected device.
• Consult the service representative for further suggestions.
The manufacturer is not responsible for any interference or
responses caused by the use of interconnecting cables other
than those recommended, or by unauthorized changes or
modifications to this unit. Unauthorized changes or
modifications could void the user's authority to operate the
equipment.
To comply with the regulations on electromagnetic interference,
all interconnecting cables to peripheral devices must be
shielded and properly grounded. Use of cables not properly
shielded and grounded may result in the equipment causing or
responding to radio frequency interference, in violation of the
European Union Medical Device Directive and FCC regulations.
Devices which intrinsically transmit radio waves such as cellular
phones, radio transceivers, mobile radio transmitters,
radio-controlled toys, and so on, should preferably not be
operated near the unit. See page 15-21 about the
recommended minimum separation distances between portable
and mobile RF communications equipment and the ultrasound
unit.
Any electrical device can unintentionally emit electromagnetic
waves. However, minimum device separation distances cannot
be calculated for such unspecified radiation. When the
ultrasound unit is used adjacent to or in close proximity to other
equipment the user should be attentive to unexpected device
behavior which may be caused by such radiation.
The ultrasound unit is intended for use in the electromagnetic
environment specified in the tables below.
The user of ultrasound unit should assure that the device is
used in such an environment.

GB092107 05
Safety
Electromagnetic emissions
Guidance and manufacturer’s declaration – electromagnetic emissions.
Emissions test Compliance Electromagnetic environment - guidance
RF emission Group 1 The ultrasound unit uses RF energy only for its internal
CISPR 11 function. Therefore, its RF emissions are very low and
EN55011 are not likely to cause any interference in nearby
electronic equipment.
RF emission Class A This system is suitable for use in all establishments,

CISPR 11 other than domestic establishments and those directly
EN55011 connected to the public low-voltage power supply
network that supplies buildings used for domestic
Harmonic emission Class A purposes, provided the following warning is heeded:
IEC 61000-3-2 Warning: This system is intended for use by health care
professionals only. This system may cause radio
Voltage fluctuations/flicker Complies
interference or may disrupt the operation of nearby
emissions equipment. It may be necessary to take mitigation
IEC 61000-3-3
measures, such as re-orienting or relocating the system
or shielding the location.
Electromagnetic immunity
Guidance and manufacturer’s declaration – electromagnetic immunity.
Electromagnetic
IEC 60601 environment –
Immunity test test level Compliance level guidance
Electrostatic discharge Floors should be wood,

(ESD) ±6 kV contact ±6 kV concrete or ceramic tile.
If floors are covered with
IEC 61000-4-2 ±8 kV air ±8 kV synthetic material, the
relative humidity should
be at least 30%.
Electrical transients / bursts ±2 kV for power-supply ±2 kV Mains power quality

IEC 61000-4-4 lines should be that of a
typical commercial or
±1 kV for input/output ±1 kV hospital environment.
lines
Surge ±1 kV line(s) to line(s) ±1 kV Mains power quality

should be that of a
IEC 61000-4-5 ±2 kV line(s) to earth ±2 kV typical commercial or
hospital environment.

GB092107 05
Guidance and manufacturer’s declaration – electromagnetic immunity.
Electromagnetic
IEC 60601 environment –
Immunity test test level Compliance level guidance
< 5% UT
(>95% dip in UT) for Compliance for all test Mains power quality
0.5 cycle levels. should be that of a
Voltage dips, short 40% UT typical commercial or
interruptions and voltage Controlled shutdown with hospital environment. If
(60% dip in UT) for
variations on power supply return to pre-disturbance the user of the
5 cycles
input lines condition after operator’s ultrasound unit requires
intervention. continued operation
70% UT
IEC 61000-4-11 (Power-on switch) during power mains
(30% dip in UT) for interruptions, it is
25 cycles recommended that the
ultrasound unit is
< 5% UT powered from an
(>95% dip in UT) for uninterruptible power
5 sec. supply or a battery.
Power frequency (50/ Power frequency

60 Hz) magnetic field magnetic fields should
3 A/m 3 A/m be at levels
IEC 61000-4-8 50 and 60 Hz characteristic of a typical
location in a typical
commercial or hospital
environment.
NOTE: UT is the a. c. mains voltage prior to application of the test level.

GB092107 05
Safety
Guidance and manufacturer’s declaration – electromagnetic immunity
IEC 60601 test Compliance Electromagnetic

Immunity test level level environment – guidancec
Portable and mobile RF

communications equipment should be
used no closer to any part of the
ultrasound unit, including cables, than
the recommended separation distance
calculated from the equation applicable
to the frequency of the transmitter.
Recommended separation distance
Conducted RF 3 Vrms 3 Vrms [V1]
IEC 61000-4-6 150 kHz to 80 MHz
80 MHz to 800 MHz
800 MHz to 2.5 GHz

Conducted RF
IEC 61000-4-3 3 V/m 3 V/m [E1]
80 MHz to 2.5 GHz where p is the maximum output power

rating of the transmitter in watts (W)
according to the transmitter
manufacturer and d is the
recommended separation distance in
metres (m).b
Field strengths from fixed RF
transmitters, as determined by an
electromagnetic site survey,a should
be less than the compliance level in
each frequency range.b
Interference may occur in the vicinity of
equipment marked with the following
symbol
NOTE 1: At 80 MHz and 800 MHz, the higher frequency range applies.
NOTE 2: These guidelines may not apply in all situations. Electromagnetic is affected by absorption and
reflection from structures, objects and people.
a
Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and
land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted
theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an
electromagnetic site survey should be considered. If the measured field strength in the location in which the
ultrasound unit is used exceeds the applicable RF compliance level above, the ultrasound unit should be
observed to verify normal operation. If abnormal performance is observed, additional measures may be
necessary, such as re-orienting or relocating the ultrasound unit.
b
Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.
c See examples of calculated separation distances in next table.

GB092107 05
Minimum distances
Recommended separation distances between portable and mobile RF communications

equipment and the ultrasound unit
The ultrasound unit is intended for use in an electromagnetic environment in which radiated RF
disturbances are controlled. The customer or the user of the ultrasound unit can help prevent
electromagnetic interference by maintaining a minimum distance between portable and mobile RF
communications equipment (transmitters) and the ultrasound unit as recommended below, according to the
maximum output power of the communications equipment.
Separation distance according to frequency of transmitter

m
Rated maximum output 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHz
of transmitter
W
0.01 0.12 0.12 0.23
0.1 0.38 0.38 0.73
1 1.2 1.2 2.3
10 3.8 3.8 7.3
100 12 12 23
For transmitters rated at a maximum output power not listed above the recommended separation distance d
in metres (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is
the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.
NOTE 1: At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.
NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by
absorption and reflection from structures, objects and people.
Essential performance
The essential performance of the ultrasound unit is:

• The ability to display physiological images as input for
diagnosis by trained physician.
• The ability to display physiological traces as aid for
diagnosis by trained physician.
• The ability to display quantified data as input for diagnosis
by trained physician.
• The display of ultrasound indexes as aid for safe use of the
unit.
• The display of probe surface temperature as aid for safe use
of the unit (Probe dependent).

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Safety
Environmental protection
System disposal
Please follow the disassembly procedure and part disposition
attached inside the unit. To access to the procedure, remove the
right side panel by unscrewing the two screws on the lower part.

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Device labels
Device labels
The following table describes the purpose and location of safety

labels and other important information provided on the
equipment.
Label Purpose Location
Identification Plate Manufacturer's name and address Rear

Model
Device Listing/Certification Labels
On/off button Control panel

Warning: system shutdown using the On/off
button does not disconnect the ultrasound
unit from mains voltage. For disconnecting the
ultrasound unit from mains voltage after system
shutdown, please set the circuit breaker close to
the mains inlet to OFF as described on page 2-6.
Equipment Type CF, indicates equipment having Phono and AUX connectors
a floating applied part having a degree of Probe connectors
protection suitable for direct cardiac contact.
Defibrillator-proof Type CF equipment. ECG connector
Rear of unit.
0123
GOST symbol. Required by Russian Regulatory Rear of unit.
agency
This product passed all conformity assessment Rear of unit.

(approval) procedures that correspond to the
requirements of applicable technical regulations
of the Customs Union
For USA only: Rear of unit.

Caution: Federal law restricts this device to sale
by or on the order of a physician.
Alternating current Various

GB092107 05
Safety
Label Purpose Location
Protective earth (ground) Internal
Equipotentiality: indicates terminal to be used for Rear of unit

connecting equipotential conductors when
interconnecting (grounding) with other equipment
as described in IEC60601-1.
Follow instructions for use. Read and understand Rear of unit (Identification
all instructions in the User's Manual before plate)
attempting to use the ultrasound unit.
CAUTION - Dangerous voltage: used to indicate Rear of unit (Identification

electric shock hazards. plate)
Attention –– Consult accompanying documents: Various

alerts the user to refer to the user documentation
when complete information cannot be provided on
the label.
The system is not designed for use with Rear of unit (Identification
flammable anesthetic gases. plate)
CAUTION - Do not push the unit sideways when Top console (both sides)
casters are in break position. Instability may
occur.
This symbol indicates that the waste of electrical Rear of unit (Identification
and electronic equipment must not be disposed plate)
as unsorted municipal waste and must be
collected separately. Please contact the
manufacturer or other authorized disposal
company to decommission your equipment.
The disassembly and parts disposition procedure
is located on the card cage front cover. To access
to the procedure, remove the right side panel.
This product consists of devices that may contain Rear of the LCD monitor
mercury, which must be recycled or disposed of in
accordance with local, state, or country laws.
(Within this system, the backlight lamps in the
monitor display contain mercury.)
This precaution is intended to prevent injury that Rear of unit (Identification

may result if one person attempts to move the unit plate)
over considerable distances or on an incline due
to the weight of the unit.

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Device labels
For China only

GB092107 05
Safety

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Chapter 16
Appendix
‘Scan Assist Pro Creator’ on page 16-2

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Appendix
Overview
The Scan Assist Pro Creator is used to build customized
Protocols that can be imported onto the Vivid E9. These
Protocols automate many of the steps normally performed
manually by the user, thereby reducing the number of user
actions and the amount of time to perform an exam.
The Scan Assist Pro Creator tool can be used both on the
scanner and as an off scanner tool. Where there are differences
in behavior, this user manual uses the term “on scanner” to
indicate when the tool is running on the scanner and “off
scanner” to indicate when the tool is running off the scanner.
Protocol export from Vivid E9 and off scanner installation of the

The installation of the Scan Assist Pro Creator on a PC can be
done after exporting the installation file from the Vivid E9.
The factory and user-defined Protocols can also be exported for
editing with the Scan Assist Pro Creator.
1. Insert the USB media to save the files.
NOTE: CD/DVD are not supported for this function.
2. Press Protocol on the Control panel and Config on the
Touch panel. Log on if required.
The Scan Assist Pro sheet is displayed.

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Figure 16-1. The Scan Assist Pro sheet
3. Select Export from the Scan Assist Pro sheet.

The Export Protocols window is displayed.
Figure 16-2. Export Protocols
4. In the Destination field, select the media to store the files on.

GB092107 05
Appendix
5. In the Protocol Directory field, select an existing folder or

enter the name of a new folder. The Protocols will be stored
to that location.
6. Highlight the Protocol(s) to be exported. If a folder is
highlighted, all Protocols in the folder are selected.
Make sure that the option Export Scan Assist Pro Creator
Installation is checked.
The installation file for the Scan Assist Pro Creator will be
stored to a separate folder named
ScanAssistantCreatorSetup (Figure 16-3).
7. Select Export.
The Protocols and the Scan Assist Pro Creator installation
file are exported.
Figure 16-3. Export folder structure
Installation of the Scan Assist Pro Creator
1. Insert the USB media mentioned above into the computer.

2. Double-click on the Setup.exe file located in the
ScanAssistantCreatorSetup folder and follow the
instructions on screen to install the Scan Assist Pro Creator.
Starting Scan Assist Pro Creator
Off scanner
1. Double-click on the Scan Assist Pro Creator icon on the

computer desktop to start the Protocol.

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Figure 16-4. Scan Assist Pro Creator screen
On scanner
1. Press Protocol on the Control panel and Config on the

Touch panel. Log on if required.
The Scan Assist Pro sheet is displayed (Figure 16-1,
page 16-3).
2. To edit an existing Protocol, select the Protocol in the
Available Protocols field on the left-hand side of the Scan
Assist Pro sheet.
3. Select Edit to start the Scan Assist Pro Creator.
File handling
Off scanner directory structure
When using Scan Assist Pro Creator off scanner, it is important

to organize the Protocols in a way that will make it easy to
import them onto the scanner. All Protocols must be stored in a
VE9_SCAN_ASSIST directory. Within this directory, one or
more user-specified directories can be created. Within each of
these user-specified directories are the category directories
(Abdominal, Cardiac, etc.) that hold the actual Protocols.
To specify the directory structure:
1. In the Scan Assist Pro Creator, select File/Directory.
The Directory configuration window is displayed.

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Appendix
Figure 16-5. The Directory configuration window
2. Select the location of the VE9_SCAN_ASSIST directory and

select or create a user Protocol subdirectory.
File extensions
Factory defined Protocols have an .ep (exam protocol)

extension while user-defined Protocols have an .uep (user exam
protocol) extension. Both factory and user-defined Protocols can
be read into the Scan Assist Pro Creator, but only user-defined
Protocols are created. If a factory Protocol is read into the Scan
Assist Pro Creator and then edited, it is saved as a user-defined
Protocol.
Creating new Protocols

A Protocol is made up of a series of steps. Each step has
various attributes that need to be defined. Protocols can be
made from scratch or by modifying an existing Protocol.
To create a new Protocol:
1. Select either:
• File/New (Ctrl+n) to start a new Protocol.
• File/Open (Ctrl+o) to open an existing Protocol (.ep or
.uep)
2. Select View/Single step: All to display all the attributes for
the first step.
3. Adjust the attributes for the current step. See ‘Step
attributes’ on page 16-10 for a description of the attributes.
4. Once done press to add a new step below the first step
(or select the next step if editing an existing Protocol) and
adjust the attributes for this new step as required.
5. Other possible adjustments:
• Select (Ctrl+Up Arrow)/ (Ctrl+Down Arrow) to
move a step.

GB092107 05
Select to delete selected step(s).

6. When all steps are created, press Check to verify the
Protocol.
Any invalid attribute settings reported should be corrected
and the Protocol rechecked.
Measurements in Protocols
Because there are many measurements available on the

Vivid E9 and because the measurement package is highly
customizable, there is some special handling for measurements.
To set up a measurement step in a Protocol:
1. Press Measurements and select a measurement category
and optionally a measurement subcategory.
The measurements available for the attributes Measure 1 to
Measure 3 and Vessel are limited to the measurements
available in the category or subcategory selected.
2. Select the desired Measure trigger parameter (see
‘Measurement attributes’ on page 16-13).
NOTE: To configure a Vessel measurement, leave the Measure
trigger attribute to None.
3. Select the desired measurements for Measure 1, Measure 2
and Measure 3.
Saving Protocols
1. Select File/Save (Ctrl+s)
NOTE: Select File/Save as to save the Protocol with a different
name.
If the Protocol was not checked, a dialog is displayed giving
the opportunity to check the Protocol for errors before
saving.
Figure 16-6. Protocol check dialog

GB092107 05
Appendix
2. Select:
• Yes to check the Protocol before saving it.
• No to bypass the Protocol check.
• Cancel to cancel the save request.
Views
A Protocol is made up of a series of steps. Each step is made up
of various step attributes. The step and step attribute data can
be viewed in many ways using the Scan Assist Pro Creator. The
different ways to look at the data are called Views. The view of
choice is selected from the View Menu or from toolbar.
Single step views
There are two Single step views: Basic and All. The Basic view
shows the most common attributes of the selected step. The All
view shows all of the attributes of the selected step.
1. List of all steps in the Protocol

2. Attributes for the selected step
Figure 16-7. Single step view (All)

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Multi step views
Multi step views show the step attributes for all the steps in a
Protocol. There are six Multi step views: General, Comment,
Scan, Measure, Custom and All.
1. List of all steps in the Protocol

2. Attributes for all steps in the Protocol
Figure 16-8. Multi step view (All)
The information displayed in each multi step view is

configurable.
1. Select Customize/Views.
The Customize multi step views window is displayed.
Each tab represents a different Multi step view. Within a tab,
the checked boxes are the step attributes that are displayed
in that Multi step view.
2. For each Multi step view check the attributes to be
displayed.
3. Select Save.

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Appendix
Step attributes
Scan Assist Pro allows the user to program the steps in an exam
and to program certain attributes for each step. The attributes
are what give the Scan Assist Pro Protocol behavior. The tables
below provide a description of all attributes.

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General attributes
Name Input Description
Step name Any text Name of the step that appears in the
Scan Assist Pro window.
Advance on Img. Store Advance to the next step after pressing

Img. Store on the Control panel.
Img. Store & Advance to the next step after pressing

Unfreeze Img. Store and Unfreeze on the
Control panel.
Img. Store & user Advance to next step after pressing

selection Img. Store on the Control panel and
Down arrow on the keyboard.
Instructions Any text Notes displayed in the Scan Assist Pro

window when the step is active.
Hint: the probe and application required
for this Protocol should be entered in
the Instruction field of the first step.
Optional An optional step is given a check mark

during Protocol execution even if no
image is acquired.
Comment attributes
Comment 1 Any text User annotation associated with the

Comment 2 step.
When editing in a Multi step view, use
Alt+Enter to create a new line.
Location 1 Top Left Location of the annotation on screen.

Location 2 Middle Left
Bottom Left
Top Center
Bottom Center
Top Right
Mid Right
Bottom Right

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Appendix
Imaging attributes
Initial modes Scanning mode associated with the

step.
Some scanning modes may be
combined (e.g PW Doppler and Color
Flow).
Octave Off Octave is off.
On Octave is on.
Default Octave not specified.
Compound Off Compound is off.
On Compound is on.
Default Compound is not specified.
Color/Doppler steer Left Color/Doppler steered to the left.
Center Color/Doppler not steered.
Right Color/Doppler steered to the right.
LogiqView Off LogiqView is off.
On LogiqView is on.
Default LogiqView not specified.
Dual Off Single screen display
Left Active Dual screen display is on with the left

image active.
Right Active Dual screen display is on with the right

image active.
Simultaneous Displays 2D and Color mode

side-by-side.
Zoom Off Zoom is off.
On Zoom is on.
Default Zoom is not specified.
Depth Default Depth is not specified.
1 – 30 cm Adjust Depth.
Color Scale Default Color Scale is not specified.
0.25 – 14 kHz Adjust Color Scale.
Doppler Scale Default Doppler Scale is not specified.
0.05 – 13 m/s Adjust Doppler Scale.

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Color Baseline Default Color Baseline is not specified.
0 – 20 Adjust Color Baseline.
Doppler Baseline Default Doppler Baseline is not specified.
0 – 20 Adjust Doppler Baseline.
Angle Scan plane 1 – 3 Default Scan plane is not specified.
0 – 355 deg. Adjust scan plane.
Measurement attributes
Measure trigger Measure key Start Measure 1 attribute when

Measure is pressed on the Control
panel.
Freeze key Start Measure 1 attribute when Freeze

is pressed on the Control panel.
Img. Store key Start Measure 1 attribute when Img.

Store is pressed on the Control panel.
None Measurement not triggered by the

Protocol.
Vessel measurements are available
when Measure trigger is set to None
(see below).
Measure 1 Various Specify the measurement to perform.

Measure 2 measurements Select a measurement category from
Measure 3 the Measurement menu.
Vessel Various Doppler Specify the vessel measurement to

vessel perform.
measurements Vessel measurement is available only if
Measure trigger is set to None.
The list of available measurements is
dependent of the category selected in
Auto Calcs Default Auto Calcs state is not specified.
Off Auto Calcs state is set to off.
Frozen Auto Calcs state is set to Frozen.
Live Auto Calcs state is set to Live.

GB092107 05
Appendix
Auto Calc Params Various Auto Calc Specify the Auto Calc parameters to be
parameters used.
Press Specify and select the Auto Calc
parameters from the Auto Calc
parameter selection window.
Press Default to set the Auto Calc
parameter selection to default.
Side Rt Set the side measurement qualifier to

Lt either Right or Left.
None Note: the side measurement qualifier is
not set by the Protocol.
Location Prox Set the location measurement qualifier

Mid to either Proximal, Middle or Distal.
Dist Note: the location measurement
None qualifier is not set by the Protocol.
Fetus A, B, C or D The fetus measurement qualifier is set

to either Fetus A, B, C od D.
Double Save (with/without The image is stored twice, once with

measurements) measurements and once without.

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Index
Numerics Compound, 4-28

Connecting peripherals, 2-19
2D-Mode, 4-3 Connecting the unit, 2-4
4D Connectivity
Cropping, 5-31 Buttons, 10-76
Full volume acquisition, 5-7 Dataflow, 10-70
Stereo vision, 5-28 contacts
4D Color Flow mode, 5-14 clinical questions, 1-5
4D MV-Assessment, 8-65 Internet, 1-5
4D Stress Echo, 6-28 service questions, 1-5
Acquisition, 6-28 Continuous capture, 6-8
Analysis, 6-33 Contrast Imaging
4D-Mode, 5-2 Vascular Contrast Imaging, 7-12
Controls, 5-40 Contrast imaging, 7-1
6 Slice, 5-37 Contrast Low MI, 7-8
LV Contrast Imaging, 7-5
A Control panel, 2-17
CW Doppler, 4-13
accessories
ordering, 1-5 D
requesting a catalog, 1-5
Air filter, 14-7 Dataflow, 10-3
Archive Delete
Configuration, 10-68 Examination, 10-22
AutoEF, 8-38 Image, 10-22
Automated 4D left ventricular volume measurements, Patient record, 10-22
8-45 Diagnosis code, 10-19
Automated Functional Imaging, 8-19 Diagnosis information, 10-16
AVI, 10-8 DICOM spooler, 10-42
DICOM SR, 10-40
B Direct report, 11-26
Disk space management, 10-53
B Flow, 4-28 DVR, 13-3
Backup, 10-61
Biopsy, 12-23 E
Blood Flow Imaging, 4-29
ECG
C Connecting, 3-13
Examination
Care and Maintenance, 14-2 Starting, 2-23
Cineloop, 3-18 Export
Cineloop store, 10-6 Patient records, 10-44
Classifications, i-3
Cleaning F
Air filter, 14-7
Ultrasound unit, 14-3 Footswitch, 2-20
Color Mode, 4-9
Comments, 10-16
Vivid E9 – User Manual Index-1

GB092107 05
H Connecting, 2-10, 12-12
Disconnecting, 2-10, 12-15
HDF, 10-8 Labelling, 12-11
Orientation markers, 12-10
I Safety, 12-20
Types, 12-2
Image store, 10-6 Pulse Pressure transducer
Import Connecting, 3-15
Patient records, 10-50 PW Doppler, 4-13
Information
Requesting, 1-5 Q
information, requesting, 1-5
Intima-Media Thickness, 8-66 Quantitative Analysis, 9-1
Anatomical M-Mode, 9-25
J Deletion of a trace, 9-12
Frame disabling, 9-12
JPEG, 10-8 Manual tracking, 9-10
Optimizing, 9-14
L Sample area, 9-9
Strain cursor, 9-10
Labels, 15-23 To generate a trace, 9-9
LogiqView, 4-27 Trace smoothing, 9-17
Wash-in curve fitting, 9-19
M Wash-out curve fitting, 9-23
Measurements, 8-1
Assign and measure, 8-6
R
Configuration, 8-76 Referral reasons, 10-16
Event timing, 8-11 Removable, 3-5
Measure and assign, 8-8 Removable media, 3-5
User-defined formulas, 8-80 Ejecting, 3-11
M-Mode, 4-6 Formatting, 3-10
Moving the unit, 2-11 Report, 11-1
MPEG, 10-8 Configuration, 11-43
MPEGVue, 10-10 Deleting, 11-9
Multi-plane mode, 5-45 Direct report, 11-26
Controls, 5-53 Export/Import templates, 11-45
Multi-plane Stress Echo, 6-20 Save, 11-7
Acquisition, 6-21 Report designer, 11-28
Analysis, 6-26 Designing a template, 11-30
Multi-Slice, 5-10 Respiration
Connecting, 3-13
O Restore data, 10-61
On/Off, 2-6
S
P Safety, 15-1
Biological hazard, 15-14
Phono
Electrical hazard, 15-13
Connecting, 3-14
Equipment safety, 15-12
Physiological traces, 3-12
Explosion hazard, 15-13
Print
Mechanical hazard, 15-11
Patient list, 10-15
Moving hazard, 15-14
Printing, 13-7
Pacemaker hazard, 15-14
Printer configuration, 13-7
Patient safety, 15-10
Probes, 12-1
Personnel safety, 15-12
Activating, 12-14
save TCP/IP settings, 14-20
Care and Maintenance, 12-16
Scan Assist Pro, 4-39
Cleaning, 12-17
Scan Assist Pro Creator, 16-2
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Scanning
Screen layout, 2-22
service, requesting, 1-5
Site requirements, 2-3
Strain, 4-22
Strain rate, 4-20
Stress Echo, 6-1
Acquisition, 6-4
Analysis, 6-15
Configuring levels, 6-45
Editing template, 6-43
Quantitative TVI Stress analysis, 6-37
Scoring, 6-17
Selecting a template, 6-3
Timers, 6-8
Tissue Tracking, 6-42
System
Controls affecting acoustic output, 15-7
Preparing the system for use, 2-3
Switching On/Off, 2-6
T
TCP/IP, 10-70
TCP/IP settings
save, 14-20
Tissue Synchronization Imaging, 4-24
Tissue Tracking, 4-18
Touch panel, 3-3
Trackball, 3-2
TSI measurements, 8-12
TVI, 4-16
U
Unlock patient record, 10-79
W
Wheels, 2-11
Worksheet, 8-97
XYZ
Zoom, 3-20
Vivid E9 – User Manual Index-3

GB092107 05
Index-4 Vivid E9 – User Manual
GB092107 05

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Technical Publications

This product complies with regulatory requirements of the following European

93/42/EEC Medical Devices Directive (MDD)

2006/42/EC Machinery Directive (MD)

2002/96/EC Waste Electrical and Electronic Equipment (WEEE)

EN55011 Emitted noise according to Class A requirements

IEC60601-1 Medical Electrical Equipment, Part 1; General Requirements

IEC60601-1 Medical Electrical Equipment, Part 1; General requirements

IEC60601-2-37 Medical electrical equipment - Part 2-37. Particular

IEC1157 / EN61157 Requirements for the declaration of the acoustic output of

IEC60601-1-1 / EN60601-1-1 Safety requirements for medical systems

EN60601-1-2 Medical Electrical Equipment - part 1-2. Collateral standard:

EN60601-1-4 Medical Electrical Equipment - part 1-4. Collateral standard:

Vivid E9 – User Manual i-1

IEC60601-1-6 Medical Electrical Equipment - part 1-6. Collateral standard:

NEMA/AIUM UD-3 Standard for real-time display of thermal and mechanical

ISO10993-1 Biological evaluation of medical devices

Country Specific Approvals

i-2 Vivid E9 – User Manual

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Normal mode Single fault condition

Patient leakage current <100 microA <500 microA

Type CF Applied part

Normal mode Single fault condition

Patient leakage current <10 microA <50 microA

Software License Acknowledgements

i-4 Vivid E9 – User Manual

Conformance Standards - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i-1

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The Vivid E9 ultrasound unit is a high performance

The system provides image generation in 4D, 2D (B)

The fully digital architecture of the Vivid E9 unit allows

Vivid E9 – User Manual 1-1

CAUTION For USA only:

Devices which intrinsically transmit radio waves such as cellular

1-2 Vivid E9 – User Manual

Indications for use

CAUTION The safety instruction must be reviewed before operation of the

NOTE: Not all features or products described in this document may be

Table of Contents, lists the main topics and their location.

Vivid E9 – User Manual 1-3

Conventions used in this manual

DANGER Indicates that a specific hazard exists that, given inappropriate

WARNING Indicates that a specific hazard exists that, given inappropriate

CAUTION Indicates that a potential hazard may exist that, given

1-4 Vivid E9 – User Manual

Contacting GE Healthcare Ultrasound

Vivid E9 – User Manual 1-5

ARGENTINA GE Healthcare TEL: 11-5298-2400

BRAZIL GE Healthcare Clinical Systems

CANADA GE Healthcare TEL: (1) 800-668-0732

LATIN & SOUTH GE Healthcare TEL: (1) 262-524-5300