Manual Administrador Ecografo SIEMENS ACUSON SEQUOIA C256 - C512 - 512

ACUSON Sequoia™ 512 Ultrasound System
ACUSON Sequoia™ C512 Echocardiography System

ACUSON Sequoia™ C256 Echocardiography System
Administrator Manual
Siemens Medical Solutions USA, Inc.

1230 Shorebird Way
P.O. Box 7393
Mountain View, CA 94043 -7393
USA
800 498 7948
650 969 9112
CE Declaration
This product is provided with a CE marking in accordance with the
regulations stated in Council Directive 93/42/EEC of June 14, 1993
0123 concerning Medical Devices. Siemens is certified by notified body 0123 to
Annex 11.3. Full Quality System.
Authorized EC Representative:
Siemens Aktiengesellschaft
Medical Solutions
Henkestraße 127 Document No. 08268710
D-91052 Erlangen Rev. 1
Germany Language: English
ii ACUSON Sequoia System 0403
COPYRIGHT Copyright © 2003 by Siemens. All rights reserved.
No part of this publication may be reproduced, transmitted, transcribed, stored in
retrieval systems, or translated into any language or computer language, in any
form or by any means, electronic, mechanical, magnetic, optical, chemical,
manual, or otherwise, without the prior written permission of Siemens.
Siemens reserves the right to change its products and services at any time. In
addition, this manual is subject to change without notice. Siemens welcomes
customer input on corrections and suggestions for improvements to this manual.
Although Siemens has attempted to ensure accuracy throughout this manual,
Siemens assumes no liability for any errors or omissions, nor for any damages
resulting from the application or use of this information.
TRADEMARKS ACUSON AcuNav, ACUSON Aspen, ACUSON Aspen Advanced, ACUSON

Cypress, ACUSON Sequoia, DELTA, MultiHertz, Native, Perspective, RES,
SpaceTime, The Value of Vision, Vector, XP, 128XP, 128XP/4, 128XP/10, and
AEGIS are registered trademarks of Siemens. 128/10c, Cadence, CCD,
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≅TEQ, Tissue Equalization, ≅Tissue Equalization, WorkPro, WebPro, WS3000,
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Multi-Imager is a trademark of International Imaging Electronics.
All other product names are trademarks of their respective companies.
CAUTION! In the United States of America, federal law restricts this device to sale or use
by, or on the order of, a physician.
0403 Administrator Manual iii

LICENSE AGREEMENT All computer programs copyright 2003 by Siemens or its suppliers. Such
programs are licensed under the following software license agreement:
Siemens or its suppliers retain(s) ownership of and title to any computer program
supplied with the equipment and to the trade secrets embodied in such computer
programs. Subject to the Buyer’s acceptance and fulfillment of the obligations in
this paragraph, Siemens grants the Buyer a personal, non-transferable, perpetual,
non-exclusive license to use any computer program supplied with the Equipment
that is necessary to operate the Equipment solely on the medium in which such
program is delivered for the purpose of operating the equipment in accordance
with the instructions set forth in the operator’s manuals supplied with the
Equipment and for no other purpose whatsoever. Buyer may not reverse-
assemble, reverse-compile or otherwise reverse-engineer such computer
programs nor may Buyer make a copy of such program or apply any techniques
to derive the trade secrets embodied therein. In the event of a failure by Buyer to
comply with the terms of this license, the license granted by this paragraph shall
terminate. Further, because unauthorized use of such computer programs will
leave Siemens without an adequate remedy at law, Buyer agrees that injunctive
or other equitable relief will be appropriate to restrain such use, threatened or
actual. Buyer further agrees that (i) any of Siemens 's suppliers of software is a
direct and intended beneficiary of this end-user sublicense and may enforce it
directly against Buyer with respect to software supplied by such supplier, and (ii)
No supplier of siemens shall be liable to buyer for any general, special, direct,
indirect, consequential, incidental or other damages arising out of the sublicense
of the computer programs supplied with the equipment.
iv ACUSON Sequoia System 0403

Table of Contents
About Your Siemens System Manuals . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Administrator Manual Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii
Chapter 1 Customizing AEGIS Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Customizing AEGIS Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Customizing DICOM Network Features . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter 2 Customizing System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Using the Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Customizing 2-D Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Customizing the AEGIS Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Customizing Auto-Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Customizing the Annotation Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Customizing Begin/Study Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Customizing Body Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Customizing Calipers/Trace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Customizing Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Customizing Color Doppler Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Customizing the Foot Switch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Customizing GYN Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Customizing Monitor Brightness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Customizing OB Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Customizing the Output Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Customizing Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Customizing Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Customizing Screen Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Customizing the Service User Interface . . . . . . . . . . . . . . . . . . . . . . . . . 39
Customizing Strip Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Customizing the System Clock and Memory Allocation . . . . . . . . . . . . 41
Customizing System Lighting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Customizing Vascular Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Customizing VCR and External Video . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Chapter 3 Customizing Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
0503 Administrator Manual v

ACUSON Exam Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Turning Exam and Image Presets ON and OFF . . . . . . . . . . . . . . . . . . . 47
Recalling Exam Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Recalling Image Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Creating a New Preset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Deleting Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Setting Default Exam Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Customizing Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Chapter 4 Customizing OB Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Customizing OB Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Changing the Report Heading and Configuration Name . . . . . . . . . . . . 55
Turning On and Off Measurements and Calculations . . . . . . . . . . . . . . 55
Customizing the Comment Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Customizing Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Chapter 5 Customizing Gynecology Calculations . . . . . . . . . . . . . . . . . . . . 61

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Customizing GYN Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Chapter 6 Customizing Vascular Calculations . . . . . . . . . . . . . . . . . . . . . . . 71

Customizing the Vascular Calculation Report . . . . . . . . . . . . . . . . . . . . 72
Selecting Studies to Include in the Report . . . . . . . . . . . . . . . . . . . . . . . 72
Customizing Study Names and Site Names . . . . . . . . . . . . . . . . . . . . . . 73
Storing Customizations to an Exam Preset . . . . . . . . . . . . . . . . . . . . . . 73
Vascular Calculation Formulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Chapter 7 Customizing Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . 75

Customizing Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Calculation Formulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
ProtoCALL Result Deletion Pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Reference Articles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Chapter 8 VCR and Printer Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Setting Up Video Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Setting Up a Video Cassette Recorder . . . . . . . . . . . . . . . . . . . . . . . . . 127
Setting up Printers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Chapter 9 Using the Service User Interface . . . . . . . . . . . . . . . . . . . . . . . . 133

Main SUI Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
vi ACUSON SequoiaSystem 0503

Hardware Diagnostic Suite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Performing Data Backup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Performing Data Restore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Reviewing Customer Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Changing Network Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
0503 Administrator Manual vii

viii ACUSON SequoiaSystem 0503
List of Figures
Figure 1-1 AEGIS Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Figure 1-2 AEGIS Free-form Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Figure 1-3 AEGIS Staged Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Figure 1-4 Network Printing Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Figure 1-5 Network Server Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Figure 1-6 Dicom Worklist Server Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Figure 2-1 Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Figure 2-2 Dialog Box Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Figure 2-3 2-D Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Figure 2-4 Auto-Doppler Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Figure 2-5 Auto-Doppler Configuration Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Figure 2-6 Programmable Annotation Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Figure 2-7 Begin/Study Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Figure 2-8 Body Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Figure 2-9 Calipers/Trace Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Figure 2-10 Color Doppler Box Sizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Figure 2-11 Footswitch Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Figure 2-12 Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Figure 2-13 Output Display Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Figure 2-14 Printing Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Figure 2-15 Screen Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Figure 2-16 Strip Modes Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Figure 2-17 System Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Figure 2-18 System Lighting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Figure 2-19 VCR/External Video Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Figure 3-1 Presets Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Figure 3-2 Exam Presets Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Figure 3-3 New Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Figure 3-4 Presets Setup Advanced Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Figure 4-1 OB Calc Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Figure 4-2 Comment Page Customization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Figure 4-3 Option 1 Customization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Figure 4-4 EFW Customization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Figure 4-5 Optional Ratio Customization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Figure 5-1 Uterus Setup Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Figure 5-2 Right Ovary Setup Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Figure 5-3 Left Ovary Setup Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Figure 5-4 Doppler Sites Setup Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Figure 6-1 Vascular Calc Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Figure 6-2 Vascular Calculation Worksheet (Accel & Ratio Page) . . . . . . . . . . . . . . . . . . 73
Figure 7-1 Cardiac Calculations Setup Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Figure 7-2 Wall Scoring and Coronary Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Figure 8-1 Connecting a Sony SVO-9500MD VCR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Figure 8-2 Quick Disconnect Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Figure 8-3 Multi-Imager Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Figure 9-1 Service User Interface Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
0403 Administrator Manual ix

x ACUSON Sequoia Ultrasound System 0403
Preface
PREFACE
Siemens is pleased to welcome you to the ACUSON Sequoia ultrasound

system, made possible by the invention of ACUSON Sequoia technology.
Unlike conventional ultrasound, your new system uses multiple beam
formers and a coherent image former to utilize information from 256 (on
ACUSON Sequoia C256 and C512 systems) or 512 (on ACUSON Sequoia
512 and C512 systems) digital processing channels. This proprietary
technology produces an ultrasound image with exceptional detail,
contrast and temporal resolution throughout the entire field of view. The
superior quality of Siemens images can give you increased diagnostic
quality and confidence.
The Sequoia 512 Ultrasound system is designed to help you perform
radiology, obstetrics, gynecology, cardiac, and/or vascular exams. The
Sequoia C256 Echocardiography system is optimized for cardiovascular
exams. The Sequoia C512 Echocardiography system is optimized for
specialty cardiovascular exams. These systems offer a wide range of
standard and optional operating modes and transducer formats.
ACUSON systems have an exceptional record of dependability and our
customer service network is ready to respond to your individual needs.
Additional advances in technology are currently under development. For
information, please consult your Siemens Sales Representative.
About Your Siemens There are four manuals in the Sequoia system manual set:
System Manuals • This Administrator Manual contains information you use to customize
your system. In addition, it also provides reference information such
as Preset charts, obstetrical calculation charts, vascular and cardiac
calculation formulas and references, and an ALARA supplement.
• Your User Manual contains information that you use regularly as you
perform ultrasound exams. It introduces you to the basic functions of
the system and identifies each operating mode and exam function.
• Your Transducer Specification Manual contains information on
available transducers, what products to use to clean and disinfect
your transducers, and power safety considerations.
• Your Safety Manual contains important safety information for all
Siemens systems. Read the Safety Manual before you use any Siemens
system.
The manuals address readers who are familiar with ultrasound
techniques and, therefore, do not include sonography training or clinical
procedures.
0403 Administrator Manual xi

Preface
Administrator This Administrator Manual is organized in two parts.

Manual Organization The main body of the manual includes detailed setup and customization
instructions for your Sequoia system. It describes setup and
customization for various system functions as well as the system’s
calculation packages. It includes the following chapters:
• Chapter 2, “Customizing System Setup,” explains how to customize
different system functions, including the output display, annotation
keys, Auto-Doppler configuration, and imaging modes.
• Chapter 1, “Customizing AEGIS Software,” explains how to
customize the protocols for the AEGIS digital image and data
management system.
• Chapter 9, “Using the Service User Interface,” explains how to
backup and restore system settings, review customer information,
and change the network configuration for an ACUSON Sequoia
system.
• Chapter 3, “Customizing Presets,” explains how to customize Image
and Exam Presets to optimize system parameters for a particular type
of image or exam.
• Chapter 4, “Customizing OB Calculations,” explains how to
customize the OB calculation package for your needs.
• Chapter 6, “Customizing Vascular Calculations,” explains how to
customize the vascular calculation package for your needs. It also
contains vascular calculation formulas.
• Chapter 7, “Customizing Cardiac Calculations,” explains how to
customize the cardiac calculations and measurements for your needs.
It also contains cardiac calculation formulas and references. Cardiac
Calculations are available on Sequoia C256, C512, or 512 systems
with Cardiac Option.
• Chapter 8, “VCR and Printer Setup,” has detailed information on
VCR installation and controls and printer setup, including printer
installation diagrams.
The appendixes cover the following reference information:
• Appendix A, “OB Calculation Formulas,” contains fetal parameter
charts and regression equations for the system’s obstetrical
calculation package.
• Appendix B, “AIUM Medical Ultrasound Safety,” describes how to
conduct exams according to the ALARA principle.
xii ACUSON Sequoia System 0403

Administrator Manual Organization
Key Conventions This manual uses several special symbols to refer to the controls on the
system or to indicate a procedure. The following table shows the symbols
and their descriptions:
SYMBOL DESCRIPTION
◆ A diamond-shaped bullet indicates steps to follow to

perform a procedure.
CALC A term in bold, uppercase font represents a key,
knob, switch, or toggle control on the system’s
keyboard. The example at left represents the CALC
key.
CODE + CLEAR A plus sign (+) used this way means to hold down
the CODE key and press the indicated key (in this
example, the CLEAR key).
[LEFT] A term in brackets represents a soft key.
[GROUP] An term in brackets represents a soft key that has a
label that changes as you press the key, to represent
a current setting or choice.
Siemens provides special alphanumeric keys and annotation terms for

labeling images in different languages. This manual uses English labels
for all keys and annotation terms. To convert your system to another
language, contact the Siemens Uptime Service Center.
0403 Administrator Manual xiii

Preface
xiv ACUSON Sequoia System 0403

CHAPTER 1
CUSTOMIZING AEGIS SOFTWARE
Customizing AEGIS Protocols 2

Customizing DICOM Network Features 9
0403 Administrator Manual 1

Chapter 1 Customizing AEGIS Software
Customizing AEGIS This chapter explains how to customize onboard AEGIS review and clip
Protocols capture protocols. There are two types of protocols: Free-form and
Staged. You can define the characteristics of each protocol, and set up
different sets of capture parameters within each protocol. You can then
switch between sets to change capture parameters during an exam.
◆ To customize onboard AEGIS software functions:
1. Select AEGIS from the Setup menu to display the AEGIS dialog box.
Figure 1-1 AEGIS Setup

2. Select a Playback Mode for stored clips.
3. Select a Playback Speed for stored clips from the pop-up menu. The
options are percentages of actual (real-time) speed.
4. Turn Save on Select on to save clips that you mark as selected.
The effect of this option depends on a protocol’s Save on Capture
setting. See “Customizing Free-Form Protocols,” next, “Customizing
Staged Protocols” on page 6, and “Setting Up Network Storage
Servers” on page 14.
2 ACUSON Sequoia System 0403

Customizing AEGIS Protocols
NOTE: An ACUSON Sequoia system that is running In-Progress Store

and that is networked to a DICOM storage server, also running Save on
Capture or Save on Select may effect the network transfer rate.
See the following table for the setting combination results:
SAVE ON SAVE ON RESULT

SELECT CAPTURE
OFF OFF Clips are not saved when you end a study. For
more information about Save on Capture, see
“Customizing Free-Form Protocols” on page 3
and “Customizing Staged Protocols” on page 6.
ON OFF Clips are saved only if you mark them as selected
during review. Upon closing a study, the
Sequoia system deletes all unselected clips!
OFF ON Clips are saved automatically. Unwanted clips
must be manually deleted from review before
closing a study.
These setting combinations may result in slow
transfer to network and server. Clip capture
quantity and size, network, server, and
workstation capabilities affect transfer rate.
ON ON All captured clips are saved.
5. Select a Protocol Type: Free-form or Staged, and click Define next to

your chosen protocol type to customize the protocol.
For more information, see “Customizing Free-Form Protocols” on
page 3 and “Customizing Staged Protocols” on page 6.
Customizing Free-Form You use a free-form protocol for exams that do not necessarily require a
Protocols structured sequence. You can customize the free-form protocol to have
several Capture Types, each with different capture parameters. You can
then use the protocol key to switch between Capture Types during an
exam to change capture parameters.
◆ To define a free-form protocol:
1. In the Protocol Type section of the AEGIS dialog box, select Free-form
and click Define to display the Free-form Protocol dialog box.

2. Use the Capture Type Control options, Capture Type Settings

options, Clip Settings, and Trig Clip Settings options to define
capture types as described in the following sections.
Figure 1-2 AEGIS Free-form Protocol

Capture Type Control ◆ To use Capture Type Control options:
1. In the Capture Type text field, enter the name of the Capture Type
you want to create or change.
2. Use the buttons in the top section of the Free-form Protocol dialog
box to add, remove, and display Capture Types. These buttons work
as follows:
BUTTON FUNCTION
Add Creates a new Capture Type with all settings as they are
currently displayed, and adds it to the end of the list of
existing Capture Types, which you name.
Insert Creates a new Capture Type with all settings as they are
currently displayed, and inserts it into the list of existing
Capture Types, immediately before the last one displayed.
Remove Removes the current Capture Type from the protocol.

Prior Displays the name and settings for the Capture Type that is
immediately before the current one.
Next Displays the name and settings for the Capture Type that is
immediately after the current one.
If a button is disabled, its function is not currently available. For example,

Add and Insert are disabled when the protocol contains the maximum
allowable number of Capture Types.

Capture Type Settings ◆ To specify settings for the current Capture Type:
1. Select a Maximum Capture Frame Rate:
• PAL: 60 (ROI captures only), 30, 20, 15, or 10 Hz
• NTSC: 50 (ROI captures only), 25, 17, 12, 8 Hz
2. Select a Clip Size: Full, Condensed, or ROI (region of interest).
3. Select a JPEG Compression level: Low, Medium, or High.
4. Turn Save On Capture on or off to specify whether the clip is
automatically saved when captured.
NOTE: If Save on Capture is turned off and Save on Select is on, clips
are saved only if you mark them as selected during review. If Save on
Select is also turned off in the main AEGIS dialog box, clips are not saved
at all.
Clip Settings ◆ To specify clip settings:
1. Select a number of Clips per Capture: 1, 2, 4, 8, or Indefinite.
2. Enter a number of Segments Per Clip from 0 to 99.
3. Select a unit type (msec, beats, or ultrasound frames) from the pop-
up menu and enter a Segment Length from 0 to 9999.
4. Enter an Alternate Segment Length to use when the correct heart
rate is not reached in a staged protocol, or when additional time is
desired in a free-form protocol.
5. Turn Enable R-Wave Gated Capture on to trigger from the R-Wave
of the ECG and enter a Trigger Delay, if delay is desired.
6. Click Add or Insert to create a Capture Type with the name you
entered and with the Capture Type Settings and Clip Settings as you
set them.
7. Press [PRIOR] or click Exit to return to the AEGIS dialog box.
8. Enter up to 10 names in the Protocol View Names text fields. Use the
scroll bar to view the whole list.
Trigger Clip Settings You can customize a free-form protocol for clips stored while the system’s
extended trigger function is active. When the extended trigger function is
active, frames are stored at each trigger point, according to the Trigger
Clip Setting.
◆ To specify Trig Clip Settings
1. Click Trig Clip Settings.
2. Select a unit type from the pop-up menu and enter a Segment Length
from 0 to 9999.
3. Enter an Alt Segment length from 0 to 9999 and select a unit type
from the pop-up menu.

Customizing Staged You use a Staged protocol to perform exams that have a set protocol or
Protocols sequence such as an exercise or pharmacological stress exam. You
proceed through a Staged protocol exam one Stage at a time, acquiring
images with the Capture Settings of each Stage.
◆ To define a staged protocol:
1. Select Staged and click Define in the AEGIS dialog box to display the
Staged Protocol dialog box.
2. Use the Stage Control options, Stage Settings options, Clip Settings
options, and Trig Clip Settings to define stages as described in the
following sections.
Figure 1-3 AEGIS Staged Protocols

Stage Control ◆ To use Stage Control options:
1. In the Stage text field, enter the name for the Stage you want to create
or change.
2. Use the buttons in the top section of the Staged Protocol dialog box to
add, remove, and display Stages. These buttons work as follows:
BUTTON FUNCTION
Add Creates a new Stage with all settings as they are currently
displayed, and adds it to the end of the list of existing
Stages, which you name.
Insert Creates a new Stage with all settings as they are currently
displayed, and inserts it into the list of existing Stages,
immediately before the last one displayed.
Remove Removes the current Stage from the protocol.

BUTTON FUNCTION
Prior Displays the name and settings for the Stage that is
immediately before the current one.
Next Displays the name and settings for the Stage that is
immediately after the current one.
If a button is disabled, its function cannot currently be carried out. For

example, Add and Insert are disabled when the protocol contains the
maximum allowable number of Stages.
Capture Type Settings ◆ To specify settings for the current stage:
1. Select a Maximum Capture Frame Rate:
• PAL: 60 (ROI captures only), 30, 20, 15, or 10 Hz
• NTSC: 50 (ROI captures only), 25, 17, 12, 8 Hz
2. Select a Clip Size: Full, Condensed, or ROI (region of interest).
3. Select a JPEG Compression level: Low, Medium, or High.
4. Turn Display Stage Time on or off to specify whether the Stage timer
appears.
5. Turn Save On Capture on or off to specify whether the clip is
automatically saved when captured.
NOTE: If Save on Capture is turned off and Save on Select is on, clips
are saved only if you mark them as selected during review. If Save on
Select is also turned off in the main AEGIS dialog box, clips are not saved
at all.
6. Turn Auto-Review on or off to automatically review captures at the
end of the capture.
7. Turn Auto-delete Unsaved Captures on or off to automatically delete
unsaved captures when you exit the current stage.
Clip Settings ◆ To specify clip settings for the current stage:
1. Select a number of Clips per Capture: 1, 2, 4, 8, or Indefinite.
2. Enter a number of Segments Per Clip from 0 to 99.
3. Select a unit type (msec, beats, or ultrasound frames) from the pop-
up menu and enter a Segment Length from 0 to 9999.
4. Turn Enable R-Wave Gated Capture on to trigger from the R-Wave
of the ECG and enter a Trigger Delay, if desired.
5. Click Add or Insert to create a Stage with the name you entered and
with the Stage Settings and Clip Settings as you set them.
6. Press [PRIOR] or click Exit to return to the AEGIS dialog box.
7. Enter up to 10 names in the Protocol View Names text fields. Use the
scroll bar to view the whole list.

Trigger Clip Settings You can customize a staged protocol for clips stored while the system’s
extended trigger function is active. When the extended trigger function is
active, clips are stored at each trigger point.
◆ To specify Trig Clip Settings
1. Click Trig Clip Settings.
2. Select a unit type from the pop-up menu and enter a Segment Length
from 0 to 9999.
3. Select a unit type from the pop-up menu and enter an Alt Segment
length from 0 to 9999.
Customizing a Stress A stress echo protocol is a type of staged protocol.

Echo Protocol
◆ To customize a stress echo protocol:
Follow the procedures for customizing AEGIS protocols (See
“Customizing AEGIS Protocols” on page 2) and customizing a staged
protocol (see “Customizing Staged Protocols” on page 6), with the
following guidelines:
1. In the AEGIS dialog box, click Loop aligned for Playback Mode.
2. Select Playback Speed of 50%.
3. Click Staged for Protocol Type.
4. Enter the names you want in each of the Protocol View Names text
fields. Enter names in the order of desired acquisition during
IM POST stage (i.e., 4CH, 2CH, PLAX and PSAX).
5. Click Define.
The Staged Protocol dialog box appears.
6. Enter the name you want for the first Stage (i.e., REST).
7. Select ROI for the Clip Size.
8. Select 30 Hz for the Maximum Capture Frame Rate.
9. Select LOW for the JPEG Compression.
10. Turn on Auto Review.
11. Select 2 or 4 for the Clips Per Capture.
12. Enter 1 for the Segments Per Clip.
13. Enter 400 (or other preferred number) for the Segment Length.
14. Select msec in the Segment Length unit pop-up menu.
15. Click Add to store the new Stage.
16. Enter the name you want for the second Stage (i.e., IM POST).
17. Turn on Display Stage Timer.
18. Select Indefinite for the Clips per Capture.
19. Enter 350 for the Segment Length.
20. Click Add to store subsequent Stages. Your settings from the previous
stage are copied. Make changes where appropriate.

Customizing DICOM Network Features
Customizing DICOM To customize DICOM network features, choose AEGIS from the Setup
Network Features menu and then set options as described in this section.
• Click Define Printers to set up network printers. See “Setting Up
Network Printers” on page 10.
• Click Define Servers to configure the system to use network storage
servers. See “Setting Up Network Storage Servers” on page 14.
• Click Define Worklist to set up the system to connect to a network
worklist server. See “Setting Up a Worklist Server” on page 16.
These features are typically set up once for your network environment
and seldom changed. Normally, a system administrator or a network
administrator sets up these features. If you are not an administrator, you
don’t need to read the following sections. Your system should have been
set up for you.
System Requirements The following circumstances may slow network and server transfer rate:
and Efficiency
• Simultaneously reconstructing a clip and executing Store In-progress
to a network.
• Simultaneously executing move and store operations.
• DICOM store error caused by external sources.
• Servers that accept only uncompressed clips (Agfa Impax 3.5 PACS).
• Network bandwidth or traffic.
• Review stations may not be able to load or handle clips (Agfa Impax
3.5 requires special setup and EFilm review station is incompatible
with clips).

Setting Up Network To set up network printers, click Define Printers from the AEGIS Setup
Printers screen and set options as described in this section. When you finish
making changes, press [PRIOR] to return to the AEGIS Setup screen or
press [EXIT] or SETUP to leave the Setup function.
Print format for film and paper
Figure 1-4 Network Printing Screen

• In the Network B&W Printer and Network Color Printer areas, use
the pop-up menus to select the network black-and-white and color
printers that you want to print to. For each printer, select the print
format, paper size, and print media from the pop-up menus.
• In the Send B-Color to area, choose a type of printer, Color Printer or
B&W Printer, for B-Color images.
• In the Send 2-D CD w/strip to area, choose a type of printer, Color
Printer or B&W Printer, for combined 2-D/strip images.
• In the Auto Print area, turn on one of the automatic printing options.
In Progress — sends images to the network printer as you press the
STORE key during an exam.
On Study Close — sends all of the images at once when you end the
exam.
Off — turns off the automatic printing feature. If automatic printing
is turned off, you can use the Study Utilities function to print a study.
See your User Manual for instructions.

DICOM Auto Print and Using auto print or auto store DICOM settings, directly affects which soft
Auto Store Interface keys are displayed for DICOM interface. These soft keys display when
you press BEGIN END.
AEGIS AUTO AUTO SOFT KEYS

SETUP PRINT COPY
Servers — OFF Copy to server.

only
— ON Not available.
Printers OFF — [PRINT STUDY]

only
ON — [PRINT NOW]
Printers OFF OFF [DICOM SERVICES] which accesses:

and [COPY TO “SERVER”] and [PRINT STUDY]
Servers
ON OFF [DICOM SERVICES] which accesses:
[PRINT NOW] and [COPY TO “SERVER”]
OFF ON [PRINT STUDY]
ON ON [PRINT NOW]
If your printer is set up to print multiple images per page (or sheet of
film), then In Progress automatic printing doesn’t occur until the
correct number of images have been sent to the printer. When you
close the study, the remaining images are printed, regardless of
whether they fill a page. When you print On Study Close, the printer
prints all images, in order, according to the image-per-page format set
up for the printer. If there are not enough images to fill the last page,
it prints anyway. The printer does not wait for additional images
from a different study.
• In the Print Default area, choose whether the system prints all stored
images (All Statics) or only images included in the select set (Select
Set). When you choose Select Set, the system prints only the images
marked as selected. Study Utilities will print all images, regardless of
the selected set. For more information on marking images as selected
or using Study Utilities, see your User Manual. Select Set option is
useful at sites that do not rely on reading images from film.
Print Now The Auto Print feature has a new Print Now soft key option. This option
is available when the Auto Print Setup page selection is either In-Progress
or On Study Close. When the Auto Print feature is turned off, one of the
following two soft keys is displayed:
• [DICOM SERVICES] when both a printer and server are configured to
the Sequoia system.
• [PRINT STUDY] when a printer only is configured to the Sequoia
system.

Print Now invokes printing upon selecting [PRINT NOW], and before the
preselected Auto Print option executes. Auto Print executes when the
number of captured images matches the film format printer selection. If
the film format selection is 3 X 5, then Auto Print will execute the print
function when 15 images have been captured. Print Now interrupts the
capture process to print an image immediately, and then allows you to
return to capture process. This is a very useful feature in emergency
situations when time is a factor.
Access [PRINT NOW] from an open study Patient Demographic page.
◆ To access the Print Now function
1. Press SETUP.
2. Select AEGIS from the Setup menu.
3. Select [DEFINE PRINTERS...].
4. Select either In-Progress or On Study Close from the Auto Print area.
5. Select [EXIT].
6. Press BEGIN/END to start a new study. The following soft keys display
on the Patient Demographic page:
[RESTART LIST][BEGIN IMAGING]
7. Begin a study and start acquiring images.
8. Press BEGIN/END to interrupt the study. The following soft keys
display:
[START NEW PT] [MODIFY STUDY] [RESUME STUDY] [PRINT NOW]
9. Select [PRINT NOW].
10. Select [RESUME STUDY] to complete the study.
Auto Retry When you turn on the Auto Retry option, the system maintains a list of
studies waiting to be printed. The system checks this list whenever it is
powered on, and automatically sends waiting studies to the printer.
If you use your system for portable studies (disconnected from the
network), turn on this feature to automatically print images from those
portable studies before you repower on the system and after reconnecting
to the network.
For both networked and portable studies, this feature helps ensure that
printer problems (for example, no paper or paper jam) don’t prevent
studies from printing. Any study that is unable to print or is partially
printed is sent to the Auto Retry que. Auto Retry initiates by one of two
ways:
1. Persistent – While the Sequoia system is being used to perform other
tasks, Auto Retry attempts print or store studies and images in the
Auto Retry que at regular intervals, until the print or store function
has been completed.

2. Power Cycle – Upon power on or shut down, Auto Retry attempts

print or store studies and images in the Auto Retry que. If a server
connection can not be established, or a printer problem not fixed, the
next print or store attempts are made on the next shut down or
power on cycle. Once a server connection can be established, or a
printer problem fixed, the next print or store attempts are made at
regular intervals, until the print or store function has been completed.
Studies that were partially printed resume printing from where they
stopped. The system does not display a message indicating a failed image
transfer.
NOTE: If a study is unable to print because of a printer problem, the
system maintains all subsequent images in the current study in the list of
unprinted images (it doesn’t try to print again). The system will re-
associate with the printer on the next new patient. Unprinted images
from the former study will not be printed until the system is powered off
and on.
When you turn off this feature, the system does not maintain the list
of unprinted studies. You must print prior studies using the Study
Utilities function (as described in your User Manual).
• In the Jobs Kept text field, enter the number of days to keep the list of
unprinted studies.
NOTE: The Auto Retry option detects the studies that have not been
printed. It does not prevent a study from being removed from the system
hard disk (either manually or automatically when the hard disk becomes
full) before it has been printed.

Setting Up Network Network storage servers store saved images, clips, patient information,
Storage Servers and calculation information in studies. To set up network storage servers,
click Define Servers from the AEGIS Setup screen and set options as
described in this section. When you finish making changes, press [PRIOR]
to return to the AEGIS Setup screen or press [EXIT] or SETUP to leave the
Setup function.
Figure 1-5 Network Server Setup

• Use the pop-up menus to select a primary (Storage Server 1) and
secondary (Storage Server 2) storage server and to assign a priority
to each server. Your Siemens Customer Engineer configures your
system to connect to storage servers.
• In the AutoCopy area, turn on one of the automatic copying options.
In Progress stores images (one at a time) to the network server
during an exam (as they are stored to the local hard disk). On Study
Close copies all of the images at once when you end the exam. Off
turns off the automatic copy feature. When automatic copy is off, you
can use the Study Utilities function to copy studies to a server. See
your User Manual for instructions on storing studies on a networked
server.
• When you turn on the Auto Retry option, the system maintains a list
of studies waiting to be stored. The system checks this list whenever
it is powered on, and automatically sends waiting studies to the
storage server.
When you turn off the Auto Retry feature, the system does not
maintain the list of unstored studies. You must manually store prior
studies using the Study Utilities function (as described in your User
Manual).
If you use your system for portable studies (disconnected from the
network), turn on Auto Retry to automatically store images from
those portable studies when you power on the system after
reconnecting to the network. When portable, a 30 second delay
occurs until the system determines there is no network connection.
NOTE: It is recommended to turn Status Line Messages off when using
portable Auto Retry to prevent Status Line Messages from interrupting a
current study.

For both networked and portable studies, this feature helps ensure
that server or network problems don’t prevent studies from being
stored. Any study that is unable to be stored or is partially stored is
saved and automatically stored the next time that the system starts
up and detects that the storage server is OK.
NOTE: If a study is unable to be stored because of a server or network
problem, the system maintains all subsequent images in the current study
in the list of unstored images (it doesn’t try to store again for the current
study). The system will reassociate with the storage server on the next
new patient. Unstored images from the former study will not be stored
until the system is powered off and on.
NOTE: If the study has been successfully stored to only one of the two
listed storage devices, the system will not attempt to send the study to the
other storage device via Auto Retry.
• In the Jobs Kept text field, enter the number of days to keep the list of
unstored studies.
NOTE: The Auto Retry option detects the studies that have not been
stored. It does not prevent a study from being removed from the system
hard disk (either manually or automatically when the hard disk becomes
full) before it has been stored.

Setting Up a Worklist The Siemens system can retrieve patient information from a Hospital
Server Information System (HIS) or Radiology Information System (RIS)
worklist server. To specify a worklist server, click Define Worklist from
the AEGIS Setup screen and set options as described in this section. When
you finish making changes, press [PRIOR] to return to the AEGIS Setup
screen or press [EXIT] or SETUP to leave the Setup function.
Figure 1-6 Dicom Worklist Server Setup Screen

• The DICOM Modality Performed Procedure Step (MPPS) feature
allows the Sequoia system to report back to the HIS/RIS that a study
(retrieved from the worklist server) has been completed. The HIS/
RIS can then remove the study from the list of procedures to be done,
start the billing process, and so on. If the worklist server and the HIS/
RIS support MPPS, then a list of servers appears in the MPPS Server
pop-up menu. Choose the appropriate server.
• Choose the worklist server from which you want to retrieve patient
information from the Worklist Server pop-up menu.
When you choose On from the Pre-Fetch pop-up menu, the system
automatically queries the worklist server for the list of scheduled studies
when you start a new patient study (by pressing [START NEW PATIENT]).
It stores the list of scheduled studies on its internal hard drive. This
option is useful for portable studies where there may not be a network
connection. You connect the system to a network at the beginning of the
day, retrieve the day’s patient information, and then have that
information available during portable studies.
NOTE: If the network connection is lost during an active Pre-Fetch query,
the system may lock-up and require that you restart the Sequoia system.
When this option is Off, the system connects to the worklist server
only when you press [QUERY] on the patient demographic page. It
does not automatically save the study list on the internal hard disk.
For more information using the Query function see “Studies”,
Chapter 3 in the User Manual.

• Choose On from the Worklist pop-up menu to turn on the worklist

retrieval function. Choose Off to turn off this function.
• Choose a maximum number of studies from the Max Entries pop-up
menu. This option limits the number of studies that the system
retrieves from the worklist server.
• Choose On from the Sent U/S Studies Only pop-up menu to retrieve
only ultrasound studies. When you choose Off, all modalities or
exam types are retrieved.
• Choose Off from the Filter Worklist pop-up menu to retrieve all
studies for an Ultrasound department. Choose On to retrieve only
studies assigned to this ultrasound system.
NOTE: A new Study Type can only be created on the Begin Study Type
set up page.
DICOM Modality Worklist Use the following guidelines to setup Modality Worklist for Patient
Guidelines Demographic pages:
IMPORTANT: Never use backslashes “ \ ”. Using a backslash in an exam procedure

name will lock-up the Sequoia system and require that you restart the
Sequoia system.
CREATE GUIDELINES
NEW STUDY
TYPE
Study You can enter up to 64 characters for Study Type names,

Type/ but only the first 16 characters will be displayed on the
Procedure Patient Demographic page.
Names
Characters
Study Procedure names on the Sequoia system study type list

Type/ must match with those on the modality worklist server,
Procedure including punctuation. A procedure name mismatch
Names may cause a stored study to be unavailable on a
HIS/RIS workstation server. Delete punctuation in HIS/RIS
Querries names to allow an exact match on Sequoia system. If
there is a mismatch, then Unknown Study Type is
displayed on the Patient Demographic page.
Messages Unknown Study Type: displays on the Patient

Demographic page if the Sequoia system study type list
is not an exact match with those on the modality
worklist server.
An “Unknown Study Type” message invokes the last
used Study Type name and Patient Demographic page
layout.


CHAPTER 2
CUSTOMIZING SYSTEM SETUP
Using the Setup Menu 20

Customizing 2-D Controls 22
Customizing the AEGIS Software 23
Customizing Auto-Doppler 23
Customizing the Annotation Keys 25
Customizing Begin/Study Type 27
Customizing Body Markers 30
Customizing Calipers/Trace 31
Customizing Cardiac Calculations 31
Customizing Color Doppler Imaging 32
Customizing the Foot Switch 33
Customizing GYN Calculations 33
Customizing Monitor Brightness 34
Customizing the Output Display 35
Customizing Presets 35
Customizing Printing 35
Customizing Screen Options 38
Customizing the Service User Interface 39
Customizing Strip Modes 39
Customizing the System Clock and Memory Allocation 41
Customizing System Lighting 42
Customizing Vascular Calculations 42
Customizing VCR and External Video 43

Chapter 2 Customizing System Setup
Using the Setup The Setup menu contains a list of functions that you can customize by
Menu setting the function’s parameters. The list of functions depends on your
system type and the options installed on your system. The following
illustration shows the Setup menu for a system with all options installed.
Figure 2-1 Setup menu

◆ To use the Setup menu:
1. Press SETUP to display the Setup menu.
2. Select the function you want to change.
3. In the dialog box that appears, set the options you want.
See the instructions for specific functions, later in this chapter.
4. Use the following controls to customize system functions.
CONTROL USE
[HIDE MENU] Temporarily remove a dialog box that is
obscuring the image, and change the soft key
label to [SHOW MENU].
[SHOW MENU] Redisplay the dialog box.
[PRIOR] Apply your changes and return to the prior
menu, either a dialog box or the Setup menu.
[EXIT] or Apply your changes and leave the Setup
SETUP function.

Using the Setup Menu
Working with Setup The Setup dialog boxes contains pop-up menus, option buttons, text
Dialog Boxes fields, and command buttons that you use to customize a function.
Figure 2-2 shows a sample dialog box.
Pop-up Menu.
Displays choices.
Option Button.
Darkened buttons are
selected.
Command Button.
Displays additional options.
Exit button.
Applies changes and leaves
the Setup function.
Figure 2-2 Dialog Box Components

Use the following techniques to set options in dialog boxes.
• Use the trackball to move the arrow cursor in the dialog box.
• To display a pop-up menu, move the arrow cursor over the menu and
click a trackball SELECT KEY. To select an option from the menu,
move the trackball to highlight that option and click a trackball
SELECT KEY.
• To select or deselect an option button, move the arrow cursor over the
option button and click a trackball SELECT KEY. Buttons that are
selected are darkened. Sometimes a set of option buttons are
mutually exclusive; if you select one, all others in that set deselect
automatically.
• To enter text in a text field, click to select inside the text field and then
use standard text editing techniques.
• To choose a command, move the arrow cursor over the command
button and click one of the trackball SELECT KEYS. You see another
dialog box in which you can specify additional options.

Customizing 2-D Use 2-D Options Setup to customize parameters that control the
Controls appearance of the 2-D image.
◆ To customize the 2-D image, select 2-D from the Setup menu.
Figure 2-3 2-D Options

Customize your system by setting the options in the following table.
When you are done, press [PRIOR] to return to the Setup menu.
OPTION DESCRIPTION
CURVED/VECTOR Choose a scale appearance from the pop-up

SCALE menu.
LINEAR SCALE Choose a scale appearance from the pop-up
menu.
TISSUE Click to display the Tissue Equalization options
EQUALIZATION dialog box. Choose the algorithm and target
tissue intensity desired.
DGC CURVE Select Single to display the DGC curve when
DISPLAY single images are displayed. Select Quad to
display the DGC curve in four-image (quad)
format.
IMAGE DEPTH Select the behavior you want (increase or
KNOB DIRECTION decrease) for the clockwise direction.
FOCUS DEPTH Select the behavior you want (increase or
KNOB DIRECTION decrease) for the clockwise direction.
AUTOMATIC IMAGE Turn on AUTOMATIC IMAGE WIDTH WITH COLOR
WIDTH WITH DOPPLER ACTIVATION to turn on the image
COLOR DOPPLER width function automatically when you enter
ACTIVATION Color Doppler mode.
IMAGE WIDTH SIZE Turn on IMAGE WIDTH SIZE AND POSITION TIED
AND POSITION TIED TO COLOR DOPPLER SIZE AND POSITION to size
TO COLOR the image width box so that it matches the size
DOPPLER SIZE AND and position of the Color Doppler box.
POSITION

Customizing the AEGIS Software
OPTION DESCRIPTION
IMAGE SIZE Click to display the 2-D Image Size Options

dialog box. Choose the size you want, then press
[PRIOR] to return to the 2-D Options dialog box.
RES BOX Click to display the 2-D RES Magnification

Imaging Format Box dialog box. Choose the RES
sizing box option you want, then press [PRIOR]
to return to the 2-D Options dialog box.
Customizing the See Chapter 1 for information on customizing onboard AEGIS digital
AEGIS Software image and data management software functions.
Customizing Use Auto-Doppler Setup to customize a set of parameters for each

Auto-Doppler configuration. The parameters include which measurements appear
during live and frozen image acquisition.
◆ To customize the Auto-Doppler setup, select Auto-Doppler from
the Setup menu.
Figure 2-4 Auto-Doppler Setup

The Auto-Doppler Setup dialog box contains activation boxes that allow
you to customize up to sixteen different configurations. Some of the
configurations may be pre-programmed by Siemens .
NOTE: You can turn on as many configurations as you want. However,
only one configuration at a time can be active.

Customize your system by setting the options as follows. When you are
done, press [PRIOR] to return to the Setup menu.
• Select the On option button next to the Configuration name to turn it
on or deselect it to turn it off. If a configuration is turned on, it
appears in the Auto-Doppler Options menu.
• Select the Active option button next to the Configuration name to
activate it. The active configuration appears with a check mark in
front of the name in the Auto-Doppler Options menu. The active
configuration settings is also stored in the Exam Preset. Only one
active configuration can be set for each Exam Preset.
• If you want to modify the parameters of a Configuration, click
Modify next to the Configuration name. The Auto-Doppler
Configuration Setup dialog box appears as shown in Figure 2-5.
Figure 2-5 Auto-Doppler Configuration Setup

Customizing the Annotation Keys
Modify a configuration by setting the options in the following table.

When you are done, press [PRIOR] to return to the Auto-Doppler Setup
dialog box or click Exit to leave the Setup function.
OPTION DESCRIPTION
Configuration Type a new name or edit the existing one.

Name
Gap Drawing Use this option to determine how the maximum

derived waveform (MAX DWF) is drawn for
gaps in the spectral strip. If it is selected, a
horizontal line across spectral gaps is drawn at
the value of the MAX DWF for the last received
spectral line. If it is deselected, a horizontal line
at zero is drawn during spectral gaps.
Initial Tracking Move the arrow cursor over the indicator sliding
Sensitivity bar to select the sensitivity percentage. You can
also adjust this value during an exam.
Number of Heart Enter a number between 1 and 9 to specify the

Beats to Average number of beats to average when calculating
Auto-Doppler values.
Heart Rate Ranges Enter the ranges for this configuration. When
you perform calculations, these values appear on
the [HR RANGE] soft key.
Calculations area Select a calculation to display it in the Auto

Doppler data display box. You can select up to
eight calculations for display. Acceleration and
Acceleration Time values appear only when the
Number of Heart Beats to Average is 1.
Customizing the Use Annotation Keys Setup to customize the six programmable
Annotation Keys annotation keys located to the right of the SPACE BAR key. You can
program each key to represent up to 15 annotation terms. Instead of
typing an annotation term, you select the annotation key.
You can set up each key to display annotation terms using one of two
methods: by cycling among available terms as you press the key, or by
displaying a pop-up menu from which you can choose the term you
want. When selecting a method, keep in mind that if you assign more
than three or four terms to a key, it is usually easier to access those terms
using a pop-up menu.

Siemens supplies an annotation key-cap kit with each system. The kit
contains key caps with labels for common annotation groupings. When
your system is installed, your Siemens Customer Engineer will help you
set up the annotation keys on your system and show you how to install
the descriptive key caps.
◆ To customize the annotation keys, select Annotation from the
Setup menu.
Figure 2-6 Programmable Annotation Keys

OPTION DESCRIPTION
Annotation Key Choose the number (1-6) of the key you want to
pop-up menu customize.
Cycle Annotations Select the method of choosing terms for the

Pop-up Menu for selected key.
Annotations
Term text boxes In each box, type a term (up to 20 characters) to

be associated with the selected key.

Customizing Begin/Study Type
Customizing When you begin a new exam, you choose a Study Type, select an Exam
Begin/Study Type Preset, and enter patient information on the Begin page. The Study Type
that you choose determines the default Exam Preset, your other Exam
Preset choices, and which patient information fields appear on the Begin
page. Use the Begin/Study Type setup function to add, change, or
remove a Study Type.
Creating or Changing a ◆ To create a new Study Type or modify an existing Study Type:
Study Type
1. Select Begin/Study Type from the Setup menu to display the
Begin/Study Type Customization dialog box.
Figure 2-7 Begin/Study Setup

2. Select the Study Type you want to change from the Study Type
pop-up menu, or select an existing Study Type to use as a basis for
creating a new one.
3. To have this Study Type take effect when the system is first powered
on, select Power Up.
4. Choose a Default Exam Preset for the Study Type from the pop-up
menu. (For more information about Exam Presets, see Chapter 3.)
5. Type the text to use as the Begin page title in the Page Title field.
6. Type the text to use as the custom field titles in the Custom Field 1
Title and Custom Field 2 Title fields.
7. Select the options fields that you want to use in the Begin page, and
deselect the options you want to omit. The following table describes
the available options.
Fields marked with an asterisk (*) are available on ACUSON Sequoia
512 systems only.

SELECT THIS OPTION TO DISPLAY THIS ITEM

BUTTON
Pt. Name - Prefix Name Prefix
Pt. Name - Suffix Name Suffix

Accession Hospital-assigned ID number from hospital
information system (HIS) database
SSN Social Security Number
Date of Birth Date of Birth uses the following formats:

• <day> <separator> <month>
<separator> <year>
• DAY: d or dd
• MONTH: m or mm
• YEAR: y, yy, or yyyy
• Separator: dash (-) or slash (/)
• Special: ddmmyy (no separators)
Age Patient’s age
GA at Birth* Gestational age at birth (wks)
Sex Patient’s sex
Height Patient’s height
Weight Patient’s weight
BSA Body Surface Area
BP Patient’s blood pressure
LMP* Patient’s last menstrual period
EDD* Estimated delivery date
Grav/Para/Abor* Patient’s OB history
Gestations* Gestation number
Diag. Physician Diagnosing physician’s name
Ref. Physician Referring physician’s name

Sonographer Sonographer’s initials
Prompt for Exam Turn on this option to automatically display

Preset the Exam Presets pop-up menu when you
begin an exam without choosing a Study
Type from the Begin page.

Customizing Begin/Study Type
SELECT THIS OPTION TO DISPLAY THIS ITEM

BUTTON
Alert Unless Free Disk The system maintains a minimum amount of

Space Exceeds (Mb) free disk space. When the free space drops
below the minimum, an alert message
appears, and the system begins to remove
old studies to make room for new ones. Use
this option to change the amount of free
storage space. To delete old studies without
a warning, set this option 0 Mb.
Indication Indication for exam
Comments Sonographer’s notes
Machine ID Ultrasound system ID number
Department Displays the department entered in this field.
Custom Field 1 Displays a customizable field
Custom Field 2 Displays a customizable field
Condense Pt. Name A single field for patient name, instead of

Entry separate fields for first and last name
Display in Metric Measurements in metric units (otherwise

Only measurements display in English units)
8. To create a new Study Type, click New Study Type and enter a name
for the Study Type in the dialog box. Click OK to continue.
9. To save your changes, click Exit or press [PRIOR].
Removing a Study Type ◆ To remove a Study Type:

1. Select Begin/Study Type from the Setup menu to display the
Begin/Study Type Customization dialog box.
2. Select the Study Type you want to remove from the Study Type
pop-up menu.
3. Click Delete Study Type.
You cannot delete the default (power on) Study Type. When these
Study Types are selected, Delete Study Type is disabled.
4. In the dialog box that appears, click Delete to confirm the deletion or
Cancel to cancel.

Customizing Body Body Markers are available on Sequoia 512 systems only.
Markers Use Body Markers Setup to specify which body markers are available
during an exam and to adjust the size of the marker and the indicator. If
you perform only certain types of exams at your site, you might want to
turn off the body markers that don’t apply to those exams.
◆ To customize Body Markers, select Body Markers from the Setup
menu.
Figure 2-8 Body Markers

OPTION DESCRIPTION
Body Markers Select the markers you want to make available

for exams, and deselect the ones you want to
omit.
Body Marker Size Select Small or Large.
Body Marker Select Small or Large.

Indicator Size

Customizing Calipers/Trace
Customizing ◆ To customize the caliper or trace measurement tools, select

Calipers/Trace Calipers/Trace from the Setup menu.
Figure 2-9 Calipers/Trace Setup

OPTION DESCRIPTION
Remove Tools Measurements can be taken only from a frozen

When Un-frozen image. To automatically remove measurement
tools when you press FREEZE to return to a
real-time (unfrozen) image, select this option.
Define Doppler Select GI/Vascular or Cardiac measurements.

Measurement For more information, see your User’s Manual.
Tools
Enable Ratio Select to turn on the Doppler ratio calculation.

Calculation
Numerator Enter a label for the numerator of the ratio

calculation. IC pk is the default, used for the
IC/CC ratio.
Denominator Enter a label for the denominator of the ratio

calculation. CC pk is the default, used for the
IC/CC ratio.
Trace Method Select the default trace method. You can override
Default this default when performing a trace.
Customizing The Cardiac Calculation package is available on Sequoia C256 systems,

Cardiac C512 Echocardiography systems, and 512 systems with Cardiac option.
Calculations See Chapter 7 for detailed information on customizing cardiac
calculations, including calculation formulas and references.

Customizing Color Use Color Doppler Imaging Setup to customize how the color Doppler
Doppler Imaging pan box resizing option functions. You can set up the size to change
relative to a fixed center or a fixed corner.
◆ To customize the pan box:
1. Select Color Doppler Imaging from the Setup menu to display the
Color Doppler Imaging dialog box.
Figure 2-10 Color Doppler Box Sizing

2. Select a CDI Box Sizing method.
3. Click [PRIOR] to return to the Setup menu, or click Exit to exit the
Setup function.
NOTE: You can also press CODE + D-COLOR at any time as a shortcut for
displaying the Color Doppler Imaging dialog box.

Customizing the Foot Switch
Customizing the You can program the two buttons on the foot switch to perform the
Foot Switch functions of frequently used keyboard keys. The foot switch settings
available to you depend on the options installed on your system.
◆ To customize the footswitch buttons, select Footswitch from the
Setup menu.
Figure 2-11 Footswitch Setup

OPTION DESCRIPTION
Left Use the pop-up menu to select a function for the

left footswitch.
Right Use the pop-up menu to select a function for the

right footswitch.
The new foot switch settings are effective immediately.
Customizing GYN See Chapter 5 for detailed information on customizing gynecology

Calculations programs and calculations.

Customizing Use Monitor Setup to customize the monitor brightness and contrast
Monitor Brightness levels.
◆ To customize the monitor settings, select Monitor from the Setup
menu.
Percentage Bars
Figure 2-12 Monitor

When you are done, press [PRIOR] to return to the Setup menu. To retain
changes in brightness and contrast, save them to an Exam Preset. See
“Setting Default Exam Presets” on page 50 for more information.
OPTION DESCRIPTION
Brightness Click in the percentage bar until the value you

want appears in the percentage box. Click Reset
to reset the brightness to the factory default.
Contrast Click in the percentage bar until the value you

want appears in the percentage box. Click Reset
to reset the contrast to the factory default.
Customizing OB See Chapter 4 for detailed information on customizing obstetrical

Calculations programs and calculations.

Customizing the Output Display
Customizing the Use Output Setup to choose which output values appear on the Output
Output Display Display. See your User Manual for more information on the Output
Display. Use Screen Options Setup to control whether or not the output
values appear on the screen. See “Customizing Screen Options” on
page 38.
◆ To customize the Output Display, select Output from the Setup
menu.
Figure 2-13 Output Display Setup

“Setting Default Exam Presets” on page 50 for more information.
OPTION DESCRIPTION
2D Use the pop-up menu to select the index to display in

column 1. The Mechanical Index (MI) always appears in
column 3.
M/CD/SD/ Use the corresponding pop-up menus to select the index to
CM-MODE display in each of the columns.
Customizing See the User Manual for detailed information on customizing Sequoia
Presets Presets.
Customizing Use Printer Setup to customize printer settings for your local
Printing black and white (B & W) and color printers. When you freeze and print
an image, set the Sequoia to return to the frozen image or to live imaging.
Also, use Printer Setup to automatically store images sent to either
printer.
You can setup primary printer, alternate printer, and image store options
for each of the following imaging modes:
• CD images
• B & W images
• 2-D CD w/strip
• B-color images

For better workflow, use the Print hard key for the primary printer, then
the CODE + ALTPRINT for the alternate printer. (You can setup the printers
to print from either keys.) The color printer has an additional format
setting that is applied to all color prints. It is a single (1) or quad (4 on 1)
print format. Single prints one image on one film sheet while quad prints
four images on one film sheet.
You can apply Auto Un-freeze After Print and Store Image On Print options
to the primary and alternate print functions.
• Auto Un-freeze After Print automatically returns the frozen image to
live imaging after completing the print function.
• Store Image On Print will automatically store the printed image for
later review.
Assigns PRINT to perform Imaging Modes Color Print Format

print functions to the selection: 1 or 4 ON 1
Local B & W Printer
Assigns CODE + ALT

PRINT to perform alternate
print functions to the
Local B & W Printer
Assigns PRINT to perform

Local Color Printer
Assigns CODE + ALT

PRINT to perform alternate
Local Color Printer
Figure 2-14 Printing Setup Screen

◆ To customize local printer options, select Printing from the
Setup menu.
1. Press SETUP.
2. Use the trackball to select Printing from the Setup menu.

Customizing Printing
3. Click on the corresponding check boxes to customize the print

settings for CD Images:
• Select a primary printer. The primary printer should be the one
used most often for the corresponding imaging mode.
• Select an alternate printer. The alternate printer should be the one
used least often for the corresponding imaging mode.
• Select Image Store to switch this function on. Use Image Store
when you want to store only the images from selected imaging modes,
but not all imaging modes. Store Image On Print will override
Image Store and print images from every imaging mode.
4. Repeat step 3 for each of the remaining imaging modes
(B & W images, 2-D CD w/strip, and B-color images).
5. Select the Color Printer Format from the pop-up menu (1 or 4 ON 1).
6. Select Auto Un-freeze After Print to unfreeze the image and return to
imaging after pressing PRINT.
7. Select Auto Un-freeze After Alt-print to unfreeze the image and return
to Imaging after pressing CODE + ALT PRINT.
8. Select Store Image On Print to store the image after pressing PRINT.
Use Store Image On Print when you want to store images from all
imaging modes. Image Store only stores selected imaging modes, not
all imaging modes.
9. Select Store Image On Alt-print to store the image after pressing
CODE + ALT PRINT. Use Store Image On Alt-Print when you want to
store images from all imaging modes. Image Store only stores selected
imaging modes, not all imaging modes.
NOTE: See the manufacturer’s printer manual for more details.

Customizing Screen Use Screen Options Setup to customize various screen display elements.
Options
◆ To customize the screen options, select Screen Options from the
Setup menu.
Figure 2-15 Screen Options

When you are done, press [PRIOR] to return to the Setup menu. The
screen format change does not take effect until you restart the system.
OPTION DESCRIPTION
Enable Patient Select this option to display the patient name at

Name the top of the screen.
Enable Patient ID Select this option to display the patient ID at the

top of the screen.
Enable Select this option to display the sonographer ID

Sonographer ID at the top of the screen.
Institution Type the Institution name you want to appear at

the top of the screen. Leave this field blank if you
do not want the Institution name to appear.
Enable Main Data Select this option to display the main system
Fields data field.
Enable Mode Data Select this option to display the data fields for
Fields different operating modes.
Enable Status Data Select this option to display status data fields.
Fields
Enable Power Select this option to display the onscreen output
Output Data display.
Fields

Customizing the Service User Interface
OPTION DESCRIPTION
Depth < 80 mm Select the cursor line dot spacing for image
depths less than 80 mm.
Depth > 80 mm Select the cursor line dot spacing for image
depths greater than 80 mm.
Adjust Brightness Click to display the Brightness Levels dialog

Levels box. Select the brightness percentages to use for
Background, Text, Graphics, and Color Bands.
Press [PRIOR] to return to the Screen Options
dialog box.
Condense Screen Select this option to compress the display, so that

to Prevent all information appears on overscan monitors. If
Clipping on you deselect this option, the display is full-sized
Overscan but some information may be missing on
Monitors overscan monitors.
Large Font Select the items for which you want to use large
fonts.
Customizing the The Service User Interface (SUI) provides you and your Siemens
Service User Customer Service Engineer access to system capabilities that aid in the
Interface maintenance of your Sequoia ultrasound system. For instructions on
using the SUI, see Chapter 9.
Customizing Strip Use Strip Modes Setup to customize the Doppler scale settings and strip
Modes size, and specify the default cursor.
◆ To customize Strip Modes, select Strip Modes from the Setup
menu.
Figure 2-16 Strip Modes Setup


“Setting Default Exam Presets” on page 50 for more information. .
OPTION DESCRIPTION
Select Update Choose every 1, 3, or 5 seconds or Infinite

Update imaging for the 2-D display while in
combined 2-D/Doppler mode. Pressing UPDATE
during Infinite freezes the 2-D display.
Doppler Scale Specify the behavior of the SCALE toggle by
selecting Up or Down as the direction to increase
the range of the Doppler scale.
Keep Cursor Select the transducer types for which you want
Active by Default to retain the cursor when you exit a strip mode.
You can turn this option on and off for linear
transducers and for all other transducer types.
Link PW Cursor to Select this option to have the Spectral Doppler

CD Pan Box and the R/C/L (right/center/left) Color
Doppler angles adjust simultaneously.
Center PW Cursor Select this option to center the Spectral Doppler

within CD Pan box cursor and gate within the CD pan box. This
selection becomes available after activating the
CD pan box and the Spectral Doppler cursor.
Auto-Invert on Select this option to invert the Spectral Doppler
Steer Change Display automatically when you change the
cursor angle from a center or right angle to a left
angle or vice versa.
Display PW Gate Select this option to display the Spectral Doppler

Depth on 2-D gate depth prior to entering PW.
Image
Anchor Baseline Select the Doppler modes for which you want to
on Invert for retain the Doppler scale when you invert the
display.
Default Cursor Select the type of cursor that appears when you
first press CURSOR.
Strip Size Click Strip Size to display the Strip Display

Sizing dialog box. Select the strip size for
M-mode and spectral Doppler modes. Press
[PRIOR] to return to the Strip Modes dialog box.

Customizing the System Clock and Memory Allocation
Customizing the Use System Setup to reset the system clock and to modify the system
System Clock and memory allocation. Your Siemens Customer Engineer sets the clock to
Memory Allocation the correct date and time during installation, and the date and time
appear in the system data field.
◆ To customize System settings, select System from the Setup
menu.
Figure 2-17 System Settings

◆ To save changes to time press EXIT.
The system will promt you to select [OK] or [CANCEL].
• Selecting [OK] saves the time change and reboots the system,
pre-empting the study.
• Selecting [CANCEL] cancels all changes.
OPTION DESCRIPTION
System Time Click the arrow buttons to adjust the hours and
minutes. Select am, pm or 24 hour.
Memory Click in the percentage bar until the values you

Allocation want appear in the percentage boxes. The Cine
and AEGIS percentages always add up to 100%.
The memory allocation changes do not take
effect until you turn off and then turn on the
system.

Customizing System There are three system lighting options: low, medium, and high. Each
Lighting option has preset levels for the down-light intensity, keyboard
illumination and output display contrast, and an optional monitor boost
function.
The down-light is the light that shines upon the alphanumeric keyboard.
The lights on the keyboard include the keyboard legends, knobs and
output display backlight. Monitor boost adds additional brightness and
contrast to the monitor display (beyond monitor knobs and the Monitor
dialog box settings) which may be useful in very high ambient lighting
conditions.
◆ To adjust the system lighting presets, select System Lighting
from the Setup menu.
Figure 2-18 System Lighting

OPTION DESCRIPTION
Light Presets Select the option (Low, Medium, or High) for

which you want to adjust the presets.
Down-light Click in the percentage bar until the value you

Intensity want appears in the percentage box. Click Reset
to return to the factory default value.
Keyboard Click in the percentage bar until the value you

Illumination want appears in the percentage box. Click Reset
Output Display Click in the percentage bar until the value you
Contrast want appears in the percentage box. Click Reset
Monitor Boost Select to turn on the monitor boost feature.
Customizing See Chapter 6 for detailed information on customizing vascular

Vascular calculations, including reports, customizing study and site names, and
Calculations calculation formulas.

Customizing VCR and External Video
Customizing VCR Use VCR/Ext-Video to modify the SVHS signal output level. For detailed
and External Video VCR setup information, see Chapter 8.
◆ To change the VCR and external video settings, select
VCR/Ext-Video from Setup menu.
Figure 2-19 VCR/External Video Setup

Set the SVHS Signal Output Level by clicking in the percentage bar until
the value you want appears in the percentage box.


CHAPTER 3
CUSTOMIZING PRESETS
Overview 46
ACUSON Exam Presets 47
Turning Exam and Image Presets ON and OFF 47
Recalling Exam Presets 48
Recalling Image Presets 48
Creating a New Preset 49
Deleting Presets 50
Setting Default Exam Presets 50
Customizing Categories 51

Chapter 3 - Customizing Presets
Overview Presets store image and format parameters for specific exam types. Use
Presets to quickly recall optimum parameters for particular exam type,
image type, or imaging mode. Presets Setup allows customization of:
• Image Presets—A collection of system parameters for each imaging
mode that affect the look of the image. Image Presets represent the
imaging goal rather the clinical application or anatomy.
• Exam Presets—A collection of Image Presets, also including screen
format and system setup information. An Exam Preset typically
contains several Image Presets for each imaging mode.
• Categories—A collection of Study Types, Exam Presets, and Image
Presets. It also includes a default Study Type and its default Exam
Preset. See “Customizing Begin/Study Type” on page 27 for
information on defining Study Types.
Use Presets Setup to create, modify, or delete Exam Presets. To modify an
Exam Preset, first initialize the correct transducer for the exam type, then
recall it so it is the active Preset.
The active Exam and Image

Presets are selected. When
selecting a different Exam
Preset the Image Presets list
updates immediately.
Figure 3-1 Presets Setup

Each Exam Preset contains Image Presets for 2-D, Color Doppler,
M-mode, and spectral Doppler modes. There are two Exam Preset
screens: SHOW MORE and SHOW LESS. The default display on power-up
is SHOW LESS, showing only the most frequently used controls. SHOW
MORE displays all interactions. The user can toggle between the two
displays with the SHOW MORE/SHOW LESS button. Thereafter, the
display reflects the last state chosen by the user.

ACUSON Exam Presets
ACUSON Exam Your ACUSON Sequoia system includes all or a subset of the following
Presets ACUSON Exam Presets. ACUSON Exam Presets can not be modified, but
can be used as a base to create new presets with modification capabilities.
CARDIOVASCULAR GENERAL IMAGING
Cardiac Abdomen
Cardiac Difficult Abdomen Difficult
CV Artery Breast
CV Carotid Carotid
CV TCI ER
CV TCI ORB EV
CV Vein Fetal Heart
Exercise Stress Musculoskeletal

Intracardiac NeoAbd
Neonatal Echo NeoHead
Pediatric Echo OB
Ped TEE PV Artery
Pharm Stress 4 PV Vein

Pharm Stress 7 Pelvic
TEE TCI
TCI Orb
Testicle
Thyroid
Turning Exam and Exam and Image presets that are not used can be turned OFF so they do
Image Presets ON not appear in the Exam Preset list.
and OFF ◆ To turn an Exam Preset OFF
1. Select the SHOW MORE menu.
2. Select the SHOW DISABLED PRESETS option button.
3. Using the trackball, double-click the on the preset name to be turned
OFF.
This action toggles the preset state from ON to OFF.
◆ To turn an Exam Preset ON
1. Using the trackball, double-click the on the preset name to be turned
ON.
This action toggles the preset state from OFF to ON.

NOTE: Image Presets for ACUSON protected Exam Presets and Power
up Exam Presets cannot be turned OFF
Recalling Exam ◆ To recall an Exam Preset, use one of the following methods:
Presets 1. When starting an exam, select the Study Type from the pop-up menu
on the BEGIN END patient demographic page. The Study Type recalls
a default Exam Preset. Choose a different Exam Preset from the Exam
Preset pop-up menu.
2. During an exam, press EXAM PRESETS and select the Exam Preset
from the pop-up menu.
Recalling Image ◆ To recall an Image Preset, use either of the following methods:
Presets 1. Turn the IMAGE knob clockwise or counterclockwise to cycle through
the available Image Presets.
While turning the knob, the result of the changed selection on the
image displays immediately, and the Image Preset selection name
displays in the data field.
2. Press the IMAGE knob to display the Image Preset menu, then turn the
IMAGE knob to make a selection. Press the IMAGE knob to activate the
selection.
Figure 3-2 Exam Presets Menu

Creating a New Preset
Creating a New ◆ To create a new Exam or Image Preset:

Preset Create Exam or Image Presets with or without transducer specific
parameters or Multihertz linking.
1. Initialize the transducer used for the Exam Preset that is to be
changed.
2. Recall an existing Preset to use as the basis for the new one.
3. Change any system or image optimization parameters. Each mode
must be stored individually.
4. Press SETUP and select PRESETS from the Setup menu.
5. Enter a name for the new Preset in the Name box below the Exam or
Image Preset list.
6. To save changes to the new exam preset or to make changes to an
existing one, click the STORE button below the Exam Preset list.
7. To save changes to the new or existing Image Preset, click the STORE
button below the Image Preset list.
8. To specify a different default Image Preset for a new Exam Preset,
select the Image Preset from the Image Preset list and click Set
Default.
9. To specify an Exam Preset to a particular transducer select the USE

TRANSDUCER SPECIFIC SETTINGS check box, and then select the
STORE button below the Exam Preset list.
Once the transducer-specific setting is ON, all Image Presets stored
are also transducer specific. Unless the operator changes the
multihertz and transducer-specific settings:
• new Exam Presets retain the “Transducer-Specific Setting” state
from the last Exam Preset selection.
• new Image Presets retain the “Linked Multihz on Store” settings
from the last Image Preset selection.
10. To store an Image Preset with a specific transducer frequency, click
the LINK MULTIHZ ON STORE check box, then click the STORE button
below the Exam Preset list.
LINK MULTIHZ ON STORE turns the Multihertz function ON to store
the desired frequency for an Image Preset, but uses the last used
Multihertz selection with the Multihertz function OFF.
11. Press [EXIT].
The new Exam Preset immediately displays in the Exam Preset list and
becomes the active Exam Preset. The new Exam Preset automatically
associates with the active Category.
Change the order in which Exam or Image Presets appear in menus.
(Default insertion of a new preset is one row below the current Preset
selection.) Add a break between Exam Presets to create a visual
separation. This break clusters exams together in groups.

Deleting Presets Delete all exam or image presets, except the following:
EXAM PRESETS IMAGE PRESETS
A power-up (*) Exam Preset The default Image Preset, marked

with an asterisk(*)
An active Exam Preset The active Image Preset
The only remaining Exam Preset

in a Category
The Default Exam Preset for any
Category
An ACUSON-protected Exam
Preset
Image Presets associated with protected Exam Presets cannot be deleted.

Only non protected Image Presets can be deleted, as long as they are not
one of the above exceptions. When selecting an Exam Preset, the Delete
button is disabled protecting both the Exam Preset and the associated
Image Presets.
◆ To delete an Exam or Image Preset:

1. Press SETUP and select PRESETS from the Setup menu.
2. Select the Exam or Image Preset to remove, and click the
corresponding DELETE button.
• To delete an Exam Preset, click the DELETE button below the
Exam Preset list.
• To delete an Image Preset, click the DELETE button below the
Image Preset list.
3. To confirm the deletion, use the trackball to select the DELETE button
within the message display box. To cancel, use the trackball to select
the CANCEL button within the message display box.
4. Press [EXIT].
Setting Default Set the default Exam Preset for a study when setting up Study Types. For
Exam Presets more information see “Customizing Begin/Study Type” on page 27.
1. To change the Default Image Preset for the current Exam Preset, select
the Image Preset and click the SET DEFAULT button under the Image
Preset list.
2. To remove an Image Preset from the Exam Preset, select the Image
Preset and click the DELETE button under the Image Preset list. An
active Image Preset or the Default Image Preset can not be removed.

Customizing Categories
Setting the Power-up The power-up Exam Preset is the one that takes effect when first turning
Exam Preset on the system (power-up). An asterisk (*) appears next to the power-up
Exam Preset in the Presets dialog box. Specify the power-up Exam Preset
when setting up the power-up Study Type. See “Customizing Begin/
Study Type” on page 27.
Customizing Categories are a collection of Exam Presets, Study types, and a default
Categories Study Type. Use Presets Setup to select, create, or delete Categories.
Selecting a Category ◆ To select a different Category, click the Category pop-up menu
and select a Category.
The Exam Presets for that Category appear.
Creating a Category ◆ To create a Category:
Figure 3-3 New Categories

1. Select a category with similar settings for a basis to create the new
category.
2. Customize the Exam and Image Presets for the category as described
“Deleting Presets” on page 50.
3. Click CREATE CATEGORY.
4. Enter a name for the new Category in the dialog box that appears and
click Create.
Deleting a Category Delete all Categories except:

• An active Category
• The last Category
• A Category with ACUSON -protected Exam Presets

If one of these categories is selected, Delete Category is disabled.

◆ To delete a Category:
1. Select the Category from the pop-up menu.
2. Click Delete Category.
A confirmation message appears.
3. Press OK to delete the Category or press CANCEL to cancel the
deletion.
When deleting a Category, the Exam Presets and Image Presets associated
with it are deleted.
Change the order in which Exam or Image Presets appear in menus. (By
default, new presets are added alphabetically.) Add a break between
Exam Presets to create a visual separation. This break clusters exams
together in groups.
Change Exam Preset 1. Select Presets from the Setup menu to display the Presets dialog box.
menu order
2. Click the Show More button to display advanced settings.
Click the arrows to move the

selected preset up or down in
the list.
Click the Add Break button to
create a separation between
presets.
Figure 3-4 Presets Setup Advanced Settings

3. Select an Exam or Image Preset to move.
4. Click the up or down arrow above or below Move to move the preset
up or down in the list.
Insert a Break between 1. To add a line between two presets, select the preset below the desired
Presets break insertion, then click the ADD BREAK button.

CHAPTER 4
CUSTOMIZING OB CALCULATIONS
Customizing OB Calculations 54
Changing the Report Heading and Configuration Name 55
Turning On and Off Measurements and Calculations 55
Customizing the Comment Page 55
Customizing Calculations 56

Chapter 4 Customizing OB Calculations
Although you can always use the standard OB calculation package, there
are several ways to customize the calculation package for your specific
needs. This chapter explains how to:
• Change the report heading and configuration name
• Turn individual measurements and calculations on or off
• Customize the report’s comment page
• Customize calculations
Your changes to the OB calculations package are stored permanently
(across system power-ups and new exams), until you change them again.
For a complete description of OB calculation package functions, see your
User Manual.
Customizing OB You use OB Calc Setup to customize the OB calculation package.

Calculations
◆ To enter OB Calc Setup, select OB Calc from the Setup menu.
Figure 4-1 OB Calc Setup

Changing the Report Heading and Configuration Name
Changing the The report title appears at the top of the OB report and worksheet.
Report Heading and
◆ To change the report title, enter the title you want in the Header
Configuration Name Text field.
The ultrasound label appears on each page of the OB report and
worksheet.
◆ To change the ultrasound label, enter the label you want in the
Config Name field.
Turning On and Off

Measurements and
Calculations
Biometry Measurements The OB Calc dialog box contains an array of option buttons for choosing
biometry measurements and calculations. Click the corresponding button
to turn on or off a measurement.
The current source for each biometry measurement appears next to its
name. You can change the source using the Customize function. See
“Customizing Optional Biometric Measurements” on page 57.
LMP% and EFW% represent the growth percentage results. Turning on
either option turns on the growth calculation.
Amniotic Fluid Index Turn on AFI to enable the AFI measurements and calculation.
Composite MA Choose a method for computing the composite MA by turning on

Calculation Hadlock composite or Arithmetic Mean.
If you enable Hadlock composite, the Hadlock composite equations are
used for composite MA and standard deviation when the only
measurements available are any combination of BPD, HC, AC and FL. If
additional measurements are available, or if you enable Arithmetic Mean,
the composite MA is an arithmetic mean of the individual MA, and no
standard deviation is available.
Circumference Choose the default measurement tool for measuring circumferences by

Measurement Tool turning on Trace or Ellipse.
Customizing the The OB worksheet contains two comment pages on which you can add
Comment Page additional information about the OB exam. The first comment page
contains several headings for fetal anatomy and biophysical profile.
During an exam, you enter comments after these headings. The second
comment page is blank.

You can customize the first comment page to change or delete any of the
headings.
◆ To customize the OB worksheet comment page:
1. Click Comments to display the Comment Page Customization dialog
box.
Figure 4-2 Comment Page Customization

2. Turn on each heading that you want to include on the comment page.
You can change heading text by editing any of the text fields.
3. Turn on Free-form Comments to display the free-form comments
section.
4. Turn on Biophysical Profile to display the biophysical profile
section.
Customizing You can customize OB calculations in the following ways:

Calculations • Specify MA coefficients for biometric measurements; see
“Customizing MA Coefficients for Biometric Measurements” on
page 57.
• Add optional biometric measurements; see “Customizing Optional
Biometric Measurements” on page 57.
• Customize the EFW equation; see “Customizing the EFW Equation”
on page 58.
• Add an optional ratio; see “Adding an Optional Ratio” on page 59.
• Customize percentiles; see “Customizing the LMP% and EFW%” on
page 59.
For alternate OB Calculation formulas, see Appendix A.

Customizing Calculations
Customizing MA You can customize the MA calculation and standard deviation for any of
Coefficients for Biometric the standard Siemens biometric measurements.
Measurements
◆ To customize obstetrical calculations biometry measurements:
1. Select the standard Siemens measurement (BPD, HC, AC, FL, or
CRL) you want from the Customize pop-up menu.
2. Choose an equation version, either Hadlock (the Siemens default
that you cannot customize) or one of the preprogrammed optional
equations. (See “Using the Charts” on page 145.) The appropriate
parameters appear automatically. Skip to step 6 to apply your change.
To replace one of the preprogrammed optional equations with a
different equation, select the optional equation, enter its name, and
continue to step 3.
3. Enter Min and Max values, in centimeters, for a User version.
The system assures that the Max value you enter is greater than the
Min value.
4. Enter the menstrual age equation in the MA text field.
You can type in any combination of numbers and letters on two lines.
Use the characters listed at the bottom of the window.
5. Enter the standard deviation equation in the SD text field.
NOTE: The system checks to ensure that you enter a valid equation or no
SD equation. If you do not, a warning message appears telling you to
enter a new equation.
6. Press [EXIT] or [PRIOR] to apply your changes.
Customizing Optional You can add optional biometric measurements to the OB calculation
Biometric Measurements package.
◆ To customize optional biometry measurements:
1. Choose one of the optional measurements from the Customize
pop-up menu: Opt1, Opt2, Opt3, or Opt4.
Option 1 Measurement
Figure 4-3 Option 1 Customization

2. Select one of the preprogrammed equations to use, or select the
preprogrammed equation that you want to replace. (For a list of
preprogrammed equations, see “Additional Equations” on page 147.)

If you want to use the selected equation, skip to step 9 to apply your
changes.
If you want to replace the equation with another, continue to step 3.
3. Enter a title for the measurement in the Meas Name text field.
The measurement name appears wherever the measurement is
displayed in the OB calculation package.
4. Choose the equation version that appears as the default for this
measurement. Enter a name for the equation version.
5. Choose Length, Circum, or Area as the Measurement Type.
6. Enter Min and Max values.
Min value.
7. Enter the menstrual age equation in the MA text field.
NOTE: You must enter the measurement label (Opt1, Opt2, Opt3, or
Opt4) in the MA equation. (For an example, see “Additional Equations”
on page 147.) If you do not, the equation is invalid. The system checks to
ensure that you enter a valid SD equation or no SD equation. If you do
not, a warning message appears telling you to enter a new equation.
Customizing the EFW ◆ To customize the EFW equation:

Equation
1. Choose EFW from the Customize pop-up menu.
EFW Measurement
Figure 4-4 EFW Customization

2. Choose an equation version: Hadlock (the Siemens default, which
you cannot customize) or one of the User customizable versions.
Enter your own names for the User versions.
If you choose Hadlock, the appropriate parameters appear
automatically and are not editable.
3. Enter Min and Max values, in weeks, for a User version.

Customizing Calculations
Min value.
4. Enter the EFW equation in the EFW text field.
NOTE: The system checks to ensure that you enter a valid equation or no
SD equation. If you do not, a warning message appears telling you to
enter a new equation.
Adding an Optional Ratio ◆ To add an optional ratio:

1. Choose Opt Ratio from the Customize pop-up menu.
Optional Ratio Measurement
Figure 4-5 Optional Ratio Customization

2. Enter a title for the ratio in the Result Name text field.
3. The ratio name appears wherever the ratio is displayed in the OB
calculation package.
4. Enter the ratio equation in the Opt Ratio text field.
NOTE: The system checks to ensure that you enter a valid equation. If
you do not, a warning message appears telling you to enter a new
equation.
Customizing the LMP% ◆ To customize LMP and EFW growth percentiles:

and EFW%
1. Choose LMP% or EFW% from the Customize pop-up menu.
2. Choose an equation version to use as the default: Williams (the
Siemens default which you cannot customize) or one of the User
customizable versions. Enter your own names for the User versions.
If you choose Williams, the appropriate parameter values appear
automatically and are not editable.
3. Enter Min and Max values, in weeks, for a User version.

For the LMP%, these values are the clinical MA. For the EFW%, these
values are the ultrasound MA.
Min value.
4. Enter a two-digit percentile in each % field, and then enter the
corresponding equation.
NOTE: The system checks to ensure that you enter a valid equation. If
you do not, a warning message appears telling you to enter a new
equation.

CHAPTER 5
CUSTOMIZING GYNECOLOGY CALCULATIONS
Overview 62
Customizing GYN Calculations 62

Chapter 5 Customizing Gynecology Calculations
Overview The GYN Calc settings in Setup are used to customize the package.
Measurements can be switched on or off, but only those that are switched
on will display in the measure menu and in reports.
Enterng and Exiting ◆ To enter GYN Calc Setup.
Setup
1. Press SETUP while in live imaging.
2. Select GYN Calc from the popup menu.
NOTE: You can not invoke GYN Calc Setup under the following
conditions: GYN Calc application has not completed loading or
measurements have already been entered into the GYN package.
◆ To exit select [EXIT] on any of the setup pages. Pressing SETUP
will not exit GYN Calc Setup.
Setup Soft keys GYN Calc Setup page soft keys:
SOFT KEY FUNCTION
[PAGE UP] Page up through the setup pages. Does nothing on

the first page.
[PAGE DOWN] Page down through the pages. Does nothing on the
last page.
[EXIT] Exit Setup, and return to live imaging.
Customizing GYN ◆ To customize GYN Calc measurements and calculations:

Calculations 1. Enter GYN Calc setup.
2. Use [PAGE UP] and [PAGE DOWN] to scroll through the pages until
the desired setup page displays.

Customizing GYN Calculations
Setup Pages There are five GYN Calc Setup pages: Uterus, Right Ovary, Left Ovary,
Doppler Sites, and Comments. Use the trackball and SELECT KEYS to
switch measurements and calculations on or off. The selections you make
will be displayed in the report page results.
Uterus You can customize the Uterus setup page to include all measurements
and calculations, or deselect the measurements and calculations you wish
to exclude.
Doppler measurement
settings
2-D
measurements
settings
Figure 5-1 Uterus Setup Page

Right Ovary The Right Ovary page displays 2-D and Doppler, ovarian and follicular
measurements and calculations.
• Changing the right ovary 2-D and Doppler settings apply only to the
right ovary.
• Changing the follicular computation (Avg Diameter and Volume)
apply to both left and right follicles. Specify whether to compute a
follicular volume or a follicular average diameter (only one can be
selected).
• Changing the individual follicle measurement setting affects only the
selected right ovary follicles.
Doppler
measurements
settings
2-D
measurements
settings
Individual
follicle
measurement
settings
Figure 5-2 Right Ovary Setup Page

Left Ovary The Left Ovary page displays 2-D and Doppler, and left ovarian follicular
measurements and calculations.
• Changing the left ovary 2-D and Doppler settings apply only to the
left ovary.
• Changing the follicular computation (Avg Diameter and Volume)
apply to both left and right follicles. Specify whether to compute a
follicular volume or a follicular average diameter (only one can be
selected).
• Changing the individual follicle measurement setting affect only the
selected left ovary follicles
Doppler
measurements
settings
2-D
measurements
settings
Individual
follicle
measurement
settings
Figure 5-3 Left Ovary Setup Page

Doppler Sites You can customize settings for Doppler site measurements and
calculations. This is often used to measure structures other than what is
listed in the setup pages.
◆ To change the name of a site:
1. Place the cursor inside the Name text cell and type in the new text.
• When adding to existing text, place the cursor where you want to
start the new text.
• When replacing all or part of existing text, use the track ball and
SELECT KEYS to select the text you want to replace.
2. Select the measurements and calculations to include with the new
site.
The new site name and on/off settings are exported to KinetDx along
with the exam data.

Figure 5-4 Doppler Sites Setup Page

Comments The Comments setup page allows you to control what is displayed in the
Comments report page. You can customize the following Comment page
attributes:
• Header text — place the cursor in this field and type any ascii text.
• Comment Labels — place the cursor in this field and type any text to
replace or add to existing text. Select the corresponding option
buttons to display that comment label.
• Free-form Comments — Click on this option button to switch display
of the Free-form comments page on or off.

2-D Measurements
MEASUREMENT NAME MEASURE MENU RESULT UNITS

ITEM TYPE
Uterus Length Uterus->Length Distance cm
Uterus Width Uterus->Width Distance cm
Uterus Height Uterus->Height Distance cm
Endometrium Thickness Uterus->Endo Thickness Distance cm
Cervix Length Uterus->Cervix Distance cm
Right Ovary Length Ovary->Length Distance cm
Right Ovary Width Ovary->Width Distance cm
Right Ovary Height Ovary->Height Distance cm
Right Follicle 1 Diam N (N=1-3) Right Follicles->Follicle 1 Distance cm
Right Follicle 10 Diam N (N=1-3) Right Follicles->Follicle Distance cm

10

11

12

13

14

15

16
Left Ovary Length Left Ovary->Length distance cm
Left Ovary Width Left Ovary->Width distance cm
Left Ovary Height Left Ovary->Height Distance cm
Left Follicle 1 Diam N (N=1-3) Left Follicles->Follicle 1 Distance cm


ITEM TYPE
Left Follicle 7 Diam N (N=1-3) Left Follicles->Follicle 7 Distance m
Doppler Measurements Doppler measurements are only available when the system is frozen.

ITEM TYPE
Uterus Maximum Velocity Uterus Velocity m/s
Uterus Minimum Velocity Uterus Velocity m/s
Uterus Time-Averaged Maximum Uterus Velocity m/s

Velocity
Uterus Acceleration Uterus Acceleration m/s2
Uterus Acceleration Time Uterus Time s
Right Ovary Maximum Velocity Right Ovary Velocity m/s
Right Ovary Minimum Velocity Right Ovary Velocity m/s
Right Ovary Time-Averaged Right Ovary Velocity m/s

Maximum Velocity
Right Ovary Acceleration Right Ovary Acceleration m/s2
Right Ovary Acceleration Time Right Ovary Time s
Left Ovary Maximum Velocity Left Ovary Velocity m/s
Left Ovary Minimum Velocity Left Ovary Velocity m/s
Left Ovary Time-Averaged Left Ovary Velocity m/s

Maximum Velocity
Left Ovary Acceleration Left Ovary Acceleration m/s2


ITEM TYPE
Left Ovary Acceleration Time Left Ovary Time s
Site 1 Maximum Velocity Site 1 Velocity m/s
Site 1 Minimum Velocity Site 1 Velocity m/s
Site 1 Time-Averaged Maximum Site 1 Velocity m/s

Velocity
Site 1 Acceleration Site 1 Acceleration m/s2
Site 1 Acceleration Time Site 1 Time s

Velocity

Velocity

Velocity
2-D Calculations The following table shows the available 2-D calculations:
2-D FORMULA UNITS

CALCULATION
Uterus Volume (UterusLength *UterusWidth*UterusHeight*PI)/6 cc
Right Ovary (ROvaryLength *ROvaryWidth*ROvaryHeight*PI)/6 cc

Volume
Left Ovary Volume (LOvaryLength *LOvaryWidth*LOvaryHeight*PI)/6 cc
Right Follicle N (4/3)*PI*((Right FollicleN Length/2)3) cc

Volume (N=1-16)
Left Follicle N (4/3)*PI*((Left FollicleN Length/2)3) cc

Volume (N=1-16)

2-D FORMULA UNITS

CALCULATION
Right Follicle N Sum(Right FollicleN Diameters)/# of Diameters cm

Avg Diameter
(N=1-16)
Left Follicle N Avg Sum(Left FollicleN Diameters)/# of Diameters cm

Diameter (N=1-16)
Doppler Calculations The following table shows the available doppler calculations:
DOPPLER STRIP FORMULA

CALCULATION
Uterus Pulsitility Index abs((Uterus Max - Uterus Min)/Uterus TAMX)
Uterus Resistivity Index abs(Uterus Max - Uterus Min)/ max(abs(Uterus Max),

abs(Uterus Min))
Uterus S/D Ratio abs(Uterus Max/Uterus Min)
Right Ovary Pulsitility Index abs((ROvaryMax - ROvaryMin)/ROvaryTAMX)
Right Ovary Resistivity Index abs(ROvaryMax - ROvaryMin)/

max(abs(ROvaryMax), abs(ROvaryMin))
Right Ovary S/D Ratio abs(ROvaryMax/ROvaryMin)
Left Ovary Pulsitility Index abs((LOvaryMax - LOvaryMin)/LOvaryTAMX)
Left Ovary Resistivity Index abs(LOvaryMax - LOvaryMin)/

max(abs(LOvaryMax), abs(LOvaryMin))
Left Ovary S/D Ratio abs(LOvaryMax/LOvaryMin)
Site 1 Pulsitility Index abs((Site1 Max - Site1 Min)/Site1 TAMX)
Site 1 Resistivity Index abs(Site1 Max - Site1 Min)/ max(abs(Site1 Max),

abs(Site1 Min))
Site 1 S/D Ratio abs(Site1 Max/Site1 Min)

abs(Site2 Min))

abs(Site3 Min))

abs(Site4 Min))


CHAPTER 6
CUSTOMIZING VASCULAR CALCULATIONS
Customizing the Vascular Calculation Report 72

Selecting Studies to Include in the Report 72
Customizing Study Names and Site Names 73
Storing Customizations to an Exam Preset 73
Vascular Calculation Formulas 74

Chapter 6 Customizing Vascular Calculations
Customizing the You can customize the vascular calculation report by:
Vascular Calculation • Selecting the studies you want to include in it
Report
• Changing the site names
• Adding your own custom title
For a full description of the vascular calculation package, refer to your
User Manual.
Selecting Studies to You select the studies that you want to include in the vascular calculation
Include in the report by turning them on. Turning off a study removes it from the
Report calculation package and the report until you turn it on again.
◆ To customize the vascular calculation report, select Vascular
Calc from the Setup menu.
If you are entering data into the vascular calculation package and want to
customize the vascular calculation setup, press CALC to exit the vascular
calculation package, and then press SETUP.
NOTE: Any customization must be performed prior to storing any
measurement values for a study. Once values are entered, measurement
tools are locked for that study.
Figure 6-1 Vascular Calc Setup Menu

1. Type in the Header Text that you want to appear at the top of the
Vascular worksheet and report.
2. Turn on or off the studies and measurements that you want to appear
in the vascular calculation package.
NOTE: When you turn off a measurement with psv in the Carotid Study,
the corresponding edv automatically turns off.
3. Press [EXIT] or SETUP to return to the image.

Customizing Study Names and Site Names
Customizing Study You customize the vascular calculation study and site names by editing
Names and Site the headings in the vascular calculation worksheet.
Names ◆ To customize study names and site names:
1. Press REPORT.
2. Press [VASCULAR] to display the vascular calculation worksheet as
shown in Figure 6-2.
3. Press [PAGE UP] or [PAGE DOWN] until the page you want to
customize in the report or worksheet appears.
4. Press [GO TO REPORT] or [GO TO WORKSHEET] to switch between
the worksheet and report.
Figure 6-2 Vascular Calculation Worksheet (Accel & Ratio Page)

5. Move the cursor to the site or study name you want to change.
6. Type the new site name. You can change the names of all of the sites.
IMPORTANT: Site names must be changed for each study that is stored in an Exam
Preset.
7. Press [IMAGE] or the REPORT key to return to imaging mode.
Storing To store vascular calculation customizations in an Exam Preset:

Customizations to 1. Press EXAM PRESET and select the Exam Preset to which you want to
an Exam Preset add your customizations from the pop-up menu.
2. Customize the studies to include in the report, study names, and site
names as described in “Selecting Studies to Include in the Report” on
page 72 and “Customizing Study Names and Site Names” on
page 73.
3. Select Presets from the Setup menu to display the Presets dialog box.

Chapter 6 Customizing Vascular Calculations
4. Click the Store button under the Exam Presets list to save you
changes to the Exam preset.
5. In the confirmation dialog box, click Overwrite to store the current
settings for the Exam Preset.
For more information about customizing Exam Presets, see Chapter 3.
Vascular Calculation
Formulas
Table 6-1 Vascular Calculation Formulas

STUDY CALCULATION FORMULAS
CAROTID ICA psv/CCA psv
ICA psv= Internal carotid peak systolic velocity (highest of three values:
ICA prox, ICA mid, ICA dist)
CCA psv= Common carotid peak systolic velocity
RESISTANCE INDICES | (MAX –MIN) | / | MAX | = RI
MAX= Maximum velocity
MIN= Minimum velocity
| (MAX–MIN) | / |TAMx | = PI
MAX= Maximum velocity
MIN= Minimum velocity
TAMx= Time averaged maximum velocity
| MAX | / | MIN | = S/D
VELOCITIES None
ACCELERATION ∆V/∆T
RATIO |NUM | / | DEN |
NUM= Any velocity
DEN= Any velocity
% STEN D |((A–a) / A)| x 100
A= Greater of AREA 1 and AREA 2
a= Lesser of AREA 1 and AREA 2
% STEN A |((D–d) / D)| x 100
D= Greater of DIAM 1 and DIAM 2
d= Lesser of DIAM 1 and DIAM 2

CHAPTER 7
CUSTOMIZING CARDIAC CALCULATIONS
Customizing Cardiac Calculations 76

Calculation Formulas 78
ProtoCALL Result Deletion Pathways 86
Reference Articles 91
Abbreviations 114

Chapter 7 Customizing Cardiac Calculations
The ACUSON Sequoia ProtoCALL calculation package is arranged to

guide you through the exact measurements required for analysis and is
organized in a goal-directed fashion; measurements are grouped together
along physiologically related concepts.
Conventional packages that you may have used in the past are typically
arranged either by mode (M-mode, 2-D, or Doppler) or by anatomy. They
do not follow the clinical investigative process, which is based on
assessing hemodynamics and physiology for each condition. The Sequoia
system organizes related measurements and calculations in synergy with
the clinical diagnostic approach.
The advantage of the ProtoCALL calculation package is that you do not
need to look up formulas or have instant recall to know which
calculations are needed or which measurements are required for a
calculation. For example, say you need to perform an LV mass
calculation, and you do not routinely perform this calculation. You
simply enter the Basic Measurements study and find the 2-D Volume/LV
Mass category. Under that category you find the measurements you need to
take in order to generate an LV mass calculation.
Furthermore, you can customize the ProtoCALL calculation package to
make any combination of measurements and calculations available for
your routine exams. For instructions on customizing the package, see
your Reference Manual.
The measurements and calculations derived with the ProtoCALL
calculation package can be viewed and edited in the report. At any time
during or at the end of an exam, you can access the report and display the
individual and mean values for each measurement. You can also print the
report to a local printer and capture the report pages to the onboard
AEGIS software.
The cardiac calculation package is available on Sequoia C256

Echocardiography systems, C512 Echocardiography systems, or 512
systems with Cardiac Option.
Customizing Your system arrived with a number of measurements and calculations

Cardiac preset for use. Depending on your protocols, you may want to turn on or
Calculations off certain items in the calculation package. This chapter describes how to
do so. It also provides reference information (abbreviations, calculation
formulas, and references) for the cardiac calculation package.

Customizing Cardiac Calculations
Customizing ◆ To customize cardiac calculations, select Cardiac Calc from the

Measurements and Setup menu.
Calculations
NOTE: If you are in cardiac calculations, first press CALC to exit.
Pages in Setup look similar to the presentation of the report pages.
Figure 7-1 shows a sample Setup page. Measurements are grouped in
categories and clusters and there is an option button for each category or
cluster (for example M-mode) and each measurement (for example,
Ao Diam.) Darkened buttons are turned on.
1. To turn a category or cluster or measurement on or off, select or
deselect the corresponding option button.
Turning off a cluster turns

off all measurements in
the cluster, and their labels
appear disabled.
Figure 7-1 Cardiac Calculations Setup Page
IMPORTANT: When you turn off a measurement in one part of the calculation package
it may still appear in other areas of the package if the measurement is
needed for other calculations. For example if you turn off LV Areas from
the apical four chamber dimensions, they will still be turned on for LV
volume calculations.
2. Press [PAGE UP] and [PAGE DOWN] or toggle the PAGE key to move
through various pages in Setup. Use the HOME key to move to the
first Setup page and the END key to move to the last Setup page.

Custom Report Title On the top line of the cardiac calculation report pages, you can enter a
custom title. The default name is Cardiac Reports.
◆ To change the name:
1. Point the cursor to the title area.
2. Press the trackball SELECT KEY three times rapidly to highlight the
entire line. Start typing the new title.
Or, point the arrow at the end of the existing text in the title box and
press trackball select once. You can backspace to erase the existing
text and then type the new text.
Calculation
Formulas
Basic Measurements
Table 7-1 Calculation Formulas for Basic Measurements

CALCULATION FORMULA
BASIC MEASUREMENTS, M-MODE
Left Ventricular End Diastolic Volume 7.0 3

= ----------------------------- × LVd
( 2.4 + LVd )
Left Ventricular End Systolic Volume 7.0 3

= ---------------------------- × LVs
( 2.4 + LVs )
Left Ventricular Stroke Volume = LV End Diastolic Volume – LV End Systolic Volume
Left Ventricular Stroke Index Stroke Volume
= -----------------------------------
BSA
Left Ventricular Cardiac Output Stroke Volume × Heart Rate

= --------------------------------------------------------------------
1000
Left Ventricular Cardiac Index Cardiac Output

= -------------------------------------
BSA
Ejection Fraction LV End Diastolic Volume – LV End Systolic Volume

= ----------------------------------------------------------------------------------------------------------------------------- × 100
LV End Diastolic Volume
Left Ventricular % Fractional Shortening LVd – LVs

= -------------------------- × 100
LVd
Interventricular Septal % Thickening IVSs – IVSd

= ------------------------------ × 100
IVSd
Left Ventricular Posterior Wall % Thickening LVPWs – LVPWd
= --------------------------------------------- × 100
LVPWd
Left Ventricular Mass = 1.04 × [ ( LVd + LVPWd + IVSd ) – LVd ]

3 3
Left Ventricular Mass, corrected ·

= ( 0.80 × LVMass ) + 0.6

Calculation Formulas
Table 7-1 Calculation Formulas for Basic Measurements (Continued)

CALCULATION FORMULA
Mean Vcfc ( LVd – LVs )
= -----------------------------------
LVd × LVETc
where LVETc = LVET

---------------
RR
STIS
LV PEPc = LV PEP + 0.4 ( HR )
LVETc = LVET + 1.6 ( HR )
RV PEPc = RV PEP + 0.37 ( HR )
RVETc = RVET + 1.09 ( HR ) – ( 2.59 × Age In Years )
2D DIMENSIONS
Interventricular Septal % Thickening IVSs – IVSd

= ------------------------------ × 100
IVSd
Left Ventricular Posterior Wall % Thickening LVPWs – LVPWd

= --------------------------------------------- × 100
LVPWd
Left Ventricular % Fractional Shortening LVd – LVs

= -------------------------- × 100
LVd
Left Ventricular % Fractional Area Change LV Area d – LV Area s

= ------------------------------------------------------ × 100
LV Area d
Right Ventricular % Fractional Area Change RV Area d – RV Area s

= -------------------------------------------------------- × 100
RV Area d
%∆, E to I Inspiration – Expiration

= -------------------------------------------------------------------- × 100
Expiration
LV Volume, Method of Disks 20

π L
= --- ∑ a i × ------
2
4 20
i=1
where ai = 20 disks obtained from A4C or A2C

LV Stroke Volume, Method of Disks = LVd MOD Vol. - LVs MOD Vol
LV Stroke Index, Method of Disks MOD Stroke Volume
= ---------------------------------------------------
BSA
LV Cardiac Output, Method of Disks MOD Stroke Volume × Heart Rate

= ------------------------------------------------------------------------------------
1000
LV Cardiac Index, Method of Disks

= MOD Cardiac Output
-----------------------------------------------------
BSA
LV Ejection Fraction, Method of Disks LVd MOD Vol – LVs MOD Vol
= ----------------------------------------------------------------------------- × 100
LVd MOD Vol
LV Volume, Area/Length Method 2

0.85 × A
= -----------------------
L


CALCULATION FORMULA
LV Stroke Volume, Area/Length Method = LVd A/L Vol – LVs A/L Vol
LV Stroke Index, Area/Length Method A/L Stroke Volume

= ----------------------------------------------
BSA
LV Cardiac Output, Area/Length Method A/L Stroke Volume × ( HR )

= -------------------------------------------------------------------
1000
LV Cardiac Index, Area/Length Method A/L Cardiac Output

= ------------------------------------------------
BSA
LV Ejection Fraction, Area/Length Method LVd A/L Vol – LVs A/L Vol
= -------------------------------------------------------------------- × 100
LVd Vol A/L
LV Volume, Biplane Method of Disks 20

π L
= --- ∑ a i × b i × ------
4 20
i=1
where ai, bi = 20 disks obtained from A4C and A2C

LV Volume, Biplane, Area/Length Method = 0.85 x A1 x A2/L
where A1, A2 = areas from orthogonal views
LV Volume, Bullet Method = 5 ⁄ 6 × LV Area SAX × L
where L = major axis, A4C
Left Atrial Volume, Biplane, Method of Disks 20
π L
= --- ∑ a i × b i × ------
4 20
i=1
where ai, bi = 20 disks obtained from orthogonal views

Right Atrial Volume, Biplane, 20
π L
Method of Disks = --- ∑ a i × b i × ------
4 20
i=1
where ai, bi = 20 disks obtained from orthogonal views
Right Ventricular Volume, Prolate Ellipse =2/3 x A1 x L2

LV Mass, Area/Length Method = 1.055 × 5 ⁄ 6 × ( LVd area SAX Epi – LVd area SAX Endo ) × L
L = Major axis, d from A4C or A2C, whichever is
longest
LV Mass, Truncated Ellipse Method = 1.05 x π [(b + t)2 x [2/3 (a + t) + d - (d3/3 (a + t)2)] -
b2 x [2/3 (a) + d - (d3/3a2)]
t = (LVd area SAX Epi/π) 1/2 - (LVd area SAX Endo/π)
1/2
b = (LVd area SAX Endo/π) 1/2
a = Semi-Major axis between apex and cavity minor
radius
d = Truncated Semi-major axis between cavity minor
radius and mitral valve.


CALCULATION FORMULA
BASIC DOPPLER SURVEY FORMULA
Peak Gradient = 4 x Vmax2
Pressure Predictions
Table 7-2 Calculation Formulas for Pressure Predictions

PRESSURE PREDICTION CALCULATION FORMULA
RVSP from Tricuspid Regurgitation = RA pressure + 4V2
V = TR Vmax
RVSP from Ventricular Septal Defect = Systolic Blood Pressure - 4V2
V = VSD Vmax
PADP = RA Pressure + 4V2
V = PR Vmax at end diastole
LVSP = Systolic cuff pressure + 4V2
V = AoV Vmax
LVEDP = Diastolic cuff pressure - 4V2
V = AR Vmax at end diastole
LASP = Systolic cuff pressure - 4V2
V = MR Vmax
Simplified Bernoulli = 4V22
Expanded Bernoulli = 4 (V2 2 - V1 2)

Valve Stenosis
Table 7-3 Calculation Formulas for Valve Stenosis

VALVE STENOSIS CALCULATION FORMULA
Peak Gradient = 4 x V2
Mean Gradient Average of all the instantaneous 4V2 over the flow
period
Continuity Equation A2 = A1 xVTI1/VTI2
OR
A2 = A1 x Pk V1/PkV2
OR
A2 = A1 x Vmean1/Vmean2
Valve Area by PISA 2
2πr × Val
= -------------------------
-
Vmax
r = PISA radius
V = aliasing velocity
al
Vmax = peak of valve stenosis jet
Valve Area by PISA with Funnel Angle 2πr × Val
2
α
Correction (MV and TV) = -------------------------- × ---------
Vmax 180
r = radius
al
Vmax = peak of valve stenosis jet
α = funnel angle
Instantaneous Flow Rate by PISA = 2πr2 x Val x 6
al
r = radius
Pressure Half-Time = 0.29 x Deceleration Time
Mitral Valve Area by Pressure Half-Time = 220/P 1/2 Time
Mitral Valve Area or Tricuspid Valve Area by = π/4 x d1 x d2
biplane ellipse

Valve Regurgitation
Table 7-4 Calculation Formulas for Valve Regurgitation

VALVE REGURGITATION FORMULA
Regurgitant Volume by PISA (ml) = Eff ROA x VTI
VTI = VTI of regurgitant jet
Effective Regurgitant Orifice Area by PISA in = Flow Rate/V
mm2 V = peak Velocity of regurgitant jet (m/sec)
Flow Rate by PISA (ml/sec) = (2π r 2) x Val x 100
r = PISA radius
Val = aliasing velocity
Regurgitant Fraction by all methods = (Regurgitant Volume/Forward Flow Across
Regurgitant Valve) x 100
Regurgitant Volume by Doppler/Doppler = SV across regurgitant valve - SV across normal valve
Method (Site 2)
SV = (πd2/4) x VTI x 100
Regurgitant Volume by 2D/Doppler Method = SV from 2D - SV from Doppler across a normal valve
Effective Regurgitant Orifice Area (Eff ROA) = Regurgitant Volume/ VTI of regurgitant jet
for Doppler/Doppler and 2D/Doppler
Aortic Regurgitation Pressure Half-time = 0.29 x Deceleration Time
Volume Flow/Shunts
Table 7-5 Calculation Formulas for Volume Flow/Shunts

VOLUME FLOW/SHUNTS CALCULATION FORMULA
Stroke Volume (SV) = CSA x VTI x 100
Stroke Index = SV/BSA
Cardiac Output = SV x HR/1000
Cardiac Index = CO/BSA
Qp/Qs = Pulmonic CO/Systemic CO
Qp-Qs = Pulmonic CO - Systemic CO, if P > S

Coronary Artery Flow
Table 7-6 Calculation Formulas for Flow Reserve LAD and Generic applications.
CORONARY ARTERY FLOW FORMULA
CALCULATION
Ratio: VTI, d peak hyperemia VTI, d / baseline VTI, d
Ratio: MeanVel, d peak hyperemia MeanVel, d / baseline MeanVel, d
Ratio: Vmax, d peak hyperemia Vmax, d / baseline Vmax, d
Ratio: VTI, s peak hyperemia VTI, s / baseline VTI, s
Ratio: MeanVel, s peak hyperemia MeanVel, s / baseline MeanVel, s
Ratio: Vmax, s peak hyperemia Vmax, s / baseline Vmax, s
Ratio: VTI, R-R peak hyperemia VTI, R-R / baseline VTI, R-R
Ratio: MeanVel, R-R peak hyperemia MeanVel, R-R / baseline MeanVel, R-R
Table 7-7 Calculation Formulas for Ventricular Function

VENTRICULAR FUNCTION CALCULATION FORMULA
% Fractional Shortening LVd – LVs

= -------------------------- × 100
LVd
Left Ventricular Wall Stress, Meridional 0.334 × ( P × LVs )

= ------------------------------------------------------------
LVPWs ×  1 + LVPWs -------------------
 LVs 
P = systolic cuff pressure
Left Ventricular Wall Stress, Circumferential 2 2
1.35 Pr [ 1 – ( 2r ⁄ L ) ]
= ---------------------------------------------------------
LVPWs
P = systolic cuff pressure
r = LVs/2
L = Max Major axis, A4C or A2C
Peak Filling Rate/Stroke Volume = Peak E/VTI
VTI = VTI of TV or MV at leaflet tips
Pulmonary Venous Flow A duration minus = PV Aduration - MV Aduration
Mitral Valve A duration
Systemic Venous Flow A duration minus = SV Aduration - TV Aduration
Tricuspid Valve A duration
Systolic Filling Fraction S VTI
= ---------------------------------- × 100
S VTI + D VTI
%∆, E to I Inspiration – Expiration

= -------------------------------------------------------------------- × 100
Expiration

Wall Motion Scoring Figure 7-2 shows region numbers used in the following formulas.
Table 7-8 Calculation Formulas for Wall Motion Scoring

WALL MOTION SCORING CALCULATION FORMULA
Index = (sum of all scores) / (# of scored regions)

%normal = (# of regions with score of 1) / (# of scored regions) x 100
LAD = (sum of LAD region scores) / (# of scored LAD regions)
where LAD = regions 1, 2, 7, 8, 13, 14, 15, and 16
LCCA = (sum of LCCA region scores) / (# of scored LCCA
regions)
where LCCA = regions 3, 4, 9, and 10
RMCA = (sum of RMCA region scores) / (# of scored RMCA
regions)
where RMCA = regions 5, 6, 11, and 12
Parasternal Short Axis (PSAX)
2 1 6 15
12 9
4 3
4
Apical 4 Chamber (A4C) Apical 2 Chamber (A2C)
7 8 13 14
6 9 12 15
5 11 16
10
Figure 7-2 Wall Scoring and Coronary Distribution

ProtoCALL Result If you edit a measurement in the calculation package some measurements
Deletion Pathways produce multiple results that are not calculations. You may wish to edit
these measurements also, since they may contribute to other calculation
formulas. These tables will assist you in finding these measurements and
the report pages in which they can be found.
Table 7-9 ProtoCALL Result Deletion Pathways

MEASUREMENT RESULTANT VALUES REPORT PANELS THAT MIGHT REQUIRE EDITING
AoV VTI (Basic) AoV VTI AoV, Basic Doppler Survey, Basic Measurements
AoV Vmax
AoV ET
AoV VTI (Stenosis) AoV VTI AoV Doppler, Valve Stenosis
AoV Vmax AoV Continuity Equation, Valve Stenosis
AoV Mn Grad
AoV Mn Vel
AoV AT
AoV ET
AR PISA Radius PISA Radius AR PISA, Valve Regurgitation
CD Velocity at Radius
AR Slope AR Slope AR Slope Indexes, AR Doppler, Valve
AR DT Regurgitation
AR VTI AR VTI AR PISA, Valve Regurgitation
AR Vmax AR Volume by Doppler/Doppler, Valve
Regurgitation
AR Volume by 2D/Doppler, Valve
Regurgitation
Flow Reserve LAD Flow Reserve LAD VTI, * Flow Reserve LAD
VTI, * Flow Reserve LAD Mean Vel, *
(* = d, s, or R-R) Flow Reserve LAD Vmax, *
Flow Reserve LAD Flow Reserve LAD Mean Vel, * Flow Reserve LAD
Mean Vel, * Flow Reserve LAD Vmax, *
(* = d, s, or R-R)
Flow Reserve Flow Reserve Generic VTI, * Flow Reserve Generic

Generic VTI, * Flow Reserve Generic
Mean Vel, *
(* = d, s, or R-R)
Flow Reserve Generic Vmax, *
Flow Reserve Flow Reserve Generic Flow Reserve Generic
Generic Mean Vel, * Mean Vel, *
Flow Reserve Generic Vmax, *
(* = d, s, or R-R)
IVC D VTI IVC D VTI Venous Flow, Basic Doppler, Basic

IVC D Vmax Measurements
Systemic Venous Flow, RV Diastolic Function,
Ventricular Function
IVC S VTI IVC S VTI Venous Flow, Basic Doppler, Basic
IVC S Vmax Measurements

ProtoCALL Result Deletion Pathways
Table 7-9 ProtoCALL Result Deletion Pathways (Continued)

LA Area, Vw 1, d LA Area LA Volumes, 2D Volumes, Basic Measurements
LA Major Axis
LA Volume
LA Area, Vw 1, s LA Area LA Volumes, 2D Volumes, Basic Measurements
LA Major Axis
LA Volume
LA Area, Vw 2, d LA Area LA Volumes, 2D Volumes, Basic Measurements
LA Major Axis
LA Volume
LA Area, Vw 2, s LA Area LA Volumes, 2D Volumes, Basic Measurements
LA Major Axis
LA Volume
LLPV D VTI LLPV D VTI Venous Flow, Basic Doppler, Basic
LLPV D Vmax Measurements
Pulmonary Venous Flow, LV Diastolic Function,
Venous Flow, Mitral Valve, Valve Regurgitation
LLPV S VTI LLPV S VTI Venous Flow, Basic Doppler, Basic
LLPV S Vmax Measurements
LUPV D VTI LUPV D VTI Venous Flow, Basic Doppler, Basic
LUPV D Vmax Measurements
LUPV S VTI LUPV S VTI Venous Flow, Basic Doppler, Basic
LUPV S Vmax Measurements
LV Area, d, A2C LV Area A2C, 2D Dimensions, Basic Measurements
LV Major Axis LV Volumes, 2D Volumes, Basic Measurements
LV Volume AR Volume by 2D/Doppler, Valve
Regurgitation
MR Volume by 2D/Doppler, Valve
Regurgitation
EF/CO, LV Systolic Function, Ventricular
Function


LV Area, d, A4C LV Area A4C, 2D Dimensions, Basic Measurements
LV Volume LV 2D Mass, A/L, Basic Measurements
LV Semi-Major Axis LV 2D Mass, TE, Basic Measurements
LV Truncated AR Volume by 2D/Doppler, Valve
Semi-Major Axis Regurgitation
Regurgitation
Function
LV Area, s, A2C LV Area A2C, 2D Dimensions, Basic Measurements
Regurgitation
Regurgitation
Function
LV Area, s, A4C LV Area A4C, 2D Dimensions, Basic Measurements
Regurgitation
Regurgitation
Function
LVOT PISA Radius PISA Radius AoV PISA, Valve Stenosis
LVOT VTI LVOT VTI AoV Continuity Equation, Valve Stenosis
LVOT Vmax AoV, Volume Flow/Shunts
LVOT Vmn
MR PISA Radius PISA Radius MR PISA, Valve Regurgitation
MR VTI MR VTI MR PISA, Valve Regurgitation
MR Vmax MR by Doppler/Doppler, Valve Regurgitation
MR by 2D/Doppler, Valve Regurgitation
MV PISA Radius PISA Radius MV PISA, Valve Stenosis
MV VTI, leaflet tips MV VTI, leaflet tips MV Doppler, Valve Stenosis
MV Mn Grad, leaflet MV Continuity Equation, Valve Stenosis
tips
PR PISA Radius PISA Radius PR PISA, Valve Regurgitation
PR VTI PR VTI PR PISA, Valve Regurgitation
PR Vmax PR by Doppler/Doppler, Valve Regurgitation
PR by 2D/Doppler, Valve Regurgitation

ProtoCALL Result Deletion Pathways

PV VTI (Basic) PV VTI PV, Basic Doppler Survey, Basic Measurements
PV Vmax RV Doppler, RV Systolic Function, Ventricular
PV ET Function
PV VTI (Stenosis) PV VTI PV Doppler, Valve Stenosis
PV Vmax PV Continuity Equation, Valve Stenosis
PV Mn Grad
PV AT
PV ET
PV Vmn
RA Area, Vw 1, d RA Area RA Volumes, 2D Volumes, Basic Measurements
RA Major Axis
RA Volume
RA Area, Vw 1, s RA Area RA Volumes, 2D Volumes, Basic Measurements
RA Major Axis
RA Volume
RA Area, Vw 2, d RA Area RA Volumes, 2D Volumes, Basic Measurements
RA Major Axis
RA Volume
RA Area, Vw 2, s RA Area RA Volumes, 2D Volumes, Basic Measurements
RA Major Axis
RA Volume
RLPV D VTI RLPV D VTI Venous Flow, Basic Doppler, Basic
RLPV D Vmax Measurements
RLPV S VTI RLPV S VTI Venous Flow, Basic Doppler, Basic
RLPV S Vmax Measurements
RUPV D VTI RUPV D VTI Venous Flow, Basic Doppler, Basic
RUPV D Vmax Measurements
RUPV S VTI RUPV S VTI Venous Flow, Basic Doppler, Basic
RUPV S Vmax Measurements
RVOT PISA Radius PISA Radius PV PISA, Valve Stenosis
RVOT VTI (Stenosis) RVOT VTI PV Continuity Equation, Valve Stenosis
RVOT Vmax
RVOT Vmn


Site PISA Radius PISA Radius Generic PISA, Valve Stenosis
Site PISA Radius PISA Radius Generic PISA, Valve Regurgitation
Site Regurg VTI PISA Radius Generic PISA, Valve Regurgitation
SVC D VTI SVC D VTI Venous Flow, Basic Doppler, Basic
SVC D Vmax Measurements
SVC S VTI SVC S VTI Venous Flow, Basic Doppler, Basic
SVC S Vmax Measurements
TR PISA Radius PISA Radius TR PISA, Valve Regurgitation
TR VTI TR VTI RVSP via TR or VSD, Pressure Predictions
TR Vmax PA Pressures, Mitral Valve, Valve Stenosis
PV Doppler, Valve Stenosis
TR PISA, Valve Regurgitation
TR Volume by Doppler/Doppler, Valve
Regurgitation
TR Volume by 2D/Doppler, Valve Regurgitation
TV PISA Radius PISA Radius TV PISA, Valve Stenosis
TV VTI, leaflet tips TV VTI TV, Basic Doppler Survey, Basic Measurements
TV Mn Grad TV Doppler, Valve Stenosis
TV Continuity Equation, Valve Stenosis
TV Flow, RV Diastolic Function, Ventricular
Function
Velocities Velocities LAD VTI Velocities LAD
LAD VTI, d Velocities LAD Mean Vel
Velocities LAD Vmax
(* = d, s, or R-R)
Velocities Velocities LAD Mean Vel Velocities LAD

LAD Mean Vel, d Velocities LAD Vmax
(* = d, s, or R-R)
Velocities Velocities Generic VTI Velocities Generic

Generic VTI, d Velocities Generic Mean Vel
Velocities Generic Vmax
(* = d, s, or R-R)
Velocities Velocities Generic Mean Vel Velocities Generic

Generic Mean Vel, d Velocities Generic Vmax
(* = d, s, or R-R)

Reference Articles
Reference Articles
Basic Measurements
M-mode Sahn DJ, DeMaria A, Kisslo J, Weyman A: Recommendations Regarding
Quantitation in M-mode Echocardiography: Results of a Survey of
Echocardiographic Measurements. Circulation 1978; 6:58.
STIs Weissler AM, Harris LC, White GD: Left-ventricular ejection time index
in man. J Appl Physiol 1963; 18:919-923.
Weissler AM, Harris WS, Schoenfeld CD: Systolic Time Intervals in Heart
Failure in Man. Circulation (February) 1968; Vol. 37.
Weissler AM, Garrard CL: Systolic Time Intervals in Cardiac Disease (I).
Journal of the AHA (January) 1971; Vol. XL, No. 1:1-8.
2D Chamber Dimensions Schnittger I, Gordon EP, Fitzgerald PJ, et al.: Standardized intracardiac
measurements of two-dimensional echocardiography. J Am Coll Cardiol
1983; 2:934-938.
Kuecherer H, et al.: Echocardiography in Serial Evaluation of Left
Ventricular Systolic and Diastolic Function: Importance of Image
Acquisition, Quantitation, and Physiologic Variability in Clinical and
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Domanski MJ, Cunnion RE, Roberts WC: Analysis of fractional area
change at various levels in the normal left ventricle. Am Journal of
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PLAX King DH, Smith EO, Huhta JC, et Al.: Mitral and tricuspid valve annular
diameter in normal children determined by two-dimensional
echocardiography. Am J Cardiol 1985; 55:787-789.
Sheil MLK, Jenkins O, Sholler GF: Echocardiographic assessment of aortic
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of aortic size independent of growth. Am J Cardiol 1995; 75:711-716.
Roman MJ, Devereux RB, Kramer-Fox R, et al.: Two-dimensional
echocardiographic aortic root dimensions in normal children and adults.
Am J Cardiol 1989; 64-507-512.
PSAX Aortic Valve Level Schnittger I, Gordon EP, Fitzgerald PJ, et al.: Standardized intracardiac
1983; 2:934-938.
Snider AR, Enderlein MA, Teitel DF, et al.: Two-dimensional
echocardiographic determination of aortic and pulmonary artery sizes
from infancy to adulthood in normal subjects. Am J Cardiol 1984; 53:218-
224.
PSAX, Chordal Level Schnittger I, Gordon EP, Fitzgerald PJ, et al.: Standardized intracardiac
1983; 2:934-938.
PSAX, Papillary Level Schnittger I, Gordon EP, Fitzgerald PJ, et al.: Standardized intracardiac
1983; 2:934-938.

A4C King DH, Smith EO, Huhta JC, et al.: Mitral and tricuspid valve annular
echocardiography. J Am Coll Cardiol 1985; 55:787-789.
Bommer W, Weinert L, Neumann A, et al.: Determination of right atrial
and right ventricular size by two-dimensional echocardiography.
Circulation 1979; 60:91-100.
SSN, Long Axis Snider AR, Enderlein MA, Teitel DF, et al.: Two-dimensional
224.
SSN, Short Axis Snider AR, Enderlein MA, Teitel DF, et al.: Two-dimensional
224.
2D Volumes / Mass Weyman A: Clinical Applications of Cross-Sectional Echocardiography.
Circulation 1982.
Silverman NH, Ports TA, Snider AR, et al.: Determination of left
ventricular volume in children: Echocardiographic and angiographic
comparisons. Circulation 1980; 62:548-557.
Mercier JC, DiSessa TG, Jarmakani JM, et al.: Two-dimensional
echocardiographic assessment of left ventricular volumes and ejection
fraction in children. Circulation 1982; 65:962-969.
Schiller NB, Acquatella H, Ports TA, et al.: Left ventricular volume from
paired biplane two-dimensional echocardiography. Circulation 1979;
60:547-555.
Wahr DW, Wang YS, Schiller NB: Left ventricular volumes determined by
two-dimensional echocardiography in a normal adult population.
J Am Coll Cardiol 1983; 1:863-868.
Schiller NB, et al.: Recommendations for quantification of the left
ventricle by two-dimensional echocardiography. J Am Soc Echo 1989;
2:358-267.
LV Volumes Schiller N, Acquatella H, et al.: Left ventricular volume from paired
biplane two-dimensional echocardiography. Circulation 1979; 60 (3): 547-
555.
ventricular volume in children: Echocardiographic and angiographic
Mercier JC, DiSessa TG, Jarmakani JM, et al.: Two dimensional

Reference Articles
LA Volumes Schabelman S, Schiller NB, Silverman NH, Ports TA: Left Atrial Volume
Estimation by Two-Dimensional Echocardiography, Catheterization and
Cardiovascular Diagnosis. Am J Cardiol 1981; 7:165-178.
Gutman J, Wang YS, Wahr D, Schiller NB: Normal Left Atrial Function
Determined by 2-Dimensional Echocardiography. Am J Cardiol (January
15) 1983; 51:236-240.
Wang Y, Gutman J, Heilbrom D, Wahr D, Schiller NB: Atrial Volume in a
Normal Adult Population by Two-dimensional Echocardiography. Chest
(October)1984; 86: 595-601.
Schabelman SE, Schiller NB, Anschultz RA, et al.: Comparison of four
two-dimensional echocardiographic views for measuring left atrial size.
Am J Cardiol 1978; 41:391-396.
RV Volumes Levine RA, Gibson TC, Aretz T, Gillam LD, Guyer D, King ME, Weyman
AE: Echocardiographic measurement of right ventricular volume.
Circulation 1984; Vol. 69, No 3:497-505.
Starling MR, Crawford MH, Sorensen SG, O’Rourke RA: A New Two-
dimensional Echocardiographic Technique for Evaluating Right
Ventricular Size and Performance in Patients with Obstructive Lung
Disease. Circulation 1982; Vol. 66, No 3:612-620.
Watanabe T, Katsume H, Matsukubo H, Furukawa K, Ijichi H: Estimation
of Right Ventricular Volume with two dimensional Echocardiography.
J Am Cardiol (June) 1982; 49:1946-1953.
Bommer W, Weinert L, Neumann A, Neef J, Mason D, DeMaria A:
Determination of Right Atrial and Right Ventricular Size by Two-
Dimensional Echocardiography. Circulation 1979; Vol. 60, No. 1.
Hiraishi S, DiSessa TG, Jarmakani JM, Nakanishi T, Isabel-Jones JB,
Friedman WF: Two-Dimensional Echocardiographic Assessment of Right
Ventricular Volume in Children with Congenital Heart Disease.
Am Journal of Cardiology (December) 1982; 50:1368-1375.
RA Volumes Lambertz H, Flachskampf FA, Heiliger R, Krebs W, Behrens B, Schmitz E:
New Echocardiographic and angiographic methods for right atrial
volume determination; in vitro validation and in vivo results.
International Journal of Cardiac Imaging 1989; 5:39-51.
Wang Y, Gutman J, Heilbrom D, Wahr D, Schiller NB: Atrial Volume in a
Normal Adult Population by Two-dimensional Echocardiography. Chest
(October) 1979; 86: 595-601.
Bommer W, Weinert L, Neumann A, Neef J, Mason DT, DeMaria A:
Determination of Right Atrial and Right Ventricular Size by
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Abbreviations
M-mode
Table 7-10 Abbreviations, M-mode

Ao Diam, d or s aortic diameter, diastole or systole
EPSS/LVEDD E-point to septal separation/left ventricular end diastolic dimension
ratio
HR heart rate
IVS % Thck interventricular septum percent thickening
IVS, d or s interventricular septum, thickness diastole or systole
IVS/LVPW interventricular septum/left ventricular posterior wall ratio
LA Diam, d or s left atrial diameter, diastole or systole
LAs/Aod left atrium systolic dimension/aortic diastolic dimension
LV CI left ventricular cardiac index
LV CO left ventricular cardiac output
LV EF left ventricular ejection fraction
LV ET left ventricular ejection time
LV ETc left ventricular ejection time, corrected
LV % FS left ventricular percent fractional shortening
LV Mass left ventricular mass, American Society of Echocardiography method
LV Mass/BSA left ventricular mass, American Society of Echocardiography method,
indexed by body surface area
LV Mass/Ht left ventricular mass index, American Society of Echocardiography
method, indexed by height
LV Vol left ventricular volume
LV PEP left ventricular pre-ejection period
LV PEP/ET left ventricular pre-ejection period/ejection time ratio
LV PEPc left ventricular pre-ejection period, corrected
LV SI left ventricular stroke index
LV SV left ventricular stroke volume
LV, d or s left ventricle, diastole or systole
LVPW % Thck left ventricular posterior wall percent thickening
LVPW, d or s left ventricular posterior wall, diastole or systole
Mean Vcfc mean velocity of circumferential shortening, corrected
MV EPSS mitral valve E-point to septal separation
PE, d pericardial effusion, diastole
RV ET right ventricular ejection time

Abbreviations
Table 7-10 Abbreviations, M-mode (Continued)

RV ETc right ventricular ejection time, corrected
RV PEP right ventricular pre-ejection period
RV PEP/ET right ventricular pre-ejection period/ejection time ratio
RV PEPc right ventricular pre-ejection period, corrected
RVAW, d or s right ventricular anterior wall, diastole or systole
RV, d or s right ventricular dimension, diastole or systole
STI systolic time interval
2-D Imaging
Table 7-11 Abbreviations, 2-D

A/L area/length
A/P anterior/posterior
A2C apical two chamber
A4C apical four chamber
Ao Diam, d or s aortic diameter, diastole or systole
AAo Diam, d or s ascending aortic diameter, diastole or systole
Ao Isth Diam, d or s aortic isthmus diameter, diastole or systole
Ao Root Diam, d or s aortic root diameter, diastole or systole
Ao ST junct Diam, d or s aortic sinotubular junction diameter, diastole or systole
AoV aortic valve
BP blood pressure
BP biplane
Bullet Bullet formula
CI cardiac index
CO cardiac output
d diastolic
desc Ao Diam, d or s descending aortic diameter, diastole or systole
EF ejection fraction
endo endocardial
epi epicardial
HR heart rate
IVS, d or s interventricular septum, diastole or systole
LA A/P Diam, d or s left atrium anterior/posterior diameter, diastole or systole
LA Area, d or s left atrial area, diastole or systole
LA R/L Diam, d or s left atrium right/left diameter, diastole or systole

Table 7-11 Abbreviations, 2-D (Continued)

LA S/I Diam, d or s left atrium superior/inferior, diastole or systole
LAD Diam, d or s left anterior descending coronary artery diameter, diastole or systole
LCCA Diam, d or s left circumflex coronary artery diameter, diastole or systole
LLPV Diam, d or s left lower pulmonary vein diameter, diastole or systole
LMCA Diam, d or s left main coronary artery diameter, diastole or systole
LPA Diam, d or s left pulmonary artery diameter, diastole or systole
LUPV Diam, d or s left upper pulmonary vein diameter, diastole or systole
LV Area, d or s left ventricular area, diastole or systole
LV CO left ventricular cardiac output
LV CI left ventricular cardiac index
LV EF left ventricular ejection fraction
LV Endo area left ventricular endocardial area
LV Epi area left ventricular epicardial area
LV % FAC left ventricular percent fractional area change
LV % FS left ventricular percent fractional shortening
LV Mass/BSA left ventricular mass, indexed by body surface area
LV Mass/Ht left ventricular mass, indexed by height
LV Minor, chord, d or s left ventricular minor axis, chordal level, diastole or systole
LV Minor, pap, d or s left ventricular minor axis, papillary muscle level, diastole systole
LV Trunc Semi-maj axis left ventricular truncated semi-major axis
LV SI left ventricular stroke index
LV SV left ventricular stroke volume
LVPW, d or s left ventricular posterior wall, diastole or systole
MOD Method of Disks
MPA Diam, d or s main pulmonary artery diameter, diastole or systole
MV Annulus Diam, d or s mitral valve annulus diameter, diastole or systole
PLAX parasternal long axis
Prol Ell prolate ellipsoid
PSAX parasternal short axis
PSAX, Chord Level parasternal short axis, chordal level
PSAX, Pap Level parasternal short axis, papillary muscle level
RA A/P Diam, d or s right atrium, anterior/posterior diameter, diastole or systole
RA Area, d or s right atrial area, diastole or systole
RA R/L Diam, d or s right atrium, right/left, diastole or systole
RA S/I Diam, d or s right atrium, superior/inferior diameter, diastole or systole

Abbreviations
Table 7-11 Abbreviations, 2-D (Continued)

RLPV Diam, d or s right lower pulmonary vein diameter, diastole or systole
RMCA Diam, d or s right coronary artery diameter, diastole or systole
RPA Diam right pulmonary artery diameter
RUPV Diam, d or s right upper pulmonary vein, diastole or systole
RV Area, d or s right ventricular area, diastole or systole
RV CI right ventricular cardiac index
RV CO right ventricular cardiac output
RV EF right ventricular ejection fraction
RV % FAC right ventricular percent fractional area change
RV Major, d or s right ventricular major axis, diastole or systole
RV Minor, d or s right ventricular minor axis, diastole or systole
RV, d or s right ventricle, diastole or systole
RVAW, d or s right ventricular anterior wall, diastole or systole
RVIT/RVOT right ventricular inflow tract/right ventricular outflow tract
RVSI right ventricular stroke index
RVSV right ventricular stroke volume
s systolic
SI stroke index
STI systolic time interval
SSN, Long Axis suprasternal notch, long axis
SSN, Short Axis suprasternal notch, short axis
Subcostal Long Axis subcostal long axis
Subcostal Short Axis subcostal short axis
SV stroke volume
SVC %∆, E to I superior vena cava, percent change expiration to inspiration
SVC Diam, exp, d or s superior vena cava diameter, expiration, diastole or systole
SVC Diam, insp, d or s superior vena cava diameter, inspiration, diastole or systole
TE truncated ellipse
Trans Ao Diam, d or s transverse aortic diameter, diastole or systole
Trunc Semi-Major Axis truncated semi-major axis
TV Annulus Diam, d or s tricuspid annulus diameter, diastole or systole

Doppler
Table 7-12 Abbreviations, Doppler

A/E A to E ratio
A/L Biplane area/length biplane method
A2C apical two chamber
A4C apical four chamber
AoV aortic valve
AoV area aortic valve area
AoV AT/ET aortic valve acceleration time/ejection time
AoV ET aortic valve ejection time
AoVmax aortic valve maximum velocity
AoV Mean Gradient aortic valve mean gradient
AoV Pk Gradient aortic valve peak gradient
AoV Vmax aortic valve maximum velocity
AoV VTI aortic valve velocity time integral
AR CD Jet ratio aortic regurgitation color Doppler jet ratio
AR Decel Rate aortic regurgitation deceleration rate
AR Decel Time aortic regurgitation deceleration time
AR Eff ROA aortic regurgitation effective regurgitant orifice area
AR end-diastolic gradient aortic regurgitation end diastolic gradient
AR end-diastolic velocity aortic regurgitation end diastolic velocity
AR jet area aortic regurgitation jet area
AR jet height aortic regurgitation jet height
AR P 1/2 Time aortic regurgitation pressure half-time
AR PISA aortic regurgitation proximal isovelocity surface area
AR V 1/2 Time aortic regurgitation velocity pressure half-time
AT acceleration time
AT/ET acceleration time to ejection time
BSA body surface area
CI cardiac index
Circum Circumferential
CO cardiac output
CSA cross sectional area
CW continous wave Doppler
d diastole
DBP, cuff diastolic blood pressure, cuff
Diam diameter

Abbreviations
Table 7-12 Abbreviations, Doppler (Continued)

Diastolic BP diastolic blood pressure
dP/dt delta pressure/delta time
E to I expiration to inspiration
E/A E to A ratio
ed velocity end diastolic velocity
EF ejection fraction
ET ejection time
Eff ROA effective regurgitant orifice area
Grad Gradient
HPRF high pulse repetition frequency
HR heart rate
Inst Flow Rt instantaneous flow rate
IVC inferior vena cava
IVC Peak A inferior vena cava peak A (wave)
IVC Peak D inferior vena cava peak D (wave)
IVC Peak S inferior vena cava peak S (wave)
IVC S VTI inferior vena cava S (wave) velocity time integral
IVC D VTI inferior vena cava D (wave) velocity time integral
IVRT isovolumic relaxation time
LA left atrium
LAD left anterior descending coronary artery
LA Sys Press left atrial systolic pressure
LA systolic pressure left atrial systolic pressure
LAP left atrial pressure
LASP left atrial systolic pressure
LCCA left circumflex coronary artery
LLPV D VTI left lower pulmonary vein peak D (wave) velocity time integral
LLPV Peak A left lower pulmonary vein peak A (wave)
LLPV Peak D left lower pulmonary vein peak D (wave)
LLPV Peak S left lower pulmonary vein peak S (wave)
LLPV S VTI left lower pulmonary vein peak S (wave) velocity time integral
LMCA left main coronary artery
LUPV D VTI left upper pulmonary vein peak D (wave) velocity time integral
LUPV Peak A left upper pulmonary vein peak A (wave)
LUPV Peak D left upper pulmonary vein peak D (wave)
LUPV Peak S left upper pulmonary vein peak S (wave)


LUPV S VTI left upper pulmonary vein peak S (wave) velocity time integral
LV left ventricle
LV end diastolic pressure left ventricular end diastolic pressure
LV ET left ventricular ejection time
LV % FAC left ventricular percent fractional area shortening
LV systolic pressure left ventricular systolic pressure
LV, d or s left ventricular dimension, diastole or systole
LVEDP left ventricular end diastolic pressure
LVOT area left ventricular outflow tract area
LVOT Diameter left ventricular outflow tract diameter
LVOT height left ventricular outflow tract height
LVOT area left ventricular outflow tract area
LVOT Mean Velocity left ventricular outflow tract mean velocity
LVOT PISA left ventricular outflow tract proximal isovelocity surface area
LVOT Vmax left ventricular outflow tract maximum velocity
LVOT VTI left ventricular outflow tract velocity time integral
LV Sys Press left ventricular systolic pressure
LVSP left ventricular systolic pressure
Mean Vel mean velocity
Merid Meridional
M/L medial/lateral
MOD Method of Disks (formerly Simpson’s volume method)
MR area PISA mitral regurgitation area, by proximal isovelocity surface area method
MR Eff ROA mitral regurgitation effective regurgitant orifice area
MR peak gradient mitral regurgitation peak gradient
MR Vmax mitral regurgitation maximum velocity
MV mitral valve
MV Aliasing velocity mitral valve aliasing velocity
MV Area, PISA mitral valve area proximal isovelocity surface area
MV CDI Alias Radius mitral valve color Doppler imaging alias radius
MV CDI Funnel Angle mitral valve color Doppler imaging funnel angle
MV Decel. time mitral valve deceleration time
MV DT mitral valve deceleration time
MV Diam mitral valve diameter
MV P 1/2 time mitral valve pressure half-time
MV Peak A velocity mitral valve peak A velocity

Abbreviations

MV Peak E velocity mitral valve peak E velocity
MV PISA mitral valve proximal isovelocity surface area
MV SV mitral valve stroke volume
MV VTI mitral valve velocity time integral
MV VTI, annulus mitral valve velocity time integral, annulus
MV VTI, leaflet tips mitral valve velocity time integral, leaflet tips
PA Pressure Pulmonary artery pressure
PA Diast Press pulmonic artery diastolic pressure
PADP pulmonary artery diastolic pressure
PASP pulmonic artery systolic pressure
PFR peak filling rate
PISA proximal isovelocity surface area
PISA AoV aortic valve proximal isovelocity surface area
PISA PV pulmonic valve proximal isovelocity surface area
Planim planimetry
PLAX parasternal long axis
PR Eff ROA pulmonic regurgitation effective regurgitant orifice area
PR end diastolic gradient pulmonic regurgitation end diastolic gradient
PR end diastolic velocity pulmonic regurgitation end diastolic velocity
PR PISA pulmonic regurgitation proximal isovelocity surface area
PR VTI pulmonic regurgitation velocity time integral
prol ellips prolate ellipse method
Prol Ell prolate ellipse method
PSAX parasternal short axis
PV pulmonic valve
PV Accel Time pulmonic valve acceleration time
PV Area pulmonic valve area
PV AT/ET pulmonic valve acceleration time/ejection time ratio
PV Ejection Time pulmonic valve ejection time
PV Mean Gradient pulmonic valve mean gradient
PV Mean Velocity pulmonic valve mean velocity
PV Peak Gradient pulmonic valve peak gradient
PV Pk Gradient pulmonic valve peak gradient
PV Vmax pulmonic valve maximum velocity
PV VTI pulmonic valve velocity time integral
Qp/Qs flow pulmonic/flow systemic ratio


RA right atrium
RA press right atrial pressure
RA pressure right atrial pressure
Regurg Vmax regurgitant maximum velocity
Regurg VTI regurgitant velocity time integral
RF regurgitation fraction
RLPV D VTI right lower pulmonary vein peak D (wave) velocity time integral
RLPV Peak A right lower pulmonary vein peak A (wave)
RLPV Peak D right lower pulmonary vein peak D (wave)
RLPV Peak S right lower pulmonary vein peak S (wave)
RLPV S VTI right lower pulmonary vein peak S (wave) velocity time integral
RUPV D VTI right upper pulmonary vein peak D (wave) velocity time integral
RMCA right main coronary artery
RUPV Peak A right upper pulmonary vein peak A (wave)
RUPV Peak D right upper pulmonary vein peak D (wave)
RUPV Peak S right upper pulmonary vein peak S (wave)
RUPV S VTI right upper pulmonary vein peak S (wave) velocity time integral
RV right ventricle
RV area, s or d right ventricular area, systole or diastole
RV maj axis right ventricular major axis
RV SV right ventricular stroke volume
RV Sys Press right ventricular systolic pressure
RVOT Area right ventricular outflow tract area
RVOT Diameter, s right ventricular outflow tract diameter systole
RVOT Mean Vel right ventricular outflow tract mean velocity
RVOT PISA right ventricular outflow tract proximal isovelocity surface area
RVOT Vmax right ventricular outflow tract maximum velocity
RVOT VTI right ventricular outflow tract velocity time integral
RVSP via TR or VSD right ventricular systolic pressure via tricuspid regurgitation or
ventricular septal defect
s systole
SBP, cuff systolic blood pressure, cuff
S/D ratio S wave to D wave ratio
S/D vel ratio S wave to D wave velocity ratio
SI stroke index
SV stroke volume

Abbreviations

SVC superior vena cava
SVC D VTI superior vena cava D (wave) velocity time integral
SVC Peak A superior vena cava peak A (wave)
SVC Peak D superior vena cava peak D (wave)
SVC Peak S superior vena cava peak S (wave)
SVC S VTI superior vena cava S (wave) velocity time integral
Systolic BP systolic blood pressure
Sys Filling Frac systolic filling fraction
TR CDI tricuspid regurgitation, color Doppler imaging
TR Eff ROA tricuspid regurgitation effective regurgitant orifice area
TR peak gradient tricuspid regurgitation peak gradient
TR PK gradient tricuspid regurgitation peak gradient
TR PISA tricuspid regurgitation proximal isovelocity surface area
TR Vmax tricuspid regurgitation maximum velocity
TR VTI tricuspid regurgitation velocity time integral
TV tricuspid valve
TV area tricuspid valve area
TV area PISA tricuspid valve area proximal isovelocity surface area
TV Decel. Time tricuspid valve deceleration time
TV DT tricuspid valve deceleration time
TV diameter A/P tricuspid valve diameter anterior/posterior
TV diameter M/L tricuspid valve diameter medial/lateral
TV Mean Gradient tricuspid valve mean gradient
TV P 1/2 Time tricuspid valve pressure half-time
TV Peak A velocity tricuspid valve peak A velocity
TV Peak E velocity tricuspid valve peak E velocity
TV VTI tricuspid valve velocity time integral
TV VTI, annulus tricuspid valve velocity time integral, annulus
TV VTI, leaflet tips tricuspid valve velocity time integral, leaflet tips
Vcfc mean circumferential shortening
Vmax maximum velocity
Vmean mean velocity
VSD peak velocity ventricular septal defect peak velocity
VTI velocity time integral
% ý E to I percent change expiration to inspiration


CHAPTER 8
VCR AND PRINTER SETUP
Setting Up Video Controls 126

Setting Up a Video Cassette Recorder 127
Setting up Printers 129

Chapter 8 VCR and Printer Setup
Setting Up Video The video setup function sets the VCR counter and selects the external
Controls video input source for viewing on the monitor.
Setting Up the VCR The Siemens system displays a VCR counter in the data field to identify
Counter VCR recorded time. This feature displays a time setting in relation to
taped images, allowing for easier next-time retrieval. Set the VCR counter
to zero to record on a new tape, or set it to match the number displayed
on the VCR’s tape counter when recording on a tape that already contains
images. The tape counter is highlighted when recording. The three tape
counter fields are hours, minutes, and seconds. For example:
0:45:32
◆ To display the VCR counter, press VCR CTRL.

1. To reset the VCR counter to zero, press [ZERO].
2. To input a time other than zero, use the numeric keys. Use the Tab
key to change fields.
3. To enter the new counter values, press [ENTER].
The setting is entered into the Siemens system.
4. To leave the VCR counter feature, press VCR CTRL, or press RETURN
on the Siemens system.
The soft key menu and the VCR counter display disappear from the
screen.
Adjusting Brightness, Adjust the brightness, color levels, and contrast during video playback.
Color Levels, and
Contrast ◆ To display [BIGHTNESS], [COLOR LEVEL], and [CONTRAST] press
PLAY, and then press VCR CTRL.
1. Press [BRIGHT=XX], [CONTRAST=XX], or [COLOR=XX] to select the
adjustment to make. Move the trackball up to increase or down to
decrease the corresponding level.
2. To save the new level as a default level, press [SAVE].
3. Repeat steps 1 and 2 for each level to adjust.
4. To leave this function, press RETURN or VCR CTRL.
126 ACUSON Sequoia Ultrasound System 0403

Setting Up a Video Cassette Recorder
Setting Up a Video The ACUSON Sequoia user interface was designed for use with the Sony
Cassette Recorder SVO-9500MD VCR and requires a special cable from Siemens to integrate
the VCR controls. Connect a different VCR using the Siemens system’s
external video connection. However, such an external VCR is not
integrated with the VCR control keys on the Siemens system keyboard.
NOTE: The system only supports playback of Super VHS video formats.
VCRs from Siemens will be connect to the Siemens system by your
Siemens Customer Engineer. Regardless of where you purchased your
VCR, you must purchase from Siemens the cables for connecting it to the
Siemens system.
WARNING! A VCR must be plugged into one of the isolated accessory outlets on the
back of the Siemens system. Using another power source compromises
electrical patient isolation and may exceed safe leakage current levels.
Connecting a Sony Your Siemens Customer Engineer installs the integrated Sony
SVO-9500MD VCR SVO-9500MD VCR. To reinstall the VCR, refer to Figure 8-1 for an
installation diagram.
Siemens System
I/O Panel
connect to
“S-VHS”
VCR Cable
P/N 30182
VCR
Remote
Siemens adapter required
Audio Out L-1
P/N 37478
Audio In L-1
S-VHS In
Audio Audio Monitor Video

Video In Out on
In/Out Out Out
off
CH-1/L CH-1/L
S-Video RS-2320
S-Video
75 W 75 W
CH-2/P off on off on CH-2/P
INDICATE
AC Power
Audio Out R-2
Audio In R-2
S-VHS Out
Figure 8-1 Connecting a Sony SVO-9500MD VCR

Adjusting the Sony 9500 The Sony 9500 VCR has settings that specify how it records and plays
VCR Settings back video information. Your Siemens Customer Engineer will configure
the VCR to Siemens recommended settings upon installation.
Front Panel Controls Set the controls on the front panel of the VCR as described in the
following table.
Table 8-1 Front Panel Settings

Switch Recommended Setting
Monitor Mix
Audio Hi-Fi
Hi-Fi On
Tracking Detent (adjust detent, if required, to produce a
stable, uniform image)
Program Off
Index CTL
Back Panel Controls Set the controls on the back panel of the VCR as described in the
following table.
Table 8-2 Back Panel Settings

Switch Recommended Setting
75Ω (both) On
DIP 1-4 Off (down)
DIP 5-6 On (up)
Programmable Settings ◆ To change the VCR’s programmable settings:

1. Press STOP on the Siemens keyboard.
2. Turn the VCR’s INDEX switch from CTL to MENU.
3. Press and hold the VCR PLAY button.
4. Press the VCR ITEM button to scroll through the menu of available
settings.
5. To change the setting for a menu item, press the VCR DATA button
while continuing to hold PLAY.
Siemens recommends the settings shown in Table 8-3.

Setting up Printers
6. To exit the setup function and return to normal operation, turn the
VCR’s INDEX switch from MENU to CTL.
Table 8-3 Recommended VCR Settings

Parameter Recommended Setting (NTSC and PAL)
nOn On
FrA On
HS On
uS On
u1A On
FOt LE
tPE Et
SuH At
Cnr OF
Ynr OF
YEn OF
FrE Fr
SOP OF
34P PA
FrS PA
LPH 45
L1n OF
Setting up Printers See “Customizing Printing” on page 35 for customizing the Sequoia
system printing configuration and the manufacturer’s printer manual for
more details.
There are two ways to install a printer:
• Connect the printer directly to the Siemens system’s I/O panel. Use
this method when the printer is placed directly on the Siemens
system’s accessory shelf.
• Connect the printer using the special Siemens Quick Disconnect
cable. Use the Quick Disconnect cable when a printer is placed on an
accessory cart, needs the ability to be readily disconnected.
WARNING! DO NOT plug printers, or other connected peripheral devices,

directly into a wall power outlet. Always use the isolated AC
power outlets on the ultrasound system to avoid the possible risk
of ELECTROCUTION!
Avoid placing the printer in a location subject to high humidity, high

temperatures, excessive dust, mechanical vibration, or direct sunlight.

Clean the cabinet, panel, and controls with a dry soft cloth or a soft cloth
lightly moistened with a mild detergent solution. Do not use any type of
solvent, such as alcohol or benzene, that may damage the finish.
Quick Disconnect To connect a printer using the Quick Disconnect cable, connect it between
Installation the printer and the system as shown in the following illustration.
NOTE: The Quick Disconnect cable is sold separately. Please contact
your the Siemens Uptime Service Center for more information.
ACUSON
SYSTEM
Connect to
“Quick Disconnect
Rear View
COLOR PAGE PRINTER

CONNECTIONS
Cable EXAMPLE: SONY 5650
Labels PRINTER
SYSTEM QUICK
DISCONNECT
CABLE P/N 39933
IMAGER IN- RED OUTPUT - R
IMAGER IN- GREEN OUTPUT - G
IMAGER IN- BLUE OUTPUT - B
IMAGER IN- SYNC OUTPUT - SYNC
IMAGER OUT- RED INPUT - R
IMAGER OUT- GREEN IINPUT - G
IMAGER OUT- BLUE INPUT - B
IMAGER OUT- SYNC INPUT - SYNC
IMAGER - VIDEO OUT N/C
IMAGER - EXPOSE/ N/C
IMAGER - REMOTE RS-232C
NOTE: ACUSON
ADAPTER REQUIRED
P/N 43410
B/W MULTI IMAGE CAMERA

Cable CONNECTIONS EXAMPLE:
Labels IIE 4000 CAMERA
MIC - VIDEO VIDEO IN
MIC - EXPOSE/ REMOTE EXPOSE
Figure 8-2 Quick Disconnect Installation

Setting up Printers
Observe the following safety precautions when using the printer:

• when a printer will not be used for a long period of time, unplug the
printer from the Siemens system.
• Do not turn the power off while the printer is printing; otherwise the
thermal head may be damaged.
• Do not touch the printer cutting blade.
• Do not carry and move the printer when the paper roll is placed in
the printer.
• Unplug the printer immediately if any liquid falls into the cabinet.
Have the printer serviced immediately.
Installing and Servicing Your Siemens Customer Engineer will initially install the printer. To
the Multi-Imager remove and reinstall the printer, do so as shown in the following
diagram.
Siemens System
I/O Panel
connect to connect to
“Rmt Exp” “B/W Img Out”
Remote Print cable B/W Camera Video Cable

P/N 34819 P/N 34820
Video In
Remote
Expose
AC Power
Figure 8-3 Multi-Imager Installation

For complete installation instructions, see the International Imaging
Electronics Multi-Imager MP Series IIE Operator’s and Service Manual.
Observe the following safety precautions for the Multi-Imager:
• Do not remove the covers of the Multi-Imager. It contains internal
high voltage.
• Connect the power cord to a grounded, hospital-grade outlet.
• Do not attempt to service the Multi-Imager. Always have a trained
service engineer (for example, your Siemens Customer Engineer)
service the equipment.

• Replacement fuses must be of the same type and rating as the original
fuses.
• Do not modify the Multi-Imager except as described in the
International Imaging Electronics Multi-Imager MP Series IIE Operator’s
and Service Manual.
• Do not apply any signal to the unit except a standard level video
signal.
• Do not use the Multi-Imager in the presence of flammable
anesthetics.
Connecting a Computer Connect any IBM PC-compatible printer, including a laser printer, that
Printer has a Centronics parallel interface. Use the printer to print text
information such as calculation reports. Also, purchase from Siemens an
IBM-compatible printer interconnect cable for use with the Siemens
system.
WARNING! The printer must get power from the isolated accessory outlet. If it does
not, chassis leakage current may rise above a safe level and affect patient
safety. If the printer gets power from a nonisolated source, its chassis
leakage current will be coupled to the Siemens system via the printer
interface cable.
WARNING! Verify that the total power drain from the isolated outlets by all
accessories (multi-image camera, video cassette recorder, printer, and so
on) does not exceed the limits specified in the Safety Manual. See the
particular accessory’s operator manual for specifications.
WARNING! The printer must be located at least 1.5 meters away from the patient
environment.
Unpack and assemble the printer according to the manufacturer’s

instructions. Plug the printer power cord into the isolated accessory
outlet on the back of the Siemens system. Plug one end of the printer
interconnect cable into the printer and the other end into the
input/output panel connector labeled PARALLEL PRINTER on the rear of
the Siemens system.
If the message PRINTER NOT AVAILABLE appears on the screen when
trying to print a report, check that the printer is plugged in and is
powered on.

CHAPTER 9
USING THE SERVICE USER INTERFACE
Main SUI Menu 135

Hardware Diagnostic Suite 135
Performing Data Backup 136
Performing Data Restore 137
Reviewing Customer Information 138
Changing Network Settings 138

Chapter 9 Using the Service User Interface
The Service User Interface (SUI) provides you and your Siemens
Customer Service Engineer with access to system capabilities that aid in
the maintenance of the ACUSON Sequoia ultrasound system.
This section describes how to access the following functions that a system
administrator might need to use:
• Data Backup
• Data Restore
• Customer Information
• Network Settings
There are two methods for entering the Service User Interface menu.
Enter the SUI menu while imaging or during a power up cycle.
◆ To enter while imaging: Press the SETUP key and select Service
UI from the drop down menu.
◆ To enter during a power up: Simultaneously press the S key and
hold the MULTIHZ key in the up possition, power on the system,
and continue holding the hard keys for five seconds.
All SUI functions are now accessible from the imaging mode (except for
Hardware Diagnostics) without powering the system OFF and then back
ON. When making changes to SUI functions, some functions require that
the system be rebooted in order to apply changes; while other functions
take immediate effect, requiring no reboot. Also, some functions allow
returning to imaging without rebooting. The following table lists
functions and their reboot requirements:
FUNCTION NO EFFECT UNTIL RETURN TO IMAGING

REBOOT OR REBOOT
Customer Yes Return to imaging

Information
Data Backup No Return to imaging
Data Restore Yes Reboot
Network Setup Yes Return to imaging
For changes that require a system reboot, the following message displays
“PRESS OK TO RESTORE THE HIGHLIGHTED FILE. THE SYSTEM
WILL REBOOT UPON EXITING THE SERVICE TOOL”, allowing a
choice to save the changes by rebooting or restore the settings without
saving.
Other SUI functions are reserved for Siemens Customer Engineers.

Main SUI Menu
Main SUI Menu ◆ To enter Service UI Setup, select Service UI from the Setup menu
to display the SUI menu.
Figure 9-1 Service User Interface Setup

Select an item in the SUI menu by moving the pointer, then pressing one
of the trackball SELECT KEYS.
Hardware Hardware Diagnostics allows you to detect basic hardware failures. This
Diagnostic Suite feature is accessible without a password. Hardware Diagnostic displays
the estimated time for test completion. In-progress tests can be aborted at
any time. Upon test completion, the system displays test results as PASS,
FAIL, or CANCEL.
◆ To perform a Basic Test access SUI and complete the following
steps:
1. Select [HARDWARE DIAGNOSTICS] and follow the instructions on the
Hardware Diagnostics Initialization screen.
2. Select the Basic Test button and Select [OK].
3. Complete all system prompts. (The prompts displayed may vary

based on system configuration.)
• Estimated test time to complete the test
4. Select [OK]. The Basic Test begins running.
• Select [CANCEL] at any time during the test to cancel the Basic
Test

Upon completion of the Basic Test (including cancelled tests) the Sequoia
system displays one of the following based on the Basic Test results:
• PASS - Basic diagnostic test passed
• FAIL - Basic diagnostic test did not pass, call the Siemens Uptime
Service Center
• CANCEL - Basic diagnostic test was cancelled
5. Select [OK].
6. Select [PRIOR] to return to the SUI menu.
Performing Data ◆ To backup data:

Backup 1. Enter the SUI menu while imaging or during powerup:
• To enter while imaging: Press the SETUP key and select SUI from the
drop down menu.
• To enter during a power up: Simultaneously press the S key and hold
the MULTIHZ key in the up possition, power on the system, and
continue holding the hard keys for five seconds.
2. Select the SUI menu and select DATA BACKUP from the SUI menu.
3. Insert an MO disk in the MO drive under the monitor. If the disk is
not yet formatted, select FORMAT MO, select [OK], and follow the
system prompts.
4. Select ACUSON FAS BACKUPS.
5. Turn on the button for each type of data to archive., then select OK.
CHOOSE THIS OPTION TO BACKUP
EXAM PRESET Exam and Image Presets

CALC DATA Custom calculations, custom
calculation headings, and site names
PROG ANNOTATION Customer defined Annotation keys
AUTO DOPPLER Customer defined Auto Doppler
SYSTEM Network settings, Set-and-forget, and
CONFIGURATION miscellaneous configurations
FEATURE CONTROL Enabled system features
The other options are reserved for Siemens Customer Engineers.

6. Enter a name in the BACKUP NAME field (this is optional). This
name is saved along with a unique name the system generates with
each backup. Select OK. The system will display the name of the
backup it is about to perform. Select OK to continue or CANCEL.
7. When the system performs the backup it will display Backup
Complete. Select OK.

Performing Data Restore
Performing Data ◆ To restore data:

Restore 1. Enter the SUI menu while imaging or during powerup:
• To enter while imaging: Press the SETUP key and select SUI from the
drop down menu.
• To enter during a power up: Simultaneously press the S key and hold
the MULTIHZ key in the up possition, power on the system, and
continue holding the hard keys for five seconds.
2. Select DATA RESTORE from the SUI menu.
3. Insert the MO disk that contains the backup data to restore into the
MO drive.
4. The window displays a list of the different files available. Point to the
file to restore and press the SELECT KEY. This will highlight the line
and place its name in the second window.
FILE NAME DESCRIPTION
AUTOD Auto Doppler

CALC All calculation packages: Cardiac, OB and Vascular
CONFIG System Configuration
FRCTRL Feature Control
PROANN Programmable Annotation
EXAMPR Exam Presets
SYSTEM System Data
5. Press the OK button to begin transferring data to the system disk. The
system will display Restore Complete when done with the task. Select
OK.
6. Press OK to reboot the system, allowing the restored data to take
effect.

Reviewing ◆ To review customer information, select Customer Information

Customer from the SUI menu.
Information
Changing Network The Sequoia system’s network configuration includes the Sequoia
Settings system’s network address and the addresses of other devices (such as
print and file servers) that it communicates with on the network. Set up
multiple network configurations to connect to different networks or to
the same network with different parameters. For example, when a system
is shared by two departments in a hospital, there might be one
configuration for each department. The local network administrator or
Siemens Customer Engineer should set up network configurations. Once
network configurations are set up, anyone should be able to switch
between them.
◆ To change network settings:
1. Select Network Setup from the SUI menu.
2. Select the Change Network button.
The following sections describe how to use options on the Network Setup
page.
Activating Networking The Sequoia system can function as either a stand-alone or a networked
system. For it to communicate with other systems on a network, first
activate the network.
◆ To activate networking, select the Enable button. Click OK to
save.
◆ To deactivate networking, select the Disable button. Click OK to
save.
Activating a Network The active network configuration is the one that the system is currently
Configuration using to connect to the network.
◆ To change the active configuration:
1. Select a configuration from the Network Configuration Names list,
and click the Activate Selected Network button.
When selecting a configuration, the network devices in that
configuration appear in the Network Host list.
2. Click OK to dismiss the status message. The chosen configuration
appears as the Next Active Network.
3. To activate the new configuration, exit SUI and restart the system.
Creating a New Network ◆ To create a new network configuration:

Configuration
1. Choose whether to create an empty configuration with no devices in
the Network Host list, or copy an existing configuration so that its
devices appear in the Network Host list for the new configuration.
To create an empty configuration, click the Add button below the
Network Configuration Names list.

Changing Network Settings
To create a new configuration by copying an existing configuration,

select the configuration to copy and click the Copy button below the
2. In the dialog box that appears, type the name of the new
configuration and click OK.
3. Add or change devices for the configuration as described in
“Specifying Printers and Servers for a Network Configuration” on
page 140.
Changing the Name of a ◆ To change the name of a network configuration:

Network Configuration
1. Select the configuration and click the Edit button below the Network
Configuration Names list.
2. In the dialog box that appears, change the name of the configuration
and click OK.
Removing a Network ◆ To remove a network configuration:

Configuration
1. Select the configuration and click the Delete button below the
2. In the confirmation dialog box that appears, click OK to delete or
Cancel to cancel.

Specifying Printers and The Network Host list shows the correspnding network devices (for
Servers for a Network example printers and servers) for the selected configuration. This list
Configuration updates whenever selecting a different configuration in the Network
Configuration Names list. When creating a new empty configuration, the
Network Host list is empty.
Use the buttons below the Network Host list as described in the following
sections to add and remove devices and change settings for devices in the
list.
Adding a Device ◆ To add a new device to the Network Host list:
1. Click the Add button below the Network Host list.
2. In the dialog box that appears, choose the device type.
This choice determines which network settings appear in the dialog
box.
3. Enter the appropriate network settings.
Consult with the Network Administrator when necessary.
4. Click OK to add the device to the list.
Changing a Device’s ◆ To change network settings for a device:
Settings
1. Select the device to change in the Network Host list.
2. Click the Edit button below the Network Host list and select [OK].
3. In the dialog box that appears, choose the device type.
This choice determines which network settings appear in the dialog
box.
4. Enter the appropriate network settings.
Consult with the Network Administrator when necessary.
5. Click OK to apply the changes.
Removing a Device ◆ To remove a device:

1. Select the device to remove in the Network Host list.
2. Click the Delete button below the Network Host list.
3. In the confirmation dialog box that appears, click OK to delete or
Cancel to cancel.

APPENDIX A
OB CALCULATION FORMULAS
Using the Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Using the Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Standard Equations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Additional Equations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
OB Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
AC Chart, Campbell ............................................................................................. 149
AC Chart, Hadlock ............................................................................................... 152
AC Chart, Jeanty ................................................................................................... 155
Binocular Distance Chart, Jeanty........................................................................ 156
BPD Chart, Campbell ........................................................................................... 157
BPD Chart, Doubilet............................................................................................. 158
BPD Chart, Hadlock ............................................................................................. 159
BPD Chart, Hansmann......................................................................................... 160
BPD Chart, Jeanty ................................................................................................. 161
BPD Chart, Kurtz .................................................................................................. 162
BPD Chart, Sabbagha ........................................................................................... 163
BPD Chart, Yale..................................................................................................... 164
Cerebellum Chart, Goldstein .............................................................................. 165
Cerebellum Chart, Hata ....................................................................................... 166
Cerebellum Chart, McLeary................................................................................ 167
CRL Chart, Hadlock ............................................................................................. 168
CRL Chart, Hansmann......................................................................................... 169
CRL Chart, Jeanty ................................................................................................. 170
CRL Chart, Nelson................................................................................................ 171
CRL Chart, Robinson, 1975 ................................................................................. 172
CRL Chart, Robinson, 1988 ................................................................................. 173
EFW Chart, Shepard............................................................................................. 174
Fibula Chart, Jeanty .............................................................................................. 182
FL Chart Campbell, .............................................................................................. 183
FL Chart, Hadlock ................................................................................................ 184
FL Chart, Hansmann ............................................................................................ 185
FL Chart, Hohler ................................................................................................... 186
FL Chart, Jeanty .................................................................................................... 187
FL Chart, O’Brien.................................................................................................. 188
FL Chart, Queenan ............................................................................................... 189
Foot Chart, Mercer................................................................................................ 190
Gestational Sac, Hansmann................................................................................. 191
Gestational Sac, Hellman..................................................................................... 192

OB Calculation Formulas
Gestational Sac Chart, Nyberg ........................................................................... 193

HC Chart, Campbell ............................................................................................ 194
HC Chart, Hadlock .............................................................................................. 195
HC Chart, Hansmann.......................................................................................... 198
HC Chart, Hoffbauer ........................................................................................... 199
HC Chart, Jeanty .................................................................................................. 200
Humerus Chart, Jeanty ....................................................................................... 201
Humerus Chart, Merz ......................................................................................... 202
Humerus Chart, Queenan .................................................................................. 203
Outer Orbits Chart, Mayden .............................................................................. 204
Thoracic Circumference, Romero ...................................................................... 205
Thoracic Diameter, Hansmann .......................................................................... 206
Tibia Chart, Jeanty ............................................................................................... 207
Tibia Chart, Merz ................................................................................................. 208
Transverse Trunk Diameter TTD Chart ........................................................... 209
TTD Chart, Persson.............................................................................................. 210
Ulna Chart, Jeanty................................................................................................ 211
OB Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
AC Chart, Campbell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
AC Chart, Hadlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
AC Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Binocular Distance Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
BPD Chart, Campbell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
BPD Chart, Doubilet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
BPD Chart, Hadlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
BPD Chart, Hansmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
BPD Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
BPD Chart, Kurtz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
BPD Chart, Sabbagha . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
BPD Chart, Yale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Cerebellum Chart, Goldstein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Cerebellum Chart, Hata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Cerebellum Chart, McLeary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
CRL Chart, Hadlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
CRL Chart, Hansmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
CRL Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
CRL Chart, Nelson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
CRL Chart, Robinson, 1975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
CRL Chart, Robinson, 1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
EFW Chart, Shepard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Fibula Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
FL Chart Campbell, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
FL Chart, Hadlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
FL Chart, Hansmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
FL Chart, Hohler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
142 ACUSON SequoiaSystem 0403

FL Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
FL Chart, O’Brien . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
FL Chart, Queenan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Foot Chart, Mercer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Gestational Sac, Hansmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Gestational Sac, Hellman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Gestational Sac Chart, Nyberg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
HC Chart, Campbell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
HC Chart, Hadlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
HC Chart, Hansmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
HC Chart, Hoffbauer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
HC Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Humerus Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Humerus Chart, Merz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Humerus Chart, Queenan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Outer Orbits Chart, Mayden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Thoracic Circumference, Romero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Thoracic Diameter, Hansmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Tibia Chart, Jeanty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Tibia Chart, Merz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Transverse Trunk Diameter TTD Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
TTD Chart, Persson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Ulna Chart, Jeanty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

OB Calculation Formulas
144 ACUSON SequoiaSystem 0403

Using the Charts The charts in this appendix provide equations used to calculate MA or
EFW. This chapter lists all equations in alphabetical order, by
measurement.
Siemens assumes no responsibility or liability for customers choosing
nonstandard regression coefficients in the Siemens OB Calculation
Option. The resulting equations are calculated by a standard regression
analysis technique contained in the Visi-Trend/Plot program,
manufactured by Paladin Software of San Jose, California.
The accuracy of the regression equation in actual use depends on the
accuracy of the data entered in the Siemens system, among other factors.
Siemens assumes no responsibility for the accuracy of the regression
program or the equation derived from the program.
IMPORTANT: The equations are valid only within the limits provided.
The terms gestational age and menstrual age are often used
interchangeably in ultrasound literature despite the fact that they have
different meanings. Siemens assumes that the age data in the
user-supplied table was expressed as menstrual age, regardless of how
the table is labeled.
IMPORTANT: The instructions for entering equations in this section apply to

ACUSON Sequoia systems only.

Appendix A OB Calculation Formulas
Standard Equations The following equations are preprogrammed on your system. To use one
of them, you simply select it in the appropriate OB calculations setup
dialog box. See Chapter 4.
You cannot change the standard equation for a measurement. The
preprogrammed, optional equations can be replaced by the equations
described in “Additional Equations,” next.
MEASUREMENT STANDARD EQUATION PREPROGRAMMED

OPTIONAL EQUATIONS
AC Hadlock Campbell (1994)

Jeanty
BPD Hadlock Campbell (1994)
Hansmann
CRL Hadlock Nelson (1975)
Robinson
FL Hadlock Campbell (1994)
Hansmann
HC Hadlock Campbell (1994)
Hansmann
OPT 1 Preprogrammed for Hellman
Gestational Sac Hansmann
Nyberg
OPT 2 Preprogrammed for Goldstein
Cerebellum McLeary
Hata
OPT 3 Preprogrammed for Jeanty
Humerus Merz
Queenan
OPT 4 Preprogrammed for Bonn
Transverse Trunk Persson
Diameter
146 ACUSON SequoiaUltrasound System 0403

Additional Equations You can program the Sequoia system to use any of the equations in the
following table. Enter the regression equation, standard deviation
equation (if there is one), and limits as shown on the chart for the
equation in this chapter. To enter an additional equation, you might have
to overwrite one of the preprogrammed optional equations. You can re-
enter an equation later, using the information in the charts.
MEASUREMENT EQUATION
BPD Campbell (1975)

Doubilet
Jeanty
Kurtz,
Sabbagha
Yale
CRL Hansmann
Jeanty
FL Hohler
Jeanty
O’Brien
Queenan
HC Hoffbauer
Jeanty
OPT 1 - OPT 4 Binocular Distance, Jeanty
Foot, Mercer
Outer Orbit, Mayden
Thoracic Diameter, Hansmann
Ulna, Jeanty
When entering an equation as an OPT1, OPT2, OPT3, or OPT4

measurement, be sure to enter the corresponding measurement (OPT1,
OPT2, OPT3, or OPT4) in place of the measurement name in the equation.
For example. the regression equation for the Mayden Outer Orbits chart
is:
5.635285+4.391298*OOR+0.064272*OOR^2+–0.102344*OOR^3+0.022172*OOR^4
where OOR represents the outer orbits measurement.

To program the equation as the OPT4 measurement, enter:
5.635285+4.391298*OPT4+0.064272*OPT4^2+–0.102344*OPT4^3+0.022172*OPT4^4

References
Calculation Valid Range Reference
Menstrual Age (MA) 12-40 weeks Hadlock, F. P., et al. 1984. Estimating Fetal Age:
Computer-Assisted Analysis of Multiple Fetal Growth
Parameters. Radiology 152:497-501.
Menstrual Age (CRL) 5.7-18 weeks Hadlock, F., et al. 1992. Fetal Crown-Rump Length:
Reevaluation of Relation to Menstrual Age (5-18 weeks) with
High-Resolution Real-Time US. Radiology 182:501-505.
Cephalic Index (CI) 14-40 weeks Hadlock, F. P., et al. 1981. The Effect of Head Shape on the
Accuracy of BPD in Estimating Fetal Gestational Age. Am. J.
Radiol. 137:83-85.
FL/AC Ratio 21-42 weeks Hadlock, F. P., et al. 1985. Use of the Femur Length/
Abdominal Circumference Ratio in Detecting the Macrosomic
Fetus. Radiology 154:503-505.
FL/BPD Ratio 23-40 weeks Hohler, C. 1981. American Journal of Obstetrics and Gynecology
141:759-762.
HC/AC Ratio 12-40 weeks Hadlock, F. P., and Athey. 1985. Ultrasound in Obstetrics and
Gynecology. C.V. Mosby Co.
EFW 12-40 weeks Hadlock F. P., et al. 1984. Sonographic Estimation of Fetal
Weight. Radiology 150:535-540. Errata noted in Radiology, Feb.,
1985.
LMP Percentile 22-40 weeks Williams, R. L., et al. 1982. Fetal Growth and Perinatal
Viability in California. Obstet. and Gynecol. 59(5):624-632.
Biophysical Profile Manning, F. A., et al. 1980. Antepartum Fetal Evaluation:
Development of a Fetal Biophysical Profile Score. Am. J.
Obstet. 136:787.
AFI Moore, T. R., et al. 1990. The Amniotic Fluid Index in Normal
Human Pregnancy. American Journal of Obstetrics and
Gynecology 162:1168-1173.
Phelan, J. P., et al. 1987. Amniotic Fluid Index Measurements
During Pregnancy. Journal of Reproductive Medicine 32:601-604.
Doppler Maulik, D., et al. 1990. Doppler Velocimetry in Obstetrics.
Obstetrics and Gynecology Clinics of North America 17:163.
Thompson, R. S., et al. 1988. Doppler Ultrasound Waveform
Indices: A/B Ratio, Pulsatility Index and Pourcelot Ratio.
British Journal of Obstetrics and Gynecology 95:581-588.
OB Charts All OB Charts are listed in alphabetical order, beginning on the next page.

AC Chart, Campbell
1994
12-41 weeks
AC Menstrual Age
(cm) Weeks
6.00 12
7.02 13
8.46 14
9.43 15
10.96 16
11.75 17
13.06 18
14.44 19
15.20 20
16.53 21
17.03 22
18.51 23
19.54 24
20.46 25
21.54 26
22.62 27
24.12 28
25.35 29
25.22 30
27.30 31
27.98 32
29.21 33
30.14 34
31.09 35
31.85 36
32.94 37
33.10 38
34.26 39
36.04 40
36.89 41
Regression Equation:
6.721738 + 0.8814810*AC + -0.0021765*AC^2 + 0.0001075*AC^3
Limits
MIN = 6.0 cm
MAX = 35.96 cm
Reference: Chitty, L., Campbell, S., “Charts of fetal size: Abdominal measurements,”
British J of OB and Gyn., February 1994, Vol. 101, pp 125-131, Table 1.

AC Chart, Campbell
1994
12-41 weeks
AC Menstrual Age
(cm) Weeks
6.00 12
7.02 13
8.46 14
9.43 15
10.96 16
11.75 17
13.06 18
14.44 19
15.20 20
16.53 21
17.03 22
18.51 23
19.54 24
20.46 25
21.54 26
22.62 27
24.12 28
25.35 29
25.22 30
27.30 31
27.98 32
29.21 33
30.14 34
31.09 35
31.85 36
32.94 37
33.10 38
34.26 39
36.04 40
36.89 41
6.721738 + 0.8814810*AC + -0.0021765*AC^2 + 0.0001075*AC^3
Limits
MIN = 6.0 cm
MAX = 35.96 cm

AC Chart, Campbell
1994
12-41 weeks
AC Menstrual Age
(cm) Weeks
6.00 12
7.02 13
8.46 14
9.43 15
10.96 16
11.75 17
13.06 18
14.44 19
15.20 20
16.53 21
17.03 22
18.51 23
19.54 24
20.46 25
21.54 26
22.62 27
24.12 28
25.35 29
25.22 30
27.30 31
27.98 32
29.21 33
30.14 34
31.09 35
31.85 36
32.94 37
33.10 38
34.26 39
36.04 40
36.89 41
6.721738 + 0.8814810*AC + -0.0021765*AC^2 + 0.0001075*AC^3
Limits
MIN = 6.0 cm
MAX = 35.96 cm

AC Chart, Hadlock
12-42 weeks
AC MA 2 Std AC MA 2 Std AC MA 2 Std

(cm) (weeks) Dev (cm) (weeks) Dev (cm) (weeks) Dev
5.1 12.1 1.7 9.0 15.2 1.7 13.0 18.5 2.1

5.2 12.2 1.7 9.1 15.3 1.7 13.1 18.6 2.1
5.3 12.2 1.7 9.2 15.4 1.7 13.2 18.7 2.1
5.4 12.3 1.7 9.3 15.5 1.7 13.3 18.8 2.1
5.5 12.4 1.7 9.4 15.5 1.7 13.4 18.9 2.1
5.6 12.5 1.7 9.5 15.6 1.7 13.5 19.0 2.1
5.7 12.5 1.7 9.6 15.7 1.7 13.6 19.0 2.1
5.8 12.6 1.7 9.7 15.8 1.7 13.7 19.1 2.1
5.9 12.7 1.7 9.8 15.9 1.7 13.8 19.2 2.1
9.9 15.9 1.7 13.9 19.3 2.1
6.0 12.8 1.7 10.0 16.0 1.7 14.0 19.4 2.1

6.1 12.9 1.7 10.1 16.1 1.7 14.1 19.5 2.1
6.2 12.9 1.7 10.2 16.2 1.7 14.2 19.6 2.1
6.3 13.0 1.7 10.3 16.3 1.7 14.3 19.6 2.1
6.4 13.1 1.7 10.4 16.4 1.7 14.4 19.7 2.1
6.5 13.2 1.7 10.5 16.4 1.7 14.5 19.8 2.1
6.6 13.3 1.7 10.6 16.5 1.7 14.6 19.9 2.1
6.7 13.3 1.7 10.7 16.6 1.7 14.7 20.0 2.1
6.8 13.4 1.7 10.8 16.7 1.7 14.8 20.1 2.1
6.9 13.5 1.7 10.9 16.8 1.7 14.9 20.2 2.1
7.0 13.6 1.7 11.0 16.9 1.7 15.0 20.2 2.1

7.1 13.7 1.7 11.1 16.9 1.7 15.1 20.3 2.1
7.2 13.7 1.7 11.2 17.0 1.7 15.2 20.4 2.1
7.3 13.8 1.7 11.3 17.1 1.7 15.3 20.5 2.1
7.4 13.9 1.7 11.4 17.2 1.7 15.4 20.6 2.1
7.5 14.0 1.7 11.5 17.3 1.7 15.5 20.7 2.1
7.6 14.1 1.7 11.6 17.4 1.7 15.6 20.8 2.1
7.7 14.2 1.7 11.7 17.4 1.7 15.7 20.8 2.1
7.8 14.2 1.7 11.8 17.5 1.7 15.8 20.9 2.1
7.9 14.3 1.7 11.9 17.6 1.7 15.9 21.0 2.1
8.0 14.4 1.7 12.0 17.7 1.7 16.0 21.1 2.1

8.1 14.5 1.7 12.1 17.8 1.7 16.1 21.2 2.1
8.2 14.6 1.7 12.2 17.9 1.7 16.2 21.3 2.1
8.3 14.6 1.7 12.3 17.9 1.7 16.3 21.4 2.1
8.4 14.7 1.7 12.4 18.0 2.1 16.4 21.5 2.1
8.5 14.8 1.7 12.5 18.1 2.1 16.5 21.5 2.1
8.6 14.9 1.7 12.6 18.2 2.1 16.6 21.6 2.1
8.7 15.0 1.7 12.7 18.3 2.1 16.7 21.7 2.1
8.8 15.0 1.7 12.8 18.4 2.1 16.8 21.8 2.1
8.9 15.1 1.7 12.9 18.5 2.1 16.9 21.9 2.1

AC Chart, Hadlock
(continued)

17.0 22.0 2.1 21.0 25.5 2.2 25.0 29.2 2.2

17.1 22.1 2.1 21.1 25.6 2.2 25.1 29.3 2.2
17.2 22.2 2.1 21.2 25.8 2.2 25.2 29.4 2.2
17.3 22.2 2.1 21.3 25.8 2.2 25.3 29.5 2.2
17.4 22.3 2.1 21.4 25.9 2.2 25.4 29.6 2.2
17.5 22.4 2.1 21.5 26.0 2.2 25.5 29.7 2.2
17.6 22.5 2.1 21.6 26.1 2.2 25.6 29.8 2.2
17.7 22.6 2.1 21.7 26.2 2.2 25.7 29.9 2.2
17.8 22.7 2.1 21.8 26.3 2.2 25.8 30.0 2.2
17.9 22.8 2.1 21.9 26.4 2.2 25.9 30.1 3.0
18.0 22.9 2.1 22.0 26.4 2.2 26.0 30.2 3.0

18.1 22.9 2.1 22.1 26.5 2.2 26.1 30.2 3.0
18.2 23.0 2.1 22.2 26.6 2.2 26.2 30.3 3.0
18.3 23.1 2.1 22.3 26.7 2.2 26.3 30.4 3.0
18.4 23.2 2.1 22.4 26.8 2.2 26.4 30.5 3.0
18.5 23.3 2.1 22.5 26.9 2.2 26.5 30.6 3.0
18.6 23.4 2.1 22.6 27.0 2.2 26.6 30.7 3.0
18.7 23.5 2.1 22.7 27.1 2.2 26.7 30.8 3.0
18.8 23.6 2.1 22.8 27.2 2.2 26.8 30.9 3.0
18.9 23.7 2.1 22.9 27.3 2.2 26.9 31.0 3.0
19.0 23.7 2.1 23.0 27.4 2.2 27.0 31.1 3.0

19.1 23.8 2.1 23.1 27.5 2.2 27.1 31.2 3.0
19.2 23.9 2.1 23.2 27.5 2.2 27.2 31.3 3.0
19.3 24.0 2.2 23.3 27.6 2.2 27.3 31.4 3.0
19.4 24.1 2.2 23.4 27.7 2.2 27.4 31.5 3.0
19.5 24.2 2.2 23.5 27.8 2.2 27.5 31.6 3.0
19.6 24.3 2.2 23.6 27.9 2.2 27.6 31.7 3.0
19.7 24.4 2.2 23.7 28.0 2.2 27.7 31.8 3.0
19.8 24.5 2.2 23.8 28.1 2.2 27.8 31.9 3.0
19.9 24.6 2.2 23.9 28.2 2.2 27.9 32.0 3.0
20.0 24.6 2.2 24.0 28.3 2.2 28.0 32.0 3.0

20.1 24.7 2.2 24.1 28.4 2.2 28.1 32.1 3.0
20.2 24.8 2.2 24.2 28.5 2.2 282 32.2 3.0
20.3 24.9 2.2 24.3 28.6 2.2 28.3 32.3 3.0
20.4 25.0 2.2 24.4 28.7 2.2 28.4 32.4 3.0
20.5 25.1 2.2 24.5 28.7 2.2 28.5 32.5 3.0
20.6 25.2 2.2 24.6 28.8 2.2 28.6 32.6 3.0
20.7 25.3 2.2 24.7 28.9 2.2 28.7 32.7 3.0
20.8 25.4 2.2 24.8 29.0 2.2 28.8 32.8 3.0
20.9 25.5 2.2 24.9 29.1 2.2 28.9 32.9 3.0

AC Chart, Hadlock
(continued)

29.0 33.0 3.0 32.0 35.9 3.0 35.0 38.9 3.0

29.1 33.1 3.0 32.1 36.0 3.0 35.1 39.0 3.0
29.2 33.2 3.0 32.2 36.1 3.0 35.2 39.1 3.0
29.3 33.3 3.0 32.3 36.2 3.0 35.3 39.2 3.0
29.4 33.4 3.0 32.4 36.3 3.0 35.4 39.3 3.0
29.5 33.5 3.0 32.5 36.4 3.0 35.5 39.4 3.0
29.6 33.6 3.0 32.6 36.5 3.0 35.6 39.5 3.0
29.7 33.7 3.0 32.7 36.6 3.0 35.7 39.6 3.0
29.8 33.8 3.0 32.8 36.7 3.0 35.8 39.7 3.0
29.9 33.9 3.0 32.9 36.8 3.0 35.9 39.8 3.0
30.0 34.0 3.0 33.0 36.9 3.0 36.0 39.9 3.0

30.1 34.1 3.0 33.1 37.0 3.0 36.1 40.0 3.0
30.2 34.2 3.0 33.2 37.1 3.0 36.2 40.1 3.0
30.3 34.3 3.0 33.3 37.2 3.0 36.3 40.2 3.0
30.4 34.4 3.0 33.4 37.3 3.0 36.4 40.3 3.0
30.5 34.5 3.0 33.5 37.4 3.0 36.5 40.4 3.0
30.6 34.6 3.0 33.6 37.5 3.0 36.6 40.5 3.0
30.7 34.7 3.0 33.7 37.6 3.0 36.7 40.6 3.0
30.8 34.7 3.0 33.8 37.7 3.0 36.8 40.7 3.0
30.9 34.8 3.0 33.9 37.8 3.0 36.9 40.8 3.0
31.0 34.9 3.0 34.0 37.9 3.0 37.0 40.9 3.0

31.1 35.0 3.0 34.1 38.0 3.0 37.1 41.0 3.0
31.2 35.1 3.0 34.2 38.1 3.0 37.2 41.1 3.0
31.3 35.2 3.0 34.3 38.2 3.0 37.3 41.2 3.0
31.4 35.3 3.0 34.4 38.3 3.0 37.4 41.3 3.0
31.5 35.4 3.0 34.5 38.4 3.0 37.5 41.4 3.0
31.6 35.5 3.0 34.6 38.5 3.0 37.6 41.5 3.0
31.7 35.6 3.0 34.7 38.6 3.0 37.7 41.6 3.0
31.8 35.7 3.0 34.8 38.7 3.0 37.8 41.7 3.0
31.9 35.8 3.0 34.9 38.8 3.0 37.9 41.8 3.0
38.0 42.0 3.0
8.14+0.753*AC+0.0036*AC^2
Limits
MIN = 5.1 cm
MAX = 38.0 cm
Reference: Hadlock, F. P. et al. 1984. Estimating Fetal Age: Computer-Assisted Analysis of Multiple
Fetal Growth Parameters. Radiology 152 (no.2) 499.

AC Chart, Jeanty
12-40 weeks
AC Menstrual Age
(cm) (weeks)
5.7 12
6.7 13
7.7 14
8.8 15
9.8 16
10.9 17
11.9 18
13.0 19
14.1 20
15.2 21
16.3 22
17.3 23
18.4 24
19.5 25
20.5 26
21.5 27
22.5 28
23.5 29
24.4 30
25.4 31
26.2 32
27.1 33
27.9 34
28.6 35
29.3 36
30.0 37
30.6 38
31.1 39
31.6 40
4.4675610+1.4946060*AC+–0.0402130*AC^2+0.0008904*AC^3
Limits
MIN = 5.7 cm
MAX = 31.6 cm
Reference: Jeanty, P., Romero, R. 1984. A Longitudinal Study of Fetal Abdominal Growth.
Obstetrical Ultrasound.

Binocular Distance Chart, Jeanty

10.4 - 40.1 weeks
Binocular Menstrual Binocular Menstrual
Distance Age Distance Age
(cm) (weeks + days) (cm) (weeks + days)
1.5 10 + 3 4.0 25 + 2
1.6 11 + 0 4.1 25 + 6
1.7 11 + 4
1.8 12 + 1 4.2 26 + 4
1.9 12 + 6 4.3 27 + 1
4.4 27 + 5
2.0 13 + 3 4.5 28 + 2
2.1 14 + 0 4.6 28 + 6
2.2 14 + 4 4.7 29 + 4
2.3 15 + 1 4.8 30 + 1
2.4 15 + 6 4.9 30 + 5
2.5 16 + 3
2.6 17 + 0 5.0 31+ 2
2.7 17 + 4 5.1 31 + 6
2.8 18 + 1 5.2 32 + 4
2.9 18 + 6 5.3 33 + 0
5.4 33 + 4
3.0 19 + 3 5.5 34 + 1
3.1 20 + 0 5.6 34 + 6
3.2 20 + 4 5.7 35 + 3
3.3 21 + 1 5.8 36 + 0
3.4 21 + 5 5.9 36 + 4
3.5 22 + 2
3.6 22 + 6 6.0 37 + 1
3.7 23 + 4 6.1 37 + 6
3.8 24 + 1 6.2 38 + 3
3.9 24 + 5 6.3 39 + 0
6.4 39 + 4
6.5 40 + 1
MA: 0.3659456+7.592804*BIN+–0.9036491*BIN^2+0.23932220*BIN^3+–0.0304329*BIN^4+0.0014845*BIN^5
SD: 3.357496+–0.0005119*BIN
Limits
MIN = 1.5 cm
MAX = 6.5 cm
Reference: Jeanty, P. and R. Romero. 1984. Obstetrical Ultrasound. McGraw Hill. Fibula Chart, Jeanty.

BPD Chart, Campbell
1994
12-42 weeks
BPD Menstrual Age

(cm) Weeks
1.93 12
2.19 13
2.73 14
2.95 15
3.36 16
3.58 17
4.05 18
4.34 19
4.52 20
4.91 21
5.21 22
5.56 23
5.84 24
6.16 25
6.38 26
6.84 27
7.18 28
7.48 29
7.70 30
7.85 31
8.13 32
8.24 33
8.48 34
8.67 35
8.85 36
9.02 37
9.19 38
9.21 39
9.49 40
9.60 41
9.67 42
10.98241 + -1.751939*BPD + 1.615847*BPD ^2 + -0.2310684*BPD^3 + 0.0120804*BPD^4
Limits
MIN = 1.93 cm
MAX = 9.67 cm
Reference: Chitty, L., Campbell, Stuart, “Charts of fetal size: 2 Head measurements,”
British J of OB & Gyn., January 1994, Vol 101, pp 35-43, Table 1.

BPD Chart, Doubilet

13.2 - 42 weeks
BPD Menstrual Age BPD Menstrual Age
(cm) (weeks) (cm) (weeks)
2.0 13.2 6.0 24.2
2.1 13.4 6.1 24.5
2.2 13.6 6.2 24.9
2.3 13.8 6.3 25.3
2.4 14.0 6.4 25.7
2.5 14.3 6.5 26.1
2.6 14.5 6.6 26.5
2.7 14.7 6.7 26.9
2.8 14.9 6.8 27.3
2.9 15.1 6.9 27.7
3.0 15.4 7.0 28.1

3.1 15.6 7.1 28.5
3.2 15.8 7.2 29.0
3.3 16.1 7.3 29.4
3.4 16.3 7.4 29.9
3.5 16.6 7.5 30.3
3.6 16.8 7.6 30.8
3.7 17.1 7.7 31.2
3.8 17.3 7.8 31.7
3.9 17.6 7.9 32.2
4.0 17.9 8.0 32.7

4.1 18.1 8.1 33.2
4.2 18.4 8.2 33.7
4.3 18.7 8.3 34.2
4.4 19.0 8.4 34.7
4.5 19.3 8.5 35.2
4.6 19.6 8.6 35.8
4.7 19.9 8.7 36.3
4.8 20.2 8.8 36.9
4.9 20.5 8.9 37.4
5.0 20.8 9.0 38.0

5.1 21.1 9.1 38.6
5.2 21.4 9.2 39.2
5.3 21.7 9.3 39.8
5.4 22.1 9.4 40.4
5.5 22.4 9.5 41.0
5.6 22.8 9.6 41.6
5.7 23.1 9.7 42.0
5.8 23.5
5.9 23.8
2.718^(2.27969+0.015091*BPD)
Limits
MIN = 2.0 cm
MAX = 9.7 cm
Reference: Doubilet, Peter et al. “Improved Prediction of Gestational Age in the Late Third Trimester”
J. Ultrasound Med. 12: 647-653, 1993.

BPD Chart, Hadlock
12.1 - 41.6 weeks
BPD MA 2 Std BPD MA 2 Std BPD MA 2 Std

1.5 12.1 1.2 4.4 19.3 1.7 7.3 29.3 2.2

1.6 12.3 1.2 4.5 19.6 1.7 7.4 29.7 2.2
1.7 12.5 1.2 4.6 19.9 1.7 7.5 30.1 3.1
1.8 12.8 1.2 4.7 20.2 1.7 7.6 30.5 3.1
1.9 13.0 1.2 4.8 20.5 1.7 7.7 3.0.9 3.1
4.9 20.8 1.7 7.8 31.3 3.1
2.0 13.2 1.2 7.9 31.7 3.1
2.1 13.4 1.2 5.0 21.1 1.7
2.2 13.6 1.2 5.1 21.5 1.7 8.0 32.1 3.1
2.3 13.8 1.2 5.2 21.8 1.7 8.1 32.5 3.1
2.4 14.1 1.2 5.3 22.1 1.7 8.2 33.0 3.1
2.5 14.3 1.2 5.4 22.4 1.7 8.3 33.4 3.1
2.6 14.5 1.2 5.5 22.8 1.7 8.4 33.8 3.1
2.7 14.8 1.2 5.6 23.1 1.7 8.5 34.2 3.1
2.8 15.0 1.2 5.7 23.4 1.7 8.6 34.7 3.1
2.9 15.2 1.2 5.8 23.8 1.7 8.7 35.1 3.1
5.9 24.1 2.2 8.8 35.6 3.1
3.0 15.5 1.2 8.9 36.0 3.2
3.1 15.7 1.2 6.0 24.5 2.2
3.2 16.0 1.2 6.1 24.8 2.2 9.0 36.5 3.2
3.3 16.3 1.2 6.2 25.2 2.2 9.1 36.9 3.2
3.4 16.5 1.2 6.3 25.5 2.2 9.2 37.4 3.2
3.5 16.8 1.2 6.4 25.9 2.2 9.3 37.8 3.2
3.6 17.0 1.2 6.5 26.3 2.2 9.4 38.3 3.2
3.7 17.3 1.2 6.6 26.6 2.2 9.5 38.7 3.2
3.8 17.6 1.2 6.7 27.0 2.2 9.6 39.2 3.2
3.9 17.9 1.2 6.8 27.4 2.2 9.7 39.7 3.2
6.9 27.7 2.2 9.8 40.2 3.2
4.0 18.1 1.7 9.9 40.6 3.2
4.1 18.4 1.7 7.0 28.1 2.2
4.2 18.7 1.7 7.1 28.5 2.2 10.0 41.1 3.2
4.3 19.0 1.7 7.2 28.9 2.2 10.1 41.6 3.2
9.54+1.482*BPD+0.1676*BPD^2
Limits
MIN = 1.5 cm
MAX = 10.1 cm
Reference: Hadlock, F.P. et al. 1984. Estimating Fetal Age: Computer-Assisted Analysis of Multiple

BPD Chart, Hansmann

12.6 - 41.6 weeks
(cm) (wks + days) (cm) (wks + days)
2.0 12 + 4 6.0 23 + 7
2.1 12 + 6 6.1 24 + 2
2.2 13 + 1 6.2 24 + 4
2.3 13 + 2 6.3 24 + 6
2.4 13 + 4 6.4 25 + 1
2.5 13 + 6 6.5 25 + 4
2.6 14 + 2 6.6 25 + 6
2.7 14 + 3 6.7 26 + 1
2.8 14 + 5 6.8 26 + 3
2.9 14 + 7 6.9 26 + 5
3.0 15 + 2 7.0 27 + 1
3.1 15 + 4 7.1 27 + 3
3.2 15 + 6 7.2 24 + 6
3.3 16 + 1 7.3 28 + 1
3.4 16 + 3 7.4 28 + 4
3.5 16 + 5 7.5 28 + 6
3.6 16 + 7 7.6 29 + 2
3.7 17 + 2 7.7 29 + 4
3.8 17 + 4 7.8 29 + 7
3.9 17 + 5 7.9 30 + 3
4.0 18 + 1 8.0 30 + 5
4.1 18 + 3 8.1 31 + 1
4.2 18 + 4 8.2 31 + 4
4.3 18 + 6 8.3 31 + 7
4.4 19 + 1 8.4 32 + 3
4.5 19 + 3 8.5 32 + 5
4.6 19 + 5 8.6 33 + 1
4.7 20 + 1 8.7 33 + 4
4.8 20 + 3 8.8 34 + 1
4.9 20 + 5 8.9 34 + 4
5.0 20 + 7 9.0 34 + 7
5.1 21 + 2 9.1 35 + 3
5.2 21 + 4 9.2 35 + 7
5.3 21 + 6 9.3 36 + 4
5.4 22 + 1 9.4 37 + 1
5.5 22 + 3 9.5 37 + 5
5.6 22 + 5 9.6 38 + 3
5.7 23 + 1 9.7 39 + 1
5.8 23 + 3 9.8 39 + 6
5.9 23 + 5 9.9 40 + 4
10.0 41 + 4
3.565691+6.942194*BPD+–1.896854*BPD^2+0.4028942*BPD^3+–0.0403642*BPD^4+0.0015878*BPD^5
Limits
MIN = 2.0 cm
MAX = 10.0 cm
Reference: Hansmann, M., et al. 1985. Ultrasound Diagnosis in Obstetrics and Gynecology.
Springer-Verlag.

BPD Chart, Jeanty
14 - 38.3 weeks
2.8 14 6.2 24 + 1
2.9 14 + 1 6.3 24 + 4
3.0 14 + 4 6.4 24 + 6
3.1 14 + 6 6.5 25 + 2
3.2 15 + 1 6.6 25 + 4
3.3 15 + 2 6.7 26
3.4 15 + 4 6.8 26 + 3
3.5 15 + 6 6.9 26 + 5
3.6 16 + 1 7.0 27 + 1
3.7 16 + 3 7.1 27 + 4
3.8 16 + 5 7.2 27 + 6
3.9 17 7.3 28 + 2
4.0 17 + 2 7.4 28 + 5
4.1 17 + 4 7.5 29 + 1
4.2 17 + 6 7.6 29 + 4
4.3 18 + 1 7.7 29 + 6
4.4 18 + 3 7.8 30 + 2
4.5 18 + 5 7.9 30 + 5
4.6 19 8.0 31 + 1
4.7 19 + 2 8.1 31 + 4
4.8 19 + 4 8.2 32
4.9 19 + 6 8.3 32 + 4
5.0 20 + 2 8.4 32 + 6
5.1 20 + 4 8.5 33 + 3
5.2 20 + 6 8.6 33 + 6
5.3 21 + 1 8.7 34 + 2
5.4 21 + 4 8.8 34 + 6
5.5 21 + 6 8.9 35 + 2
5.6 22 + 1 9.0 35 + 5
5.7 22 + 4 9.1 36 + 1
5.8 22 + 6 9.2 36 + 5
5.9 23 + 1 9.3 37 + 1
6.0 23 + 4 9.4 37 + 5
6.1 23 + 6 9.5 38 + 2
5.752573+3.682932*BPD+–0.4774910*BPD^2+0.0946081*BPD^3+–0.0073637*BPD^4+0.0002514*BPD^5
Limits
MIN = 2.8 cm
MAX = 9.5 cm
Reference: Jeanty, P. and R. Romero. 1984. Obstetrical Ultrasound. McGraw Hill.

BPD Chart, Kurtz

14 - 40 weeks
BPD Menstrual Age
(cm) (weeks)
2.7 14
3.1 15
3.4 16
3.8 17
4.1 18
4.5 19
4.8 20
5.1 21
5.4 22
5.7 23
6.0 24
6.3 25
6.6 26
6.9 27
7.1 28
7.4 29
7.6 30
7.9 31
8.1 32
8.3 33
8.5 34
8.7 35
8.9 36
9.1 37
9.2 38
9.4 39
9.5 40
MA: 5.6546870+4.3971500*BPD+–0.9223110*BPD^2+0.2162220*BPD^3+–
0.0222450*BPD^4+0.000921*BPD^5
SD: –7.0429760+0.9529071*BPD+–0.0337610*BPD^2+0.0003800*BPD^3
Limits
MIN = 2.7 cm
MAX = 9.5 cm
Reference: Kurtz, A.B., et al. 1980. Analysis of Biparietal Diameter as an Accurate Indicator of Gestation
Age. J. Clin. Ultrasound 8:319.

BPD Chart, Sabbagha
14 - 40 weeks
BPD Menstrual Age
(cm) (weeks)
2.8 14
3.2 15
3.6 16
3.9 17
4.2 18
4.5 19
4.8 20
5.1 21
5.4 22
5.8 23
6.1 24
6.4 25
6.7 26
7.0 27
7.2 28
7.5 29
7.8 30
8.0 31
8.2 32
8.5 33
8.7 34
8.8 35
9.0 36
9.2 37
9.3 38
9.4 39
9.5 40
4.992107 + 5.448433 * BPD + – 1.749823 * BPD^2 + 0.4740796 * BPD^3 + – 0.0556852 * BPD^4 + 0.0024300 * BPD^5
Limits
MIN = 2.8 cm
MAX = 9.5 cm
Reference: Sabbagha, R.E. and M. Hughey. 1978. Standardization of Sonar Cephalometry and
Gestational Age. Obstet Gynecol. 52:402.

BPD Chart, Yale

11.6 - 39.8 weeks
BPD Menstrual Age BPD Menstrual Age BPD Menstrual Age BPD Menstrual Age
(cm) (weeks) (cm) (weeks) (cm) (weeks) (cm) (weeks)
1.9 11.6 4.0 18.4 6.0 24.7 8.0 33.0
2.0 11.6 4.2 18.9 6.1 25.2 8.2 33.5
2.1 12.1 4.3 19.4 6.2 25.2 8.3 34.0
2.2 12.6 4.4 19.4 6.3 25.7 8.4 34.4
2.3 12.6 4.5 19.9 6.4 26.2 8.5 35.0
2.4 13.1 4.6 20.4 6.5 26.2 8.6 35.4
2.5 13.6 4.7 20.4 6.6 26.7 8.8 35.9
2.6 13.6 4.8 20.9 6.7 27.2 8.9 36.4
2.7 14.1 4.9 21.3 6.8 27.6
2.8 14.6 6.9 28.1 9.0a 36.9
2.9 14.6 5.0 21.3 9.1a 37.3
5.1 21.8 7.0 28.6 9.2a 37.8
3.0 15.0 5.2 22.3 7.1 29.1 9.3a 38.3
3.1 15.5 5.3 22.3 7.3 29.6 9.4a 38.8
3.2 15.5 5.4 22.8 7.4 30.0 9.6a 39.3
3.3 16.0 5.5 23.3 7.5 30.6 9.7a 39.8
3.4 16.5 5.6 23.3 7.6 31.0
3.5 16.5 5.7 23.8 7.7 31.5
3.6 17.0 5.8 24.3 7.8 32.0
3.7 17.5 5.9 24.3 7.9 32.5
3.8 17.9
a Indicates a fetus of 36 or more weeks in a nondiabetic.
5.386194+3.383561*BPD+–0.091307*BPD^2+0.011580*BPD^3
Limits
MIN = 1.9 cm
MAX = 9.7 cm
Reference: Hobbins, John C., M.D., et al. 1983. Ultrasonography in Obstetrics and Gynecology.
Second Edition. Williams & Wilkins, Baltimore, M.D.
Yale Nomogram for BPD using leading edge to leading edge based on B-mode dots (graticule).

Cerebellum Chart, Goldstein
15 - 39 weeks
Cerebellum Diameter Tabulated Calculated
(cm) Menstrual Agea (weeks) Menstrual Ageb (weeks)
1.40 15 15.2
1.60 16 16.0
1.70 17 17.4
1.80 18 18.2
1.90 19 19.1
2.00 20 19.6
2.20 21 21.4
2.30 22 22.1
2.40 23 23.0
2.50 24 23.6
2.80 25 26.0
2.90 26 26.5
3.00 27 27.3
3.10 28 28.1
3.40 29 30.1
3.50 30 30.5
3.80 31 32.3
3.80 32 32.3
4.00 33 33.4
4.00 34 33.4
4.05 35 —
4.30 36 34.6
4.50 37 35.4
4.85 38 —
5.20 39 36.5
a Tabulated Menstrual Age is based on the 50th-percentile listings in Goldstein’s table.
b
Calculated Menstrual Age is based on Goldstein’s Regression Equation.
6.329+4.807*CER+1.484*CER^2+–0.2474*CER^3
Limits
MIN = 1.4 cm
MAX = 5.2 cm
Reference: Goldstein, I. 1987. Cerebellum Measurements with Ultrasonography in the Evaluation of
Fetal Growth and Development. American Journal of Obstetrics and Gynecology. 1987.156:1065-1069

Cerebellum Chart, Hata

1987
17-40 weeks
CER Menstrual Age

(cm) Weeks
1.7 17
1.9 18
2.0 19
2.2 20
2.3 21
2.4 22
2.6 23
2.7 24
2.9 25
3.0 26
3.2 27
3.3 28
3.4 29
3.6 30
3.7 31
3.9 32
4.0 33
4.2 34
4.3 35
4.5 36
4.6 37
4.7 38
4.9 39
5.0 40
6.944*CER +5.055
Limits
MIN = 1.7 cm
MAX = 5.0 cm
Reference: Hata, Toshiyuki, et al, “A review of Fetal Organ Measurements obtained with Ultrasound:
Normal Growth,” J Clin Ultrasound 20:155-174, Table 3, March-April 1992.

Cerebellum Chart, McLeary
16 - 37 weeks
Cerebellum Diameter Menstrual Age
(cm) (weeks)
1.50 16
1.60 17
1.70 18
1.85 19
2.00 20
2.10 21
2.30 22
2.40 23
2.50 24
2.70 25
2.80 26
2.95 27
3.15 28
3.30 29
3.50 30
3.65 31
3.85 32
4.00 33
4.25 34
4.60 35
4.90 36
5.30 37
–8.079585+29.303240*CER+–14.032870*CER^2+4.455406*CER^3+
–0.7016286*CER^4+0.0416698*CER^5
Limits
MIN = 1.5 cm
MAX = 5.3 cm
Reference: McLeary, R. D. 1984. Ultrasonography of the Fetal Cerebellum. Radiology. 1984:151: 439-442.

CRL Chart, Hadlock

5.7 - 18 weeks
CRL Menstrual CRL Menstrual CRL Menstrual CRL Menstrual
(cm) Age (cm) Age (cm) Age (cm) Age
0.2 5.7 3.2 10.1 6.3 12.7 9.4 15.3

0.3 5.9 3.3 10.2 6.4 12.8
0.4 6.1 3.4 10.3 6.5 12.8 9.5 15.3
0.5 6.2 3.5 10.4 6.6 12.9 9.6 15.4
3.6 10.5 6.7 13.0 9.7 15.5
0.6 6.4 3.7 10.6 6.8 13.1 9.8 15.6
0.7 6.6 3.8 10.7 6.9 13.1 9.9 15.7
0.8 6.7 3.9 10.8 7.0 13.2 10.0 15.9
0.9 6.9 4.0 10.9 7.1 13.3 10.1 16.0
1.0 7.1 4.1 11.0 10.2 16.1
1.1 7.2 7.2 13.4 10.3 16.2
1.2 7.4 4.2 11.1 7.3 13.4 10.4 16.3
1.3 7.5 4.3 11.2 7.4 13.5
1.4 7.7 4.4 11.2 7.5 13.6 10.5 16.4
1.5 7.9 4.5 11.3 7.6 13.7 10.6 16.5
4.6 11.4 7.7 13.8 10.7 16.6
1.6 8.0 4.7 11.5 7.8 13.8 10.8 16.7
1.7 8.1 4.8 11.6 7.9 13.9 10.9 16.8
1.8 8.3 4.9 11.7 8.0 14.0 11.0 16.9
1.9 8.4 5.0 11.7 8.1 14.1 11.1 17.0
2.0 8.6 5.1 11.8 11.2 17.1
2.1 8.7 8.2 14.2 11.3 17.2
2.2 8.9 5.2 11.9 8.3 14.2 11.4 17.3
2.3 9.0 5.3 12.0 8.4 14.3
2.4 9.1 5.4 12.0 8.5 14.4 11.5 17.4
2.5 9.2 5.5 12.1 8.6 14.5 11.6 17.5
5.6 12.2 8.7 14.6 11.7 17.6
2.6 9.4 5.7 12.3 8.8 14.7 11.8 17.7
2.7 9.5 5.8 12.3 8.9 14.8 11.9 17.8
2.8 9.6 5.9 12.4 9.0 14.9 12.0 17.9
2.9 9.7 6.0 12.5 9.1 15.0 12.1 18.0
3.0 9.9 6.1 12.6 9.2 15.1
3.1 10.0 6.2 12.6 9.3 15.2
5.340164+1.921032*CRL+–0.1690442*CRL^2+0.0081207*CRL^3
Limits
MIN = 0.2 cm
MAX = 12.1 cm
Reference: Hadlock, F., et al. 1992. Fetal Crown-Rump Length: Reevaluation of Relation to Menstrual
Age (5-18 weeks) with High-Resolution Real-Time US. Radiology 1992; 182:501-505.
168 ACUSON Sequoia Aspen Ultrasound System 0403

Ob Charts
CRL Chart, Hansmann

7.1 - 22.4 weeks
CRL Menstrual Age CRL Menstrual Age CRL Menstrual Age CRL Menstrual Age
(cm) (wks + days) (cm) (wks + days) (cm) (wks + days) (cm) (wks + days)
.6 7+1 4.2 12 + 3 7.9 15 + 1 11.6 18 + 2
.7 7+2 4.3 12 + 4 8.0 15 + 1 11.7 18 + 2
.8 7+4 4.4 12 + 5 8.1 15 + 1 11.8 18 + 3
.9 7+6 4.5 12 + 6 8.2 15 + 2 11.9 18 + 3
4.6 12 + 6 8.3 15 + 2
1.0 7+7 4.7 12 + 7 8.4 15 + 3 12.0 18 + 4
1.1 8+2 4.8 12 + 7 8.5 15 + 3 12.1 18 + 5
1.2 8+3 4.9 13 + 1 8.6 15 + 4 12.2 18 + 6
1.3 8+4 8.7 15 + 4 12.3 18 + 7
1.4 8+6 5.0 13 + 1 8.8 15 + 5 12.4 18 + 8
1.5 8+7 5.1 13 + 2 8.9 15 + 5 12.5 19 + 1
1.6 9+2 5.2 13 + 2 12.6 19 + 2
1.7 9+3 5.3 13 + 3 9.0 15 + 6 12.7 19 + 3
1.8 9+4 5.4 13 + 3 9.1 15 + 6 12.8 19 + 4
1.9 9+5 5.5 13 + 4 9.2 15 + 7 12.9 19 + 5
5.6 13 + 4 9.3 15 + 7
2.0 9+6 5.7 13 + 5 9.4 16 + 1 13.0 19 + 6
2.1 9+7 5.8 13 + 5 9.5 16 + 2 13.1 19 + 6
2.2 10 + 1 5.9 13 + 6 9.6 16 + 3 13.2 19 + 7
2.3 10 + 2 9.7 16 + 3 13.3 20 + 1
2.4 10 + 3 6.0 13 + 6 9.8 16 + 4 13.4 20 + 2
2.5 10 + 4 6.1 13 + 6 9.9 16 + 4 13.5 20 + 3
2.6 10 + 5 6.2 13 + 7 13.6 20 + 4
2.7 10 + 6 6.3 13 + 7 10.0 16 + 5 13.7 20 + 5
2.8 10 + 7 6.4 13 + 7 10.1 16 + 5 13.8 20 + 6
2.9 11 + 1 6.5 14 + 1 10.2 16 + 6 13.9 20 + 6
6.6 14 + 1 10.3 16 + 7
3.0 11 + 2 6.7 14 + 2 10.4 17 + 1 14.0 20 + 7
3.1 11 + 2 6.8 14 + 2 10.5 17 + 1 14.1 21 + 1
3.2 11 + 3 6.9 14 + 3 10.6 17 + 2 14.2 21 + 2
3.3 11 + 4 10.7 17 + 2 14.3 21 + 3
3.4 11 + 5 7.0 14 + 3 10.8 17 + 3 14.4 21 + 4
3.5 11 + 6 7.1 14 + 4 10.9 17 + 3 14.5 21 + 5
3.6 11 + 6 7.2 14 + 4 14.6 21 + 6
3.7 11 + 7 7.3 14 + 5 11.0 17 + 4 14.7 21 + 7
3.8 12 + 1 7.4 14 + 5 11.1 17 + 5 14.8 22 + 1
3.9 12 + 2 7.5 14 + 6 11.2 17 + 6 14.9 22 + 2
7.6 14 + 6 11.3 17 + 7 15.0 22 + 3
4.0 12 + 2 7.7 14 + 7 11.4 18 + 1
4.1 12 + 3 7.8 14 + 7 11.5 18 + 1
MA: 6.303340+2.063087*CRL+–0.1780907*CRL^2+0.0075699*CRL^3
SD: 3.784486+–0.726592*CRL+0.0568590*CRL^2+–0.0012292*CRL^3
Limits
MIN = .6 cm
MAX = 15.0 cm
Reference: Hansmann, M., et. al. 1985. Ultrasound Diagnosis in Obstetrics and Gynecology.
Springer-Verlag.

CRL Chart, Jeanty

6.3 - 12.1 weeks
CRL Menstrual Age CRL Menstrual Age
.5 6+2 3.0 9+6
.6 6+4 3.1 10 + 0
.7 6+5 3.2 10 + 1
.8 6+6 3.3 10 + 1
.9 7+1 3.4 10 + 2
1.0 7+2 3.5 10 + 3

1.1 7+3 3.6 10 + 4
1.2 7+4 3.7 10 + 4
1.3 7+6 3.8 10 + 5
1.4 7+6 3.9 10 + 6
1.5 8+1 4.0 10 + 6
1.6 8+1 4.1 11 + 0
1.7 8+3 4.2 11 + 1
1.8 8+4 4.3 11 + 1
1.9 8+4 4.4 11 + 1
2.0 8+6 4.5 11 + 2

2.1 8+6 4.6 11 + 3
2.2 9+0 4.7 11 + 4
2.3 9+1 4.8 11 + 4
2.4 9+1 4.9 11 + 5
2.5 9+3 5.0 11 + 6
2.6 9+4 5.1 11 + 6
2.7 9+4 5.2 11 + 6
2.8 9+5 5.3 12 + 0
2.9 9+6 5.4 12 + 1
5.279715+2.273903*CRL+–0.3109710*CRL^2+0.0231365*CRL^3
Limits
MIN = .5 cm
MAX = 5.4 cm

Ob Charts
CRL Chart, Nelson

8.1 - 14.1 weeks
CRL Menstrual Age
(cm) (weeks)
1.0 8.1
1.2 8.3
1.4 8.5
1.6 8.6
1.8 8.8
2.0 9.0
2.2 9.2
2.4 9.3
2.6 9.5
2.8 9.7
3.0 9.9
3.2 10.0
3.4 10.2
3.6 10.4
3.8 10.5
4.0 10.7
4.2 10.9
4.4 11.1
4.6 11.2
4.8 11.4
5.0 11.6
5.2 11.7
5.4 11.9
5.6 12.1
5.8 12.3
6.0 12.4
6.2 12.6
6.4 12.8
6.6 12.9
6.8 13.1
7.0 13.3
7.2 13.5
7.4 13.6
7.6 13.8
7.8 14.0
8.0 14.1
7.234143+0.8856020*CRL+–0.0046905*CRL^2+0.0002347*CRL^3
Limits
MIN = 1.0 cm
MAX = 8.0 cm
Reference: Nelson, L. H. 1981. Comparison of methods for determining crown-rump measurement by
real-time ultrasound. J. Clin. Ultrasound. 9:67-70.

CRL Chart, Robinson, 1975

6.4 weeks - 14.0 weeks
CRL MA 2 Std Dev 2 Std Dev CRL MA 2 Std Dev 2 Std Dev
(cm) (weeks) (1-2) (>3) (cm) (weeks) (1-2) (>3)
.6 6.4 0.7 0.4 4.2 11.1 0.7 0.4

.7 6.6 0.7 0.4 4.3 11.2 0.7 0.4
.8 6.8 0.7 0.4 4.4 11.3 0.7 0.4
.9 7.0 0.7 0.4 4.5 11.4 0.7 0.4
4.6 11.5 0.7 0.4
1.0 7.2 0.7 0.4 4.7 11.6 0.7 0.4
1.1 7.4 0.7 0.4 4.8 11.7 0.7 0.4
1.2 7.6 0.7 0.4 4.9 11.8 0.7 0.4
1.3 7.7 0.7 0.4
1.4 7.9 0.7 0.4 5.0 11.9 0.7 0.4
1.5 8.0 0.7 0.4 5.1 11.9 0.7 0.4
1.6 8.2 0.7 0.4 5.2 12.0 0.7 0.4
1.7 8.3 0.7 0.4 5.3 12.1 0.7 0.4
1.8 8.5 0.7 0.4 5.4 12.2 0.7 0.4
1.9 8.6 0.7 0.4 5.5 12.3 0.7 0.4
5.6 12.4 0.7 0.4
2.0 8.8 0.7 0.4 5.7 12.4 0.7 0.4
2.1 8.9 0.7 0.4 5.8 12.5 0.7 0.4
2.2 9.0 0.7 0.4 5.9 12.6 0.7 0.4
2.3 9.1 0.7 0.4
2.4 9.3 0.7 0.4 6.0 12.7 0.7 0.4
2.5 9.4 0.7 0.4 6.1 12.7 0.7 0.4
2.6 9.5 0.7 0.4 6.2 12.8 0.7 0.4
2.7 9.6 0.7 0.4 6.3 12.9 0.7 0.4
2.8 9.7 0.7 0.4 6.4 13.0 0.7 0.4
2.9 9.8 0.7 0.4 6.5 13.0 0.7 0.4
6.6 13.1 0.7 0.4
3.0 9.9 0.7 0.4 6.7 13.2 0.7 0.4
3.1 10.1 0.7 0.4 6.8 13.3 0.7 0.4
3.2 10.2 0.7 0.4 6.9 13.3 0.7 0.4
3.3 10.3 0.7 0.4
3.4 10.4 0.7 0.4 7.0 13.4 0.7 0.4
3.5 10.5 0.7 0.4 7.1 13.5 0.7 0.4
3.6 10.6 0.7 0.4 7.2 13.5 0.7 0.4
3.7 10.7 0.7 0.4 7.3 13.6 0.7 0.4
3.8 10.8 0.7 0.4 7.4 13.7 0.7 0.4
3.9 10.9 0.7 0.4 7.5 13.8 0.7 0.4
7.6 13.8 0.7 0.4
4.0 11.0 0.7 0.4 7.7 13.9 0.7 0.4
4.1 11.1 0.7 0.4 7.8 14.0 0.7 0.4
4.933912+2.800700*CRL+–0.6356975*CRL^2+0.1170670*CRL^3+–0.0116220*CRL^4+0.0004623*CRL^5
Limits
MIN = .6 cm
MAX = 7.8 cm
Reference: Robinson, H.P. et. al. 1975. A Critical Evaluation of Sonar “Crown-Rump Length”
Measurements. British Journal of Obstetrics and Gynecology, 82. (Sept.) 707.

Ob Charts
CRL Chart, Robinson, 1988

5.6 - 14.2 weeks
CRL Menstrual Age CRL Menstrual Age
.193 5+3 3.05 10 + 0
.238 5+4 3.18 10 + 1
.283 5+5 3.32 10 + 2
.328 5+6 3.46 10 + 3
3.60 10 + 4
.373 6+0 3.74 10 + 5
.418 6+1 3.89 10 + 6
.463 6+2
.508 6+3 4.04 11 + 0
.553 6+4 4.19 11 + 1
.598 6+5 4.35 11 + 2
.658 6+6 4.51 11 + 3
4.67 11 + 4
.743 7+0 4.83 11 + 5
.85 7+1 5.00 11 + 6
.96 7+2
1.07 7+3 5.17 12 + 0
1.20 7+4 5.34 12 + 1
1.29 7+5 5.52 12 + 2
1.38 7+6 5.70 12 + 3
5.88 12 + 4
1.47 8+0 6.06 12 + 5
1.57 8+1 6.25 12 + 6
1.66 8+2
1.76 8+3 6.43 13 + 0
1.87 8+4 6.63 13 + 1
1.97 8+5 6.82 13 + 2
2.08 8+6 7.02 13 + 3
2.19 9+0 7.22 13 + 4
7.42 13 + 5
2.31 9+1 7.63 13 + 6
2.42 9+2 7.83 14 + 0
2.54 9+3
2.67 9+4
2.79 9+5
2.92 9+6
4.999137+3.081557*CRL+–0.9486124*CRL^2+0.2253123*CRL^3+–0.0268326*CRL^4+0.0012157*CRL^5
Limits
MIN = .193 cm
MAX = 7.83 cm
Reference: Robinson, H.P. and J. E. E. Fleming. 1975. A Critical Evaluation of Sonar
“Crown-Rump Length” Measurements. British Journal of Obstetrics and Gynecology. 82: 702-710.
(modified)
Yeh Hsui Chung MD. 1988. Amniotic Sac Development, Ultrasound Feature of Early
Pregnancy. Radiology. 166:97-103.

EFW Chart, Shepard

Abdominal Circumference
Biparietal
Diameter
15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5 20.0 20.5 21.0 21.5
3.1 225 235 245 256 267 279 292 304 318 332 347 362 378
3.2 231 241 252 263 275 287 299 313 327 341 356 372 388
3.3 238 248 259 270 282 295 308 321 335 350 365 381 398
3.4 245 255 267 278 290 303 316 330 344 359 375 391 408
3.5 252 263 274 286 298 311 325 339 353 369 385 401 418
3.6 259 270 282 294 307 320 334 348 363 378 395 411 429
3.7 267 278 290 302 315 329 343 357 372 388 405 422 440
3.8 275 286 298 311 324 338 352 367 382 399 415 433 451
3.9 283 295 307 320 333 347 362 377 393 409 426 444 463
4.0 291 303 316 329 342 357 372 387 403 420 437 456 475
4.1 299 312 325 338 352 367 382 397 414 431 449 467 487
4.2 308 321 334 348 362 377 392 408 425 442 460 479 499
4.3 317 330 343 357 372 387 403 419 436 454 472 492 512
4.4 326 340 353 368 382 398 414 431 448 466 485 504 525
4.5 336 349 363 378 393 409 425 442 460 478 497 517 538
4.6 346 359 374 389 404 420 437 454 472 491 510 531 552
4.7 356 370 384 400 415 432 449 466 485 504 524 544 566
4.8 366 381 395 411 427 444 461 479 498 517 537 558 580
4.9 377 392 407 422 439 456 474 492 511 531 551 573 595
5.0 388 403 418 434 451 468 486 505 525 545 566 587 610
5.1 399 414 430 447 464 481 500 519 539 559 580 603 626
5.2 411 426 443 459 477 495 513 533 553 574 596 618 641
5.3 423 439 455 472 490 508 527 547 568 589 611 634 658
5.4 435 451 468 486 504 522 542 562 583 605 627 650 675
5.5 448 464 482 499 518 537 557 577 598 620 643 667 692
5.6 461 478 495 513 532 552 572 593 614 637 660 684 709
5.7 474 492 509 528 547 567 587 609 631 654 677 702 727
5.8 488 506 524 543 562 583 604 625 648 671 695 720 746
5.9 503 520 539 558 578 599 620 642 665 689 713 739 765
6.0 517 536 554 574 594 615 637 659 683 707 732 758 784
6.1 532 551 570 590 611 632 654 677 701 725 751 777 804
6.2 548 567 587 607 628 650 672 696 720 745 770 797 825
6.3 564 583 603 624 645 668 691 714 739 764 790 818 846
6.4 580 600 621 642 664 686 709 734 759 784 811 839 867
6.5 597 617 638 660 682 705 729 753 779 805 832 860 889
6.6 615 635 657 678 701 725 749 774 800 826 854 882 912
6.7 633 654 675 698 721 745 769 795 821 848 876 905 935
6.8 651 673 695 717 741 765 790 816 843 870 899 928 959
6.9 670 692 714 738 762 786 812 838 865 893 922 952 983
7.0 690 712 735 758 783 808 834 861 888 917 946 977 1008
7.1 710 733 756 780 805 830 857 884 912 941 971 1002 1034
7.2 731 754 777 802 827 853 880 908 936 966 996 1028 1060
7.3 752 775 800 825 850 877 904 932 961 991 1022 1054 1087
7.4 774 798 822 848 874 901 929 958 987 1018 1049 1081 1115
7.5 797 821 846 872 898 926 954 983 1013 1044 1076 1109 1143
7.6 820 845 870 896 924 952 980 1010 1041 1072 1104 1138 1172
7.7 844 869 895 922 949 978 1007 1037 1068 1100 1133 1167 1202
7.8 868 894 921 948 976 1005 1035 1065 1097 1129 1163 1197 1233
7.9 894 920 947 975 1003 1033 1063 1094 1126 1159 1193 1228 1264
8.0 920 946 974 1002 1031 1061 1092 1124 1156 1190 1224 1260 1296
8.1 947 974 1002 1030 1060 1090 1122 1154 1187 1221 1256 1292 1329
8.2 974 1002 1030 1060 1090 1121 1152 1185 1219 1253 1289 1325 1363
8.3 1003 1031 1060 1090 1120 1152 1184 1217 1251 1286 1322 1360 1398
8.4 1032 1061 1090 1120 1151 1183 1216 1250 1285 1320 1357 1395 1433
8.5 1062 1091 1121 1152 1184 1216 1249 1284 1319 1355 1392 1431 1470
8.6 1093 1123 1153 1185 1217 1250 1284 1318 1354 1391 1429 1467 1507
8.7 1125 1155 1186 1218 1251 1284 1319 1354 1390 1428 1466 1505 1545

Ob Charts
Biparietal
Diameter
15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5 20.0 20.5 21.0 21.5
8.8 1158 1189 1220 1252 1286 1320 1355 1391 1427 1465 1504 1544 1585
8.9 1192 1223 1255 1288 1322 1356 1392 1428 1466 1504 1543 1584 1625
9.0 1227 1258 1291 1324 1358 1394 1430 1467 1505 1544 1583 1624 1666
9.1 1262 1295 1328 1362 1396 1432 1469 1506 1545 1584 1625 1666 1709
9.2 1299 1332 1366 1400 1435 1472 1509 1547 1586 1626 1667 1709 1752
9.3 1337 1370 1405 1440 1476 1512 1550 1589 1628 1669 1711 1753 1797
9.4 1376 1410 1445 1480 1517 1554 1592 1632 1672 1713 1755 1798 1843
9.5 1416 1451 1486 1522 1559 1597 1636 1676 1716 1758 1801 1845 1890
9.6 1458 1493 1529 1565 1603 1641 1681 1721 1762 1805 1848 1892 1938
9.7 1500 1536 1572 1609 1648 1687 1727 1767 1809 1852 1896 1941 1987
9.8 1544 1580 1617 1655 1694 1733 1774 1815 1858 1901 1945 1991 2037
9.9 1589 1626 1663 1702 1741 1781 1822 1864 1907 1951 1996 2042 2089
10.0 1636 1673 1711 1750 1790 1830 1872 1915 1958 2003 2048 2095 2142

EFW Chart, Shepard (continued)

Biparietal
Diameter
22.0 22.5 23.0 23.5 24.0 24.5 25.0 25.5 26.0 26.5 27.0 27.5 28.0
3.1 395 413 431 450 470 491 513 536 560 585 611 638 666
3.2 405 423 442 461 482 503 525 548 573 598 624 652 681
3.3 415 434 453 473 493 515 537 561 586 611 638 666 695
3.4 426 444 464 484 505 527 550 574 599 625 652 680 710
3.5 437 455 475 496 517 539 563 587 612 639 666 695 725
3.6 448 467 487 508 529 552 576 600 626 653 681 710 741
3.7 459 478 499 520 542 565 589 614 640 668 696 726 757
3.8 470 490 511 532 555 578 603 628 655 683 711 741 773
3.9 482 502 523 545 568 592 617 643 670 698 727 758 789
4.0 494 515 536 559 582 606 631 658 685 713 743 774 806
4.1 507 528 549 572 596 620 646 673 700 729 759 791 823
4.2 519 541 563 586 610 635 661 688 716 746 776 808 841
4.3 532 554 577 600 625 650 676 704 732 762 793 825 859
4.4 546 568 591 615 639 665 692 720 749 779 811 843 877
4.5 560 582 605 629 655 681 708 736 766 797 829 862 896
4.6 574 596 620 645 670 697 725 753 783 814 847 880 915
4.7 588 611 635 660 686 713 741 771 801 833 865 900 935
4.8 603 626 651 676 703 730 759 788 819 851 884 919 955
4.9 618 642 667 693 719 747 776 806 838 870 904 939 975
5.0 633 658 683 709 737 765 794 825 857 890 924 959 996
5.1 649 674 700 727 754 783 813 844 876 909 944 980 1018
5.2 666 691 717 744 772 801 832 863 896 930 965 1001 1039
5.3 682 708 735 762 791 820 851 883 916 951 986 1023 1062
5.4 700 726 753 781 810 840 871 903 937 972 1008 1045 1084
5.5 717 744 771 799 829 860 891 924 958 993 1030 1068 1107
5.6 735 762 790 819 849 880 912 945 980 1016 1053 1091 1131
5.7 754 781 809 839 869 901 933 967 1002 1038 1076 1115 1155
5.8 773 800 829 859 890 922 955 989 1025 1061 1100 1139 1180
5.9 792 820 849 880 911 943 977 1012 1048 1085 1124 1164 1205
6.0 812 841 870 901 933 966 1000 1035 1072 1109 1149 1189 1231
6.1 832 861 892 923 955 988 1023 1059 1096 1134 1174 1215 1257
6.2 853 883 913 945 978 1012 1047 1083 1121 1159 1200 1241 1284
6.3 875 905 936 968 1001 1036 1071 1108 1146 1185 1226 1268 1312
6.4 897 927 959 991 1025 1060 1096 1133 1172 1212 1253 1296 1340
6.5 919 950 982 1015 1050 1085 1122 1159 1198 1239 1281 1324 1368
6.6 942 974 1006 1040 1075 1111 1148 1186 1226 1267 1309 1353 1398
6.7 966 998 1031 1065 1100 1137 1174 1213 1253 1295 1338 1382 1428
6.8 990 1023 1056 1091 1127 1164 1202 1241 1282 1324 1367 1412 1458
6.9 1015 1048 1082 1117 1154 1191 1230 1270 1311 1353 1397 1443 1489
7.0 1041 1074 1109 1144 1181 1219 1258 1299 1340 1383 1428 1474 1521
7.1 1067 1101 1136 1172 1209 1248 1287 1328 1371 1414 1459 1506 1554
7.2 1094 1128 1164 1200 1238 1277 1317 1359 1402 1446 1491 1538 1587
7.3 1121 1156 1192 1229 1268 1307 1348 1390 1433 1478 1524 1572 1621
7.4 1149 1185 1221 1259 1298 1338 1379 1422 1466 1511 1558 1606 1656
7.5 1178 1214 1251 1290 1329 1370 1411 1455 1499 1545 1592 1641 1691
7.6 1208 1244 1282 1321 1361 1402 1444 1488 1533 1579 1627 1676 1727
7.7 1238 1275 1313 1353 1393 1435 1478 1522 1568 1615 1663 1713 1764
7.8 1269 1307 1346 1385 1426 1469 1512 1557 1603 1651 1700 1750 1802
7.9 1301 1339 1379 1419 1461 1503 1547 1593 1640 1688 1737 1788 1840
8.0 1334 1373 1412 1453 1495 1539 1583 1629 1677 1725 1775 1827 1880
8.1 1367 1407 1447 1488 1531 1575 1620 1667 1715 1764 1814 1866 1920
8.2 1402 1441 1482 1524 1568 1612 1658 1705 1753 1803 1854 1907 1961
8.3 1437 1477 1519 1561 1605 1650 1697 1744 1793 1843 1895 1948 2003
8.4 1473 1514 1556 1599 1643 1689 1736 1784 1834 1885 1937 1991 2046
8.5 1510 1552 1594 1638 1683 1729 1776 1825 1875 1927 1979 2034 2090
8.6 1548 1590 1633 1677 1723 1770 1818 1867 1918 1970 2023 2078 2134
8.7 1587 1629 1673 1718 1764 1811 1860 1910 1961 2014 2068 2123 2180

Ob Charts
Biparietal
Diameter
22.0 22.5 23.0 23.5 24.0 24.5 25.0 25.5 26.0 26.5 27.0 27.5 28.0
8.8 1627 1670 1714 1760 1806 1854 1903 1954 2005 2059 2113 2169 2227
8.9 1668 1711 1756 1802 1849 1898 1947 1998 2051 2104 2160 2216 2274
9.0 1710 1754 1799 1846 1893 1942 1993 2044 2097 2151 2207 2264 2323
9.1 1753 1797 1843 1890 1939 1988 2039 2091 2145 2199 2256 2313 2372
9.2 1797 1842 1888 1936 1985 2035 2087 2139 2193 2249 2305 2364 2423
9.3 1842 1888 1935 1983 2032 2083 2135 2188 2243 2299 2356 2415 2475
9.4 1888 1935 1982 2031 2081 2132 2185 2238 2294 2350 2408 2467 2528
9.5 1935 1983 2031 2080 2131 2182 2236 2290 2346 2403 2461 2521 2582
9.6 1984 2032 2080 2130 2182 2234 2287 2342 2399 2456 2515 2575 2637
9.7 2034 2082 2131 2182 2234 2287 2341 2396 2453 2511 2570 2631 2694
9.8 2085 2134 2184 2235 2287 2340 2395 2451 2508 2567 2627 2688 2751
9.9 2137 2187 2237 2289 2342 2396 2451 2507 2565 2624 2685 2747 2810
10.0 2191 2241 2292 2344 2398 2452 2508 2565 2623 2683 2744 2806 2870


Biparietal
Diameter
28.5 29.0 29.5 30.0 30.5 31.0 31.5 32.0 32.5 33.0 33.5 34.0 34.5
3.1 696 727 759 793 828 865 904 944 986 1030 1076 1123 1173
3.2 711 742 775 809 845 882 921 962 1004 1049 1095 1143 1194
3.3 726 757 791 825 862 899 939 980 1023 1068 1115 1163 1214
3.4 741 773 807 842 879 917 957 998 1042 1087 1135 1184 1235
3.5 757 789 823 859 896 935 975 1017 1061 1107 1155 1205 1257
3.6 773 806 840 876 914 953 994 1037 1081 1127 1176 1226 1279
3.7 789 822 857 894 932 972 1013 1056 1101 1148 1197 1248 1301
3.8 805 839 875 912 950 991 1032 1076 1122 1169 1218 1270 1323
3.9 822 857 893 930 969 1010 1052 1096 1142 1190 1240 1292 1346
4.0 840 875 911 949 989 1030 1073 1117 1164 1212 1263 1315 1370
4.1 857 893 930 968 1008 1050 1093 1138 1185 1234 1285 1338 1394
4.2 876 911 949 988 1028 1070 1114 1160 1207 1257 1308 1362 1418
4.3 894 930 968 1008 1049 1091 1136 1182 1230 1280 1332 1386 1442
4.4 913 950 988 1028 1069 1112 1157 1204 1253 1303 1356 1410 1467
4.5 932 969 1008 1049 1091 1134 1180 1227 1276 1327 1380 1435 1493
4.6 952 990 1029 1070 1112 1156 1202 1250 1300 1351 1405 1461 1519
4.7 972 1010 1050 1091 1134 1179 1225 1274 1324 1376 1430 1487 1545
4.8 992 1031 1071 1113 1157 1202 1249 1298 1348 1401 1456 1513 1572
4.9 1013 1052 1093 1136 1180 1225 1273 1322 1373 1427 1482 1539 1599
5.0 1035 1074 1116 1159 1203 1249 1297 1347 1399 1453 1509 1567 1627
5.1 1056 1097 1138 1182 1227 1274 1322 1373 1425 1479 1536 1594 1655
5.2 1079 1119 1162 1206 1251 1299 1348 1399 1452 1506 1563 1623 1684
5.3 1101 1143 1185 1230 1276 1324 1374 1425 1479 1534 1591 1651 1713
5.4 1125 1166 1210 1255 1301 1350 1400 1452 1506 1562 1620 1680 1743
5.5 1148 1191 1234 1280 1327 1376 1427 1479 1534 1591 1649 1710 1773
5.6 1172 1215 1260 1306 1354 1403 1454 1507 1563 1620 1679 1740 1804
5.7 1197 1241 1286 1332 1380 1430 1482 1536 1592 1649 1709 1771 1835
5.8 1222 1266 1312 1359 1408 1458 1511 1565 1621 1679 1740 1802 1867
5.9 1248 1293 1339 1386 1436 1487 1540 1595 1651 1710 1771 1834 1899
6.0 1274 1319 1366 1414 1464 1516 1569 1625 1682 1741 1803 1866 1932
6.1 1301 1347 1394 1443 1493 1545 1599 1655 1713 1773 1835 1899 1966
6.2 1329 1375 1422 1472 1523 1576 1630 1687 1745 1806 1868 1933 2000
6.3 1357 1403 1452 1501 1553 1606 1662 1719 1778 1839 1902 1967 2035
6.4 1385 1433 1481 1532 1584 1638 1693 1751 1811 1872 1936 2002 2070
6.5 1415 1462 1512 1563 1615 1670 1726 1784 1844 1906 1971 2037 2106
6.6 1444 1493 1542 1594 1647 1702 1759 1818 1879 1941 2006 2073 2142
6.7 1475 1524 1574 1626 1680 1736 1793 1852 1914 1977 2042 2110 2180
6.8 1506 1555 1606 1659 1713 1769 1827 1887 1949 2013 2079 2147 2217
6.9 1538 1588 1639 1692 1747 1804 1862 1923 1985 2050 2116 2185 2256
7.0 1570 1621 1673 1726 1782 1839 1898 1959 2022 2087 2154 2224 2295
7.1 1603 1654 1707 1761 1817 1875 1935 1996 2060 2125 2193 2263 2335
7.2 1637 1689 1742 1797 1853 1912 1972 2034 2098 2164 2232 2303 2375
7.3 1671 1724 1777 1833 1890 1949 2010 2072 2137 2204 2273 2343 2417
7.4 1707 1759 1814 1870 1928 1987 2048 2112 2177 2244 2313 2385 2459
7.5 1743 1796 1851 1907 1966 2026 2088 2152 2217 2285 2355 2427 2501
7.6 1779 1833 1889 1946 2005 2065 2128 2192 2259 2327 2397 2470 2545
7.7 1817 1871 1927 1985 2044 2106 2169 2234 2301 2369 2440 2513 2589
7.8 1855 1910 1967 2025 2085 2147 2210 2276 2343 2413 2484 2558 2634
7.9 1894 1950 2007 2066 2126 2189 2253 2319 2387 2457 2529 2603 2679
8.0 1934 1990 2048 2107 2169 2231 2296 2363 2431 2502 2574 2649 2726
8.1 1975 2032 2090 2150 2212 2275 2340 2407 2477 2548 2621 2696 2773
8.2 2017 2074 2133 2193 2255 2319 2385 2453 2523 2594 2668 2743 2821
8.3 2059 2117 2176 2237 2300 2365 2431 2499 2569 2642 2716 2792 2870
8.4 2103 2161 2221 2282 2346 2411 2478 2547 2617 2690 2764 2841 2920
8.5 2147 2206 2266 2328 2392 2458 2525 2595 2666 2739 2814 2891 2971
8.6 2192 2252 2313 2375 2440 2506 2574 2644 2715 2789 2865 2942 3022
8.7 2238 2298 2360 2423 2488 2555 2623 2694 2766 2840 2916 2994 3075

Ob Charts
Biparietal
Diameter
28.5 29.0 29.5 30.0 30.5 31.0 31.5 32.0 32.5 33.0 33.5 34.0 34.5
8.8 2286 2346 2408 2472 2538 2605 2674 2745 2817 2892 2969 3047 3128
8.9 2334 2395 2457 2522 2588 2656 2725 2797 2870 2945 3022 3101 3182
9.0 2383 2445 2508 2573 2639 2707 2778 2849 2923 2999 3076 3156 3238
9.1 2433 2495 2559 2624 2692 2760 2831 2903 2977 3054 3132 3212 3294
9.2 2484 2547 2611 2677 2745 2814 2885 2958 3033 3109 3188 3268 3351
9.3 2537 2600 2665 2731 2799 2869 2941 3014 3089 3166 3245 3326 3409
9.4 2590 2654 2719 2786 2855 2925 2997 3071 3147 3224 3304 3385 3468
9.5 2645 2709 2775 2842 2912 2982 3055 3129 3205 3283 3363 3445 3528
9.6 2701 2765 2832 2900 2969 3041 3114 3188 3265 3343 3423 3505 3590
9.7 2757 2823 2890 2958 3028 3100 3173 3248 3325 3404 3485 3567 3652
9.8 2816 2881 2949 3018 3088 3160 3234 3310 3387 3466 3547 3630 3715
9.9 2875 2941 3009 3078 3149 3222 3296 3372 3450 3530 3611 3695 3780
10.0 2936 3002 3071 3141 3212 3285 3360 3436 3514 3594 3676 3760 3845


Biparietal
Diameter
35.0 35.5 36.0 36.5 37.0 37.5 38.0 38.5 39.0 39.5 40.0
3.1 1225 1280 1337 1396 1458 1523 1591 1662 1736 1813 1894
3.2 1246 1301 1359 1419 1482 1547 1615 1687 1761 1839 1920
3.3 1268 1323 1381 1442 1505 1571 1640 1712 1787 1865 1947
3.4 1289 1345 1404 1465 1529 1595 1665 1737 1813 1892 1974
3.5 1311 1368 1427 1489 1553 1620 1690 1763 1839 1919 2002
3.6 1334 1391 1450 1513 1577 1645 1716 1789 1866 1946 2029
3.7 1356 1414 1474 1537 1602 1671 1742 1816 1893 1974 2058
3.8 1379 1438 1498 1562 1628 1696 1768 1843 1921 2002 2086
3.9 1403 1462 1523 1587 1653 1723 1795 1870 1949 2030 2116
4.0 1427 1486 1548 1612 1680 1749 1822 1898 1977 2059 2145
4.1 1451 1511 1573 1638 1706 1777 1850 1926 2006 2089 2175
4.2 1476 1536 1599 1665 1733 1804 1878 1955 2035 2119 2205
4.3 1501 1562 1626 1692 1760 1832 1907 1984 2065 2149 2236
4.4 1527 1588 1652 1719 1788 1860 1935 2014 2095 2179 2267
4.5 1553 1615 1679 1747 1817 1889 1965 2044 2125 2210 2299
4.6 1579 1642 1707 1775 1845 1919 1995 2074 2156 2242 2331
4.7 1606 1669 1735 1803 1874 1948 2025 2105 2188 2274 2363
4.8 1633 1697 1763 1832 1904 1978 2056 2136 2220 2306 2396
4.9 1661 1726 1792 1862 1934 2009 2087 2168 2252 2339 2430
5.0 1689 1754 1822 1892 1965 2040 2119 2200 2285 2373 2464
5.1 1718 1784 1852 1922 1996 2072 2151 2233 2318 2406 2498
5.2 1748 1814 1882 1953 2027 2104 2183 2266 2352 2441 2533
5.3 1777 1844 1913 1985 2059 2137 2217 2300 2386 2475 2568
5.4 1808 1875 1945 2017 2092 2170 2250 2334 2421 2511 2604
5.5 1838 1906 1976 2049 2125 2203 2284 2369 2456 2547 2640
5.6 1870 1938 2009 2082 2158 2237 2319 2404 2492 2583 2677
5.7 1902 1971 2042 2116 2193 2272 2354 2440 2528 2620 2715
5.8 1934 2003 2075 2150 2227 2307 2390 2476 2565 2657 2753
5.9 1967 2037 2110 2185 2262 2343 2426 2513 2602 2695 2791
6.0 2001 2071 2144 2220 2298 2379 2463 2550 2640 2733 2830
6.1 2035 2106 2179 2256 2335 2416 2501 2588 2679 2772 2869
6.2 2069 2141 2215 2292 2371 2454 2539 2627 2718 2812 2909
6.3 2105 2177 2252 2329 2409 2492 2577 2666 2757 2852 2950
6.4 2140 2213 2289 2366 2447 2530 2616 2705 2797 2893 2991
6.5 2177 2250 2326 2405 2486 2569 2656 2746 2838 2934 3033
6.6 2214 2288 2364 2443 2525 2609 2696 2786 2880 2976 3075
6.7 2252 2326 2403 2483 2565 2650 2737 2828 2921 3018 3118
6.8 2290 2365 2443 2523 2605 2691 2779 2870 2964 3061 3161
6.9 2329 2405 2483 2563 2647 2732 2821 2913 3007 3105 3206
7.0 2369 2445 2524 2605 2688 2775 2864 2956 3051 3149 3250
7.1 2409 2486 2565 2647 2731 2818 2907 3000 3095 3194 3296
7.2 2450 2527 2607 2689 2774 2861 2952 3045 3141 3239 3342
7.3 2492 2570 2650 2733 2818 2906 2996 3090 3186 3286 3388
7.4 2534 2613 2693 2777 2862 2951 3042 3136 3233 3333 3435
7.5 2578 2656 2738 2821 2908 2996 3088 3182 3280 3380 3483
7.6 2622 2701 2783 2867 2954 3043 3135 3230 3328 3428 3532
7.7 2666 2746 2828 2913 3000 3090 3183 3278 3376 3477 3581
7.8 2712 2792 2875 2960 3048 3138 3231 3327 3425 3527 3631
7.9 2758 2839 2922 3008 3096 3187 3280 3376 3475 3577 3682
8.0 2805 2886 2970 3056 3145 3236 3330 3426 3526 3628 3733
8.1 2853 2935 3019 3105 3194 3286 3380 3477 3577 3680 3785
8.2 2901 2984 3068 3155 3245 3337 3432 3529 3629 3732 3838
8.3 2951 3034 3119 3206 3296 3389 3484 3582 3682 3785 3892
8.4 3001 3084 3170 3258 3348 3441 3537 3635 3736 3839 3946
8.5 3052 3136 3222 3310 3401 3495 3590 3689 3790 3894 4001
8.6 3104 3188 3275 3364 3455 3549 3645 3744 3845 3950 4057
8.7 3157 3242 3329 3418 3510 3604 3700 3799 3901 4006 4113

Ob Charts
Biparietal
Diameter
35.0 35.5 36.0 36.5 37.0 37.5 38.0 38.5 39.0 39.5 40.0
8.8 3211 3296 3383 3473 3565 3659 3756 3856 3958 4063 4171
8.9 3266 3351 3439 3529 3621 3716 3813 3913 4016 4121 4229
9.0 3321 3407 3495 3586 3679 3774 3871 3972 4074 4180 4288
9.1 3378 3464 3553 3644 3737 3832 3930 4031 4134 4239 4348
9.2 3435 3522 3611 3702 3796 3892 3990 4091 4194 4300 4408
9.3 3494 3581 3670 3762 3856 3952 4050 4151 4255 4361 4470
9.4 3554 3641 3731 3823 3917 4013 4112 4213 4317 4423 4532
9.5 3614 3702 3792 3884 3979 4075 4174 4276 4380 4486 4595
9.6 3676 3764 3854 3947 4041 4138 4238 4339 4444 4550 4659
9.7 3738 3827 3918 4010 4105 4203 4302 4404 4508 4615 4724
9.8 3802 3891 3982 4075 4170 4268 4367 4470 4574 4681 4790
9.9 3867 3956 4047 4141 4236 4334 4434 4536 4641 4748 4857
10.0 3933 4022 4114 4207 4303 4401 4501 4604 4708 4815 4925
10^(1.2508+0.166*BPD+0.046*AC+-0.002646*BPD*AC)
Reference: Shepard, M.J., et. al. 1982. An Evaluation of Two Equations for Predicting Fetal Weight by
Ultrasound. American Journal of Obstetrics and Gynecology. 147: 47-54.

Fibula Chart, Jeanty

12 - 40 weeks
Fibula Menstrual
(50th Percentile) Age
(cm) (weeks)
.6 12
.9 13
1.2 14
1.5 15
1.8 16
2.1 17
2.3 18
2.6 19
2.8 20
3.1 21
3.3 22
3.5 23
3.7 24
4.0 25
4.2 26
4.4 27
4.5 28
4.7 29
4.9 30
5.1 31
5.2 32
5.4 33
5.5 34
5.7 35
5.8 36
5.9 37
6.1 38
6.2 39
6.3 40
10.31506+2.651455*FIB+0.3790657*FIB^2+–0.0615157*FIB^3+0.0083915*FIB^4
Limits
MIN = 0.6 cm
MAX = 6.3 cm

Ob Charts
FL Chart Campbell,
1994
12-42 weeks
FL Menstrual Age
(cm) Weeks
0.85 12
1.10 13
1.41 14
1.71 15
2.05 16
2.27 17
2.69 18
2.98 19
3.22 20
3.54 21
3.72 22
4.06 23
4.35 24
4.61 25
4.69 26
5.02 27
5.24 28
5.63 29
5.60 30
5.97 31
6.13 32
6.28 33
6.43 34
6.62 35
6.83 36
6.99 37
7.08 38
7.17 39
7.47 40
7.48 41
7.60 42
8.448378 + 5.006931*FL + -1.157684*FL^2 +0.3379876*FL^3 + -0.04365*FL^4 + 0.0023437*FL^5
Limits
MIN =.85 cm
MAX =7.6 cm
Reference: Chitty, l., Campbell, Stuart, “Charts of fetal size: 4 Femur Length,”
British J of OB and Gyn., February 1994, Vol 101, pp 132-135, Table 1.

FL Chart, Hadlock
12.2 - 42 weeks
FL MA 2 Std FL MA 2 Std FL MA 2 Std
.70 12.2 1.4 3.2 20.0 1.8 5.8 30.3 3.0

.80 12.4 1.4 3.3 20.3 1.8 5.9 30.8 3.0
.90 12.7 1.4 3.4 20.7 1.8
3.5 21.0 1.8 6.0 31.2 3.0
1.0 13.0 1.4 3.6 21.4 1.8 6.1 31.7 3.0
1.1 13.3 1.4 3.7 21.8 1.8 6.2 32.1 3.0
1.2 13.5 1.4 3.8 22.2 1.8 6.3 32.6 3.0
1.3 13.8 1.4 3.9 22.5 1.8 6.4 33.1 3.0
1.4 14.1 1.4 6.5 33.5 3.0
1.5 14.4 1.4 4.0 22.9 1.8 6.6 34.0 3.0
1.6 14.7 1.4 4.1 23.3 1.8 6.7 34.5 3.0
1.7 15.0 1.4 4.2 23.7 1.8 6.8 34.9 3.0
1.8 15.3 1.4 4.3 24.1 2.1 6.9 35.4 3.0
4.4 24.5 2.1
1.9 15.6 1.4 4.5 24.9 2.1 7.0 35.9 3.0
2.0 16.0 1.4 4.6 25.3 2.1 7.1 36.4 3.1
2.1 16.3 1.4 4.7 25.7 2.1 7.2 36.9 3.1
2.2 16.6 1.4 4.8 26.1 2.1 7.3 37.4 3.1
2.3 16.9 1.4 4.9 26.5 2.1 7.4 37.9 3.1
2.4 17.2 1.4 7.5 38.4 3.1
2.5 17.6 1.4 5.0 26.9 2.1 7.6 38.9 3.1
2.6 17.9 1.4 5.1 27.3 2.1 7.7 39.4 3.1
2.7 18.2 1.8 5.2 27.7 2.1 7.8 39.9 3.1
2.8 18.6 1.8 5.3 28.2 2.1 7.9 40.4 3.1
2.9 18.9 1.8 5.4 28.6 2.1
5.5 29.0 2.1 8.0 40.9 3.1
3.0 19.3 1.8 5.6 29.5 2.1 8.1 41.4 3.1
3.1 19.6 1.8 5.7 29.9 2.1 8.2 42.0 3.1
10.35+2.460*FL+0.170*FL^2
Limits
MIN = .70 cm
MAX = 8.2 cm
Reference: Hadlock, F.P. et al. 1984. Estimating Fetal age: Computer-Assisted Analysis of Multiple

Ob Charts
FL Chart, Hansmann
17.1 - 40.1 weeks
FL Menstrual Age FL Menstrual Age
2.0 17 + 1 4.8 27 + 1
2.1 17 + 3 4.9 27 + 4
2.2 17 + 5 5.0 27 + 6
2.3 17 + 7 5.1 28 + 3
2.4 18 + 2 5.2 28 + 5
2.5 18 + 4 5.3 29 + 2
2.6 18 + 7 5.4 29 + 5
2.7 19 + 2 5.5 30 + 1
2.8 19 + 5 5.6 30 + 4
2.9 19 + 7 5.7 30 + 6
5.8 31 + 3
3.0 20 + 3 5.9 31 + 6
3.1 20 + 5
3.2 21 + 1 6.0 32 + 2
3.3 21 + 3 6.1 32 + 5
3.4 21 + 5 6.2 33 + 2
3.5 22 + 1 6.3 33 + 4
3.6 22 + 4 6.4 34 + 1
3.7 22 + 6 6.5 34 + 4
3.8 23 + 2 6.6 35 + 1
3.9 23 + 4 6.7 35 + 4
6.8 36 + 1
4.0 23 + 7 6.9 36 + 5
4.1 24 + 3
4.2 24 + 5 7.0 37 + 2
4.3 25 + 1 7.1 37 + 5
4.4 25 + 4 7.2 38 + 2
4.5 25 + 6 7.3 38 + 6
4.6 26 + 2 7.4 39 + 4
4.7 26 + 5 7.5 40 + 1
MA: 10.85929+3.639269*FL+–0.6200159*FL^2+0.2392270*FL^3+–0.0338586*FL^4+0.0018145*FL^5
SD: 1.505990+–0.1308938*FL+0.0086599*FL^2+–0.0001130*FL^3
Limits
MIN = 2.0 cm
MAX = 7.5 cm
Reference: Hansmann, M., et. al. 1985. Ultrasound Diagnosis in
Obstetrics and Gynecology. Springer-Verlag.

FL Chart, Hohler
9.2 - 44.5 weeks
.0 9.2 4.4 24.0
.1 9.4 4.5 24.4
.2 9.7 4.6 24.8
.3 10.0 4.7 25.3
.4 10.3 4.8 25.7
.5 10.6 4.9 26.1
.6 10.8
.7 11.1 5.0 26.5
.8 11.4 5.1 27.0
.9 11.7 5.2 27.4
5.3 27.8
1.0 12.0 5.4 28.3
1.1 12.3 5.5 28.7
1.2 12.6 5.6 29.1
1.3 12.9 5.7 29.6
1.4 13.2 5.8 30.0
1.5 13.5 5.9 30.5
1.6 13.9
1.7 14.2 6.0 31.0
1.8 14.5 6.1 31.4
1.9 14.8 6.2 31.9
6.3 32.4
2.0 15.2 6.4 32.8
2.1 15.5 6.5 33.3
2.2 15.8 6.6 33.8
2.3 16.2 6.7 34.3
2.4 16.5 6.8 34.7
2.5 16.9 6.9 35.2
2.6 17.2
2.7 17.6 7.0 35.7
2.8 17.9 7.1 36.2
2.9 18.3 7.2 36.7
7.3 37.2
3.0 18.6 7.4 37.7
3.1 19.0 7.5 38.2
3.2 19.4 7.6 38.7
3.3 19.7 7.7 39.2
3.4 20.1 7.8 39.7
3.5 20.5 7.9 40.3
3.6 20.9
3.7 21.2 8.0 40.8
3.8 21.6 8.1 41.3
3.9 22.0 8.2 41.8
8.3 42.4
4.0 22.4 8.4 42.9
4.1 22.8 8.5 43.4
4.2 23.2 8.6 44.0
4.3 23.6 8.7 44.5
9.174068+2.670895*FL+0.159947*FL^2
Limits
MIN = .0 cm
MAX = 8.7 cm
Reference: Hohler, Charles, M.D., Miami, Florida, June, 1982.

Ob Charts
FL Chart, Jeanty
12.6 - 40 weeks
1.0 12 + 4 4.5 25
1.1 12 + 6 4.6 25 + 3
1.2 13 + 2 4.7 25 + 6
1.3 13 + 4 4.8 26 + 1
1.4 13 + 6 4.9 26 + 4
1.5 14 + 1 5.0 27
1.6 14 + 4 5.1 27 + 3
1.7 14 + 6 5.2 27 + 6
1.8 15 + 1 5.3 28 + 1
1.9 15 + 4 5.4 28 + 4
2.0 15 + 6 5.5 29 + 1
2.1 16 + 2 5.6 29 + 4
2.2 16 + 4 5.7 29 + 6
2.3 16 + 6 5.8 30 + 2
2.4 17 + 2 5.9 30 + 5
2.5 17 + 4 6.0 31 + 1
2.6 18 6.1 31 + 4
2.7 18 + 2 6.2 32
2.8 18 + 5 6.3 32 + 3
2.9 19 6.4 32 + 6
3.0 19 + 3 6.5 33 + 2
3.1 19 + 5 6.6 33 + 5
3.2 20 + 1 6.7 34 + 1
3.3 20 + 4 6.8 34 + 4
3.4 20 + 6 6.9 35
3.5 21 + 1 7.0 35 + 4
3.6 21 + 4 7.1 35 + 8
3.7 22 7.2 36 + 3
3.8 22 + 3 7.3 36 + 6
3.9 22 + 5 7.4 37 + 2
4.0 23 + 1 7.5 37 + 5
4.1 23 + 4 7.6 38 + 1
4.2 23 + 6 7.7 38 + 4
4.3 24 + 2 7.8 39 + 1
4.4 24 + 5 7.9 39 + 4
8.0 40
9.421153+3.051680*FL+0.0890988*FL^2+0.0009513*FL^3
Limits
MIN = 1.0 cm
MAX = 8.0 cm

FL Chart, O’Brien
12.0 - 40.0 weeks
1.0 12 + 0 4.6 25 + 0
1.1 12 + 3 4.7 25 + 3
1.2 12 + 6 4.8 26 + 0
1.3 13 + 1 4.9 26 + 4
1.4 13 + 4
1.5 13 + 6 5.0 27 + 0
1.6 14 + 1 5.1 27 + 2
1.7 14 + 4 5.2 27 + 5
1.8 14 + 6 5.3 28 + 0
1.9 15 + 2 5.4 28 + 3
5.5 29 + 0
2.0 15 + 3 5.6 29 + 3
2.1 15 + 6 5.7 30 + 0
2.2 16 + 1 5.8 30 + 2
2.3 16 + 4 5.9 30 + 5
2.4 16 + 6
2.5 17 + 0 6.0 31 + 0
2.6 17 + 2 6.1 31 + 4
2.7 17 + 4 6.2 32 + 0
2.8 18 + 0 6.3 32 + 3
2.9 18 + 2 6.4 33 + 0
6.5 33 + 3
3.0 18 + 4 6.6 34 + 0
3.1 18 + 6 6.7 34 + 4
3.2 19 + 3 6.8 35 + 0
3.3 19 + 5 6.9 35 + 2
3.4 20 + 0
3.5 20 + 2 7.0 35 + 5
3.6 20 + 5 7.1 36 + 0
3.7 21 + 0 7.2 36 + 3
3.8 21 + 2 7.3 37 + 0
3.9 21 + 5 7.4 37 + 3
7.5 38 + 0
4.0 22 + 0 7.6 38 + 3
4.1 22 + 4 7.7 39 + 0
4.2 23 + 0 7.8 39 + 2
4.3 23 + 3 7.9 39 + 5
4.4 24 + 0 8.0 40 + 0
4.5 24 + 3
5.184726+9.844899*FL+–3.993980*FL^2+1.0411302*FL^3+–0.116949*FL^4+0.004815*FL^5
Limits
MIN = 1.0 cm
MAX = 8.0 cm
Reference: Data adapted from composite mean values for O’Brien (American Journal of Obstetrics and
Gynecology, 1981) from 12 to 23 weeks and for Hohler (submitted to AJOG for publication)
from 23 to 40 weeks.

Ob Charts
FL Chart, Queenan
14.0 weeks - 40.0 weeks
FL Menstrual Age
(cm) (wks + days)
1.66 14
1.99 15
2.20 16
2.52 17
2.96 18
3.24 19
3.48 20
3.75 21
4.09 22
4.35 23
4.64 24
4.80 25
5.11 26
5.30 27
5.44 28
5.73 29
5.87 30
6.15 31
6.28 32
6.49 33
6.57 34
6.77 35
6.95 36
7.08 37
7.18 38
7.42 39
7.54 40
6.511794+5.909238*FL+–1.108480*FL^2+0.172456*FL^3+–0.006786*FL^4
Limits
MIN = 1.66 cm
MAX = 7.54 cm
Reference: O’Brien, G.D., J.T. Queenan et al. 1981. Femur Length to Weeks Gestation for 14 to 40
Weeks. American Journal of Obstetrics and Gynecology, 141: 833.

Foot Chart, Mercer

11 - 40 weeks
Foot Length Menstrual Age
(cm) (weeks)
.8 11
.9 12
1.0 13
1.6 14
1.6 15
2.1 16
2.4 17
2.7 18
2.8 19
3.3 20
3.5 21
3.8 22
4.2 23
4.4 24
4.7 25
5.1 26
5.4 27
5.8 28
5.7 29
6.1 30
6.2 31
6.3 32
6.7 33
6.8 34
7.1 35
7.4 36
7.5 37
7.8 38
7.8 39
8.2 40
6.3629150+8.1331350*FT+–2.636452*FT^2+0.59239260*FT^3+–0.055804*FT^4+0.0018668*FT^5
Limits
MIN = .8 cm
MAX = 8.2 cm
Reference: Mercer, B.M., et. al. 1987. Fetal foot length as a predictor of gestational age.
American Journal of Obstetrics and Gynecology. 156:350.

Ob Charts
Gestational Sac, Hansmann

6.0 - 14.0 weeks
Sac Menstrual Age Sac Menstrual Age
1.0 5+6 4.0 9+7
1.1 5+7 4.1 10 + 1
1.2 6+1
1.3 6+2 4.2 10 + 2
1.4 6+3 4.3 10 + 3
1.5 6+4 4.4 10 + 4
1.6 6+5 4.5 10 + 5
1.7 6+6 4.6 10 + 6
1.8 6+7 4.7 10 + 7
1.9 7+1 4.8 11 + 1
4.9 11 + 2
2.0 7+2
2.1 7+3 5.0 11 + 3
2.2 7+4 5.1 11 + 4
2.3 7+5 5.2 11 + 5
2.4 7+6 5.3 11 + 6
2.5 7+7 5.4 11 + 7
2.6 8+1 5.5 12 + 1
2.7 8+2 5.6 12 + 2
2.8 8+3 5.7 12 + 3
2.9 8+4 5.8 12 + 4
5.9 12 + 5
3.0 8+5
3.1 8+6 6.0 12 + 6
3.2 8+7 6.1 12 + 7
3.3 9+1 6.2 13 + 1
3.4 9+2 6.3 13 + 2
3.5 9+3 6.4 13 + 3
3.6 9+4 6.5 13 + 4
3.7 9+4 6.6 13 + 5
3.8 9+5 6.7 13 + 6
3.9 9+6 6.8 13 + 7
4.298028+1.606707*GS+–0.0653561*GS^2+0.0058119*GS^3
Limits
MIN = 1.0 cm
MAX = 6.8 cm
Springer-Verlag.

Gestational Sac, Hellman

5.0 - 12.2 weeks
Sac Menstrual Age Sac Menstrual Age
1.0 5.0 3.6 8.8
1.1 5.2 3.7 8.9
1.2 5.3 3.8 9.0
1.3 5.5 3.9 9.2
1.4 5.6 4.0 9.3
1.5 5.8 4.1 9.5
1.6 5.9 4.2 9.6
1.7 6.0 4.3 9.7
1.8 6.2 4.4 9.9
1.9 6.3 4.5 10.0
4.6 10.2
2.0 6.5 4.7 10.3
2.1 6.6 4.8 10.5
2.2 6.8 4.9 10.6
2.3 6.9
2.4 7.0 5.0 10.7
2.5 7.2 5.1 10.9
2.6 7.3 5.2 11.0
2.7 7.5 5.3 11.2
2.8 7.6 5.4 11.3
2.9 7.8 5.5 11.5
5.6 11.6
3.0 7.9 5.7 11.7
3.1 8.0 5.8 11.9
3.2 8.2 5.9 12.0
3.3 8.3 6.0 12.2
3.4 8.5
3.5 8.6
3.622507+1.425010*GS
Limits
MIN = 1.0 cm
MAX = 6.0 cm
Reference: Hellman, L.M., et. al. 1969. Growth and Development of the Human Fetus Prior to the
Twentieth Week of Gestation. American Journal of Obstetrics and Gynecology. 103: 784-800.

Ob Charts
Gestational Sac Chart, Nyberg

revised Robinson 1975
4.5-12.1 weeks
GS Menstrual Age GS Menstrual Age
(cm) Weeks (cm) Weeks
0.2 4.5 2.9 8.5

0.3 4.6 3.0 8.7
0.4 4.8 3.1 8.8
0.5 4.9 3.2 9.0
0.6 5.1 3.3 9.1
0.7 5.2 3.4 9.2
0.8 5.4 3.5 9.4
0.9 5.5 3.6 9.5
1.0 5.7 3.7 9.7
1.1 5.8 3.8 9.8
1.2 6.0 3.9 10.0
1.3 6.1 4.0 10.1
1.4 6.3 4.1 10.3
1.5 6.4 4.2 10.4
1.6 6.6 4.3 10.6
1.7 6.7 4.4 10.7
1.8 6.9 4.5 10.9
1.9 7.0 4.6 11.0
2.0 7.2 4.7 11.2
2.1 7.3 4.8 11.3
2.2 7.5 4.9 11.5
2.3 7.6 5.0 11.6
2.4 7.8 5.1 11.8
2.5 7.9 5.2 11.9
2.6 8.1 5.3 12.1
2.7 8.2
2.8 8.4
4.183 + 1.49*Opt1
Limits
MIN = 0.2 cm
MAX= 5.3 cm
Reference: Nyberg, David, Transvaginal Ultrasound, Mosby Book, page 331 Table A-2 1992.
Revised Robinson, HP. British J of OB and Gyn., 1975:82:100-107.

HC Chart, Campbell
1994
12-42 weeks
HC Menstrual Age
(cm) Weeks
7.52 12
8.55 13
10.31 14
11.14 15
12.68 16
13.54 17
15.13 18
16.48 19
17.40 20
18.89 21
19.78 22
21.00 23
22.35 24
23.37 25
24.48 26
25.60 27
26.99 28
28.19 29
28.76 30
29.71 31
30.48 32
31.08 33
31.61 34
32.33 35
33.15 36
33.48 37
33.73 38
34.04 39
34.97 40
35.59 41
35.23 42
Regression Equation
11.49979 + -0.6874748*HC + 0.1402989*HC^2 + -0.0055649*HC^3 +0.0000798*HC^4
Limits
MIN = 7.52 cm
MAX = 35.23 cm
Reference: Chitty, L., Campbell, Stuart, “Charts of fetal size: 2 Head measurements,”
British J of OB & Gyn., January 1994, Vol 101, pp 35-43, Table 3.

Ob Charts
HC Chart, Hadlock
12.2 - 41.9 weeks
HC MA 2 Std HC MA 2 Std HC MA 2 Std
5.6 12.0 1.2 10.0 14.7 1.2 14.4 17.6 1.2

5.7 12.1 1.2 10.1 14.7 1.2 14.5 17.7 1.2
5.8 12.2 1.2 10.2 14.8 1.2 14.6 17.8 1.2
5.9 12.2 1.2 10.3 14.8 1.2 14.7 17.9 1.2
10.4 14.9 1.2 14.8 17.9 1.2
6.0 12.3 1.2 10.5 15.0 1.2 14.9 18.0 1.2
6.1 12.3 1.2 10.6 15.0 1.2
6.2 12.4 1.2 10.7 15.1 1.2 15.0 18.1 1.5
6.3 12.4 1.2 10.8 15.2 1.2 15.1 18.1 1.5
6.4 12.5 1.2 15.2 18.2 1.5
6.5 12.6 1.2 10.9 15.2 1.2 15.3 18.3 1.5
6.6 12.6 1.2 11.0 15.3 1.2 15.4 18.4 1.5
6.7 12.7 1.2 11.1 15.4 1.2 15.5 18.4 1.5
6.8 12.7 1.2 11.2 15.4 1.2 15.6 18.5 1.5
6.9 12.8 1.2 11.3 15.5 1.2 15.7 18.6 1.5
11.4 15.6 1.2 15.8 18.7 1.5
7.0 12.8 1.2 11.5 15.6 1.2 15.9 18.8 1.5
7.1 12.9 1.2 11.6 15.7 1.2
7.2 13.0 1.2 11.7 15.8 1.2 16.0 18.8 1.5
7.3 13.0 1.2 11.8 15.8 1.2 16.1 18.9 1.5
7.4 13.1 1.2 11.9 15.9 1.2 16.2 19.0 1.5
7.5 13.1 1.2 16.3 19.1 1.5
7.6 13.2 1.2 12.0 16.0 1.2 16.4 19.1 1.5
7.7 13.3 1.2 12.1 16.0 1.2 16.5 19.2 1.5
7.8 13.3 1.2 12.2 16.1 1.2 16.6 19.3 1.5
7.9 13.4 1.2 12.3 16.2 1.2 16.7 19.4 1.5
12.4 16.2 1.2 16.8 19.5 1.5
8.0 13.4 1.2 12.5 16.3 1.2 16.9 19.5 1.5
8.1 13.5 1.2 12.6 16.4 1.2
8.2 13.6 1.2 12.7 16.4 1.2 17.0 19.6 1.5
8.3 13.6 1.2 12.8 16.5 1.2 17.1 19.7 1.5
8.4 13.7 1.2 12.9 16.6 1.2 17.2 19.8 1.5
8.5 13.7 1.2 17.3 19.9 1.5
8.6 13.8 1.2 13.0 16.6 1.2 17.4 19.9 1.5
8.7 13.9 1.2 13.1 16.7 1.2 17.5 20.0 1.5
8.8 13.9 1.2 13.2 16.8 1.2 17.6 20.1 1.5
8.9 14.0 1.2 13.3 16.8 1.2 17.7 20.2 1.5
13.4 16.9 1.2 17.8 20.3 1.5
9.0 14.0 1.2 13.5 17.0 1.2 17.9 20.3 1.5
9.1 14.1 1.2 13.6 17.1 1.2
9.2 14.2 1.2 13.7 17.1 1.2 18.0 20.4 1.5
9.3 14.2 1.2 13.8 17.2 1.2 18.1 20.5 1.5
9.4 14.3 1.2 13.9 17.3 1.2 18.2 20.6 1.5
9.5 14.3 1.2 18.3 20.7 1.5
9.6 14.4 1.2 14.0 17.3 1.2 18.4 20.8 1.5
9.7 14.5 1.2 14.1 17.4 1.2 18.5 20.8 1.5
9.8 14.5 1.2 14.2 17.5 1.2 18.6 20.9 1.5
9.9 14.6 1.2 14.3 17.6 1.2 18.7 21.0 1.5

HC Chart, Hadlock
(continued)
18.8 21.1 1.5 23.1 25.1 2.1 27.5 30.0 3.0

18.9 21.2 1.5 23.2 25.2 2.1 27.6 30.2 3.0
23.3 25.3 2.1 27.7 30.3 3.0
19.0 21.3 1.5 23.4 25.4 2.1 27.8 30.4 3.0
19.1 21.4 1.5 23.5 25.5 2.1 27.9 30.5 3.0
19.2 21.5 1.5 23.6 25.6 2.1 28.0 30.7 3.0
19.3 21.5 1.5 23.7 25.8 2.1 28.1 30.8 3.0
19.4 21.6 1.5 23.8 25.9 2.1
19.5 21.7 1.5 23.9 26.0 2.1 28.2 30.9 3.0
19.6 21.8 1.5 28.3 31.0 3.0
19.7 21.9 1.5 24.0 26.1 2.1 28.4 31.2 3.0
19.8 22.0 1.5 24.1 26.2 2.1 28.5 31.3 3.0
19.9 22.1 1.5 24.2 26.3 2.1 28.6 31.4 3.0
24.3 26.4 2.1 28.7 31.5 3.0
20.0 22.2 1.5 24.4 26.5 2.1 28.8 31.7 3.0
20.1 22.3 1.5 24.5 26.6 2.1 28.9 31.8 3.0
20.2 22.3 1.5 24.6 26.7 2.1
20.3 22.4 1.5 24.7 26.8 2.1 29.0 31.9 3.0
20.4 22.5 1.5 24.8 26.9 2.1 29.1 32.1 3.0
20.5 22.6 1.5 24.9 27.0 2.1 29.2 32.2 3.0
20.6 22.7 1.5 25.0 27.1 2.1 29.3 32.3 3.0
20.7 22.8 1.5 29.4 32.5 3.0
20.8 22.9 1.5 25.1 27.3 2.1 29.5 32.6 3.0
20.9 23.0 1.5 25.2 27.4 2.1 29.6 32.7 3.0
25.3 27.5 2.1 29.7 32.9 3.0
21.0 23.1 1.5 25.4 27.6 2.1 29.8 33.0 3.0
21.1 23.2 1.5 25.5 27.7 2.1 29.9 33.1 3.0
21.2 23.3 1.5 25.6 27.8 2.1
21.3 23.4 1.5 25.7 27.9 2.1 30.0 33.3 3.0
21.4 23.5 1.5 25.8 28.0 2.1 30.1 33.4 3.0
21.5 23.6 1.5 25.9 28.2 2.1 30.2 33.5 3.0
21.6 23.6 1.5 30.3 33.7 3.0
21.7 23.7 1.5 26.0 28.3 2.1 30.4 33.8 3.0
21.8 23.8 1.5 26.1 28.4 2.1 30.5 33.9 3.0
21.9 23.9 1.5 26.2 28.5 2.1 30.6 34.1 3.0
26.3 28.6 2.1 30.7 34.2 3.0
22.0 24.0 2.1 26.4 28.7 2.1 30.8 34.4 3.0
22.1 24.1 2.1 26.5 28.9 2.1 30.9 34.5 3.0
22.2 24.2 2.1 26.6 29.0 2.1
22.3 24.3 2.1 26.7 29.1 2.1 31.0 34.6 3.0
22.4 24.4 2.1 26.8 29.2 2.1 31.1 34.8 3.0
22.5 24.5 2.1 26.9 29.3 2.1 31.2 34.9 3.0
22.6 24.6 2.1 31.3 35.1 3.0
22.7 24.7 2.1 27.0 29.4 2.1 31.4 35.2 3.0
22.8 24.8 2.1 27.1 29.6 2.1 31.5 35.3 3.0
22.9 24.9 2.1 27.2 29.7 2.1 31.6 35.5 3.0
27.3 29.8 2.1 31.7 35.6 3.0
23.0 25.0 2.1 27.4 29.9 2.1 31.8 35.8 3.0

Ob Charts
HC Chart, Hadlock
(continued)
31.9 35.9 3.0 33.2 37.9 2.7 34.6 40.1 2.7

33.3 38.0 2.7 34.7 40.2 2.7
32.0 36.1 2.7 33.4 38.2 2.7 34.8 40.4 2.7
32.1 36.2 2.7 33.5 38.3 2.7 34.9 40.6 2.7
32.2 36.4 2.7 33.6 38.5 2.7
32.3 36.5 2.7 33.7 38.6 2.7 35.0 40.7 2.7
32.4 36.7 2.7 33.8 38.8 2.7 35.1 40.9 2.7
32.5 36.8 2.7 33.9 39.0 2.7 35.2 41.1 2.7
32.6 37.0 2.7 35.3 41.2 2.7
32.7 37.1 2.7 34.0 39.1 2.7 35.4 41.4 2.7
32.8 37.3 2.7 34.1 39.3 2.7 35.5 41.6 2.7
32.9 37.4 2.7 34.2 39.4 2.7 35.6 41.7 2.7
34.3 39.6 2.7 35.7 41.9 2.7
33.0 37.6 2.7 34.4 39.7 2.7
33.1 37.7 2.7 34.5 39.9 2.7
8.96+0.54*HC+0.0003*HC^3
Limits
MIN = 5.6 cm
MAX = 35.7 cm
Reference: Hadlock, F.P. et al. 1984. Estimating Fetal age: Computer-Assisted Analysis of Multiple

HC Chart, Hansmann
17.9 - 41.6 weeks
HC Menstrual Age
(cm) (weeks + days)
14.0 17 + 6
15.0 18 + 5
16.0 19 + 4
17.0 20 + 3
18.0 21 + 2
19.0 22 + 1
20.0 22 + 6
21.0 23 + 5
22.0 24 + 4
23.0 25 + 3
24.0 26 + 2
25.0 27 + 2
26.0 28 + 1
27.0 29 + 1
28.0 30 + 1
29.0 31 + 2
30.0 32 + 3
31.0 33 + 6
32.0 35 + 2
33.0 36 + 6
34.0 39 + 1
35.0 41 + 4
–12.58698+3.677255*HC+–0.1398529*HC^2+0.0022478*HC^3
Limits
MIN = 14.0 cm
MAX = 35.0 cm
Springer-Verlag.

Ob Charts
HC Chart, Hoffbauer
12 - 40 weeks
HC Menstrual Age
(cm) (weeks)
6.0 12
7.5 13
9.0 14
10.5 15
12.0 16
13.5 17
15.0 18
16.0 19
18.0 20
19.0 21
20.0 22
21.0 23
22.0 24
23.0 25
24.0 26
25.0 27
26.0 28
27.0 29
28.0 30
29.0 31
30.0 32
30.5 33
31.0 34
32.0 35
33.0 36
33.5 37
34.0 38
35.0 39
36.0 40
Regression Equation
8.907953+0.5020671*HC+0.0046350*HC^2+0.0001522*HC^3
Limits
MIN = 6.0 cm
MAX = 36.0 cm
Reference: Hoffbauer H., et al. 1979. Control of Fetal Development with Multiple Ultrasonic Body
Measures. Contr. Gynec. Obstet. 6:147.

HC Chart, Jeanty
13.3 - 41.7 weeks
HC Menstrual Age HC Menstrual Age
8.0 13 + 2 22.5 24 + 3
8.5 13 + 5 23.0 24 + 6
9.0 13 + 7 23.5 25 + 3
9.5 14 + 2 24.0 25 + 8
10.0 14 + 4 24.5 26 + 3
10.5 14 + 6 25.0 26 + 6
11.0 15 + 2 25.5 27 + 3
11.5 15 + 4 26.0 28 + 0
12.0 15 + 6 26.5 28 + 4
12.5 16 + 2 27.0 29 + 1
13.0 16 + 4 27.5 29 + 5
13.5 16 + 6 28.0 30 + 2
14.0 17 + 2 28.5 30 + 7
14.5 17 + 4 29.0 31 + 4
15.0 17 + 7 29.5 32 + 1
15.5 18 + 3 30.0 32 + 6
16.0 18 + 5 30.5 33 + 4
16.5 19 + 1 31.0 34 + 1
17.0 19 + 4 31.5 34 + 8
17.5 19 + 6 32.0 35 + 4
18.0 20 + 2 32.5 36 + 2
18.5 20 + 5 33.0 37 + 0
19.0 21 + 1 33.5 37 + 5
19.5 21 + 4 34.0 38 + 4
20.0 22 + 0 34.5 39 + 2
20.5 22 + 3 35.0 40 + 0
21.0 22 + 7 35.5 40 + 6
21.5 23 + 3 36.0 41 + 5
22.0 23 + 6
8.817808+05504550*HC+-0.0001829*HC^2+0.0002846*HC^3
Limits
MIN = 8.0 cm
MAX = 36.0 cm
Reference: Jeanty, P. and Romero, R.: Obstetrical Ultrasound. Copyright 1984.

Ob Charts
Humerus Chart, Jeanty

12.6 - 40.1 weeks
Humerus Menstrual Age Humerus Menstrual Age
Length (cm) (wks + days) Length (cm) (wks + days)
1.0 12 + 4 4.0 24 + 2
1.1 12 + 6 4.1 24 + 6
1.2 13 + 1 4.2 25 + 2
1.3 13 + 4 4.3 25 + 5
1.4 13 + 6 4.4 26 + 1
1.5 14 + 1 4.5 26 + 5
1.6 14 + 4 4.6 27 + 1
1.7 14 + 6 4.7 27 + 5
1.8 15 + 1 4.8 28 + 1
1.9 15 + 4 4.9 28 + 6
2.0 15 + 6 5.0 29 + 2
2.1 16 + 2 5.1 29 + 6
2.2 16 + 5 5.2 30 + 2
2.3 17 + 1 5.3 30 + 6
2.4 17 + 3 5.4 31 + 3
2.5 17 + 6 5.5 32 + 0
2.6 18 + 1 5.6 32 + 4
2.7 18 + 4 5.7 33 + 1
2.8 19 + 0 5.8 33 + 4
2.9 19 + 3 5.9 34 + 1
3.0 19 + 6 6.0 34 + 6
3.1 20 + 2 6.1 35 + 2
3.2 20 + 5 6.2 35 + 6
3.3 21 + 1 6.3 36 + 4
3.4 21 + 4 6.4 37 + 1
3.5 22 + 0 6.5 37 + 5
3.6 22 + 4 6.6 38 + 2
3.7 22 + 6 6.7 38 + 6
3.8 23 + 3 6.8 39 + 4
3.9 23 + 6 6.9 40 + 1
MA: 9.814957+2.454296*HUM+0.315232*HUM^2+–0.006896*HUM^3+0.0002902*HUM^4
SD: 2.5660180+0.0196600*HUM+–0.0003650*HUM^2
Limits
MIN = 1.0 cm
MAX = 6.9 cm

Humerus Chart, Merz

1987
13-40 weeks
HUM Menstrual Age

(cm) Weeks
1.0 13
1.2 14
1.4 15
1.7 16
2.0 17
2.3 18
2.6 19
2.9 20
3.2 21
3.3 22
3.7 23
3.8 24
4.2 25
4.3 26
4.5 27
4.7 28
4.8 29
5.0 30
5.3 31
5.4 32
5.6 33
5.8 34
5.9 35
6.0 36
6.1 37
6.4 38
6.5 39
6.6 40
7.552628 + 7.015744*HUM + -1.751212*HUM^2 + 0.3398326*HUM^3 + -0.0187132*HUM^4
Limits
MIN = 1.0 cm
MAX = 6.6 cm
Merz, Eberband, “Ultrasonic Mensuration of Fetal Limb Bones in the Second and Third Trimesters,”
J Clin Ultrasound 15:175-183, Table 1, March/April 1987.

Ob Charts
Humerus Chart, Queenan

1980
11-22 weeks
HUM Menstrual Age

(cm) Weeks
0.97 11
1.20 12
1.51 13
1.80 14
2.06 15
2.40 16
2.60 17
2.87 18
3.10 19
3.49 20
3.64 21
4.04 22
1.345586 + 18.79808*HUM + -13.62812*HUM^2 + 5.637898*HUM^3 + -1.08434*HUM^4 + 0.0782952*HUM^5
Limits
MIN = 0.97 cm
MAX = 4.04 cm
Reference: Queenan, J.T., Am. J. Obstet. Gynecol. 138(3):297, Table A-12, 1980.

Outer Orbits Chart, Mayden

11.6 - 39.8 weeks
Predicted Outer Menstrual Age Predicted Outer Menstrual Age
Orbital Diameter (weeks) Orbital Diameter (weeks)
(cm) (cm)
1.3 11.6 4.1 23.8
1.4 11.6 4.1 24.3
1.5 12.1 4.2 24.3
1.6 12.6 4.3 24.7
1.7 12.6 4.3 25.2
1.7 13.1 4.4 25.2
1.8 13.6
1.9 13.6 4.4 25.7
4.5 26.2
2.0 14.1 4.5 26.2
2.1 14.6 4.6 26.7
2.1 14.6 4.6 27.2
2.2 15.0 4.7 27.6
2.3 15.5 4.7 28.1
2.4 15.5 4.8 28.6
2.5 16.0 4.8 29.1
2.5 16.5 4.9 29.6
2.6 16.5
2.7 17.0 5.0. 30.0
2.7 17.5 5.0 30.6
2.8 17.9 5.1 31.0
5.1 31.5
3.0 18.4 5.2 32.0
3.1 18.9 5.2 32.5
3.2 19.4 5.3 33.0
3.2 19.4 5.4 33.5
3.3 19.9 5.4 34.0
3.4 20.4 5.4 34.4
3.4 20.4
3.5 20.9 5.5 35.0
3.6 21.3 5.5 35.4
5.6 35.9
3.6 21.3 5.6 36.4
3.7 21.8 5.7 36.9
3.8 22.3 5.7 37.3
3.8 22.3 5.8 37.8
3.9 22.8 5.8 38.3
4.0 23.3 5.8 38.8
5.9 39.3
5.9 39.8
5.635285+4.391298*OOR+0.064272*OOR^2+–0.102344*OOR^3+0.022172*OOR^4
Limits
MIN = 1.3 cm
MAX = 5.9 cm
Reference: Mayden, K.L., et. al. 1982. Orbital diameters: A new Parameter for Prenatal Diagnosis and
Dating. American Journal of Obstetrics and Gynecology. 144: 289-97.

Ob Charts
Thoracic Circumference, Romero

16.0 - 40 weeks
Thoracic Circumference, Predictive Percentile
Gestational No. 2.5 5 10 25 50 75 90 95 97.5
Age (weeks)
16 5 5.9 6.4 7.0 8.0 9.1 10.3 11.3 11.9 12.4
17 22 6.8 7.3 7.9 8.9 10.0 11.2 12.2 12.8 13.3
18 31 7.7 8.2 8.8 9.8 11.0 12.1 13.1 13.7 14.2
19 21 8.6 9.1 9.7 10.7 11.9 13.0 14.0 14.6 15.1
20 20 9.5 10.0 10.6 11.7 12.8 13.9 15.0 15.5 16.0
21 30 10.4 11.0 11.6 12.6 13.7 14.8 15.8 16.4 16.9
22 18 11.3 11.9 12.5 13.5 14.6 15.7 16.7 17.3 17.8
23 21 12.2 12.8 13.4 14.4 15.5 16.6 17.6 18.2 18.8
24 27 13.2 13.7 14.3 15.3 16.4 17.5 18.5 19.0 19.7
25 20 14.1 14.6 15.2 16.2 17.3 18.4 19.4 20.0 20.5
26 25 15.0 15.5 16.1 17.1 18.2 19.3 20.3 21.0 21.5
27 24 15.9 16.4 17.0 18.0 19.1 20.2 21.3 21.9 22.4
28 24 16.8 17.3 17.9 18.9 20.0 21.2 22.2 22.8 23.3
29 24 17.7 18.2 18.8 19.8 21.0 22.1 23.1 23.7 24.2
30 27 18.6 19.1 19.7 20.7 21.9 23.0 24.0 24.6 25.1
31 24 19.5 20.0 20.6 21.6 22.8 23.9 24.9 25.5 26.0
32 28 20.4 20.9 21.5 22.6 23.7 24.8 25.8 26.4 26.9
33 27 21.3 21.8 22.5 23.5 24.6 25.7 26.7 27.3 27.8
34 25 22.2 22.8 23.4 24.4 25.5 26.6 27.6 28.2 28.7
35 20 23.1 23.7 24.3 25.3 26.4 27.5 28.5 29.1 29.6
36 23 24.0 24.6 25.2 26.2 27.3 28.4 29.4 30.0 30.6
37 22 24.9 25.5 26.1 27.1 28.2 29.3 30.3 30.9 31.5
38 21 25.9 26.4 27.0 28.0 29.1 30.2 31.2 31.9 32.4
39 7 26.8 27.3 27.9 28.9 30.0 31.1 32.2 32.8 33.3
40 6 27.7 28.2 28.8 29.8 30.9 32.1 33.1 33.7 34.2
6.045651+1.088014*THR+0.0003387*THR^2
Limits
MIN = 9.1 cm
MAX = 30.9 cm
Reference: Romero. 1987. Journal of OB Gyn. 158:1069, 1072.

Thoracic Diameter, Hansmann

13.6 - 41.4 weeks
Thoracic Diameter Menstrual Age Thoracic Diameter Menstrual Age Thoracic Diameter Menstrual Age
(cm) (wks + days) (cm) (wks + days) (cm) (wks + days)
2.0 13 + 4 5.0 22 + 5 8.0 32 + 4
2.1 13 + 5 5.1 22 + 7 8.1 32 + 6
2.2 14 + 1 5.2 23 + 2 8.2 33 + 1
2.3 14 + 3 5.3 23 + 4 8.3 33 + 4
2.4 14 + 5 5.4 23 + 7 8.4 33 + 7
2.5 14 + 7 5.5 24 + 2 8.5 34 + 2
2.6 15 + 2 5.6 24 + 4 8.6 34 + 4
2.7 15 + 4 5.7 24 + 6 8.7 34 + 7
2.8 15 + 6 5.8 25 + 1 8.8 35 + 2
2.9 16 + 1 5.9 25 + 3 8.9 35 + 5
3.0 16 + 3 6.0 25 + 6 9.0 36 + 1

3.1 16 + 5 6.1 26 + 1 9.1 36 + 3
3.2 17 + 1 6.2 26 + 3 9.2 36 + 5
3.3 17 + 3 6.3 26 + 5 9.3 37 + 1
3.4 17 + 5 6.4 27 + 1 9.4 37 + 4
3.5 17 + 7 6.5 27 + 3 9.5 37 + 7
3.6 18 + 2 6.6 27 + 5 9.6 38 + 2
3.7 18 + 4 6.7 28 + 1 9.7 38 + 5
3.8 18 + 6 6.8 28 + 3 9.8 39 + 1
3.9 19 + 1 6.9 28 + 5 9.9 39 + 4
4.0 19 + 3 7.0 29 + 1 10.0 39 + 7

4.1 19 + 6 7.1 29 + 3 10.1 40 + 3
4.2 20 + 1 7.2 29 + 5 10.2 40 + 6
4.3 20 + 3 7.3 30+ 1 10.3 41 + 3
4.4 20 + 5 7.4 30 + 3
4.5 20 + 7 7.5 30 + 6
4.6 21 + 2 7.6 31 + 1
4.7 21 + 4 7.7 31 + 3
4.8 21 + 7 7.8 31 + 6
4.9 22 + 2 7.9 32 + 1
MA: 6.963496+3.829853*TD+–0.4430650*TD^2+0.1010238*TD^3+–0.0099702*TD^4+0.0003773*TD^5
SD: 0.9180432+–0.0336696*TD+0.0030782*TD^2
Limits
MIN = 2.0 cm
MAX = 10.3 cm
Springer-Verlag.

Ob Charts
Tibia Chart, Jeanty

11 - 40 weeks
Tibia Length Menstrual Age Tibia Length Menstrual Age
1.0 13 + 3 4.0 25 + 2
1.1 13 + 5 4.1 25 + 5
1.2 14 + 1 4.2 26 + 1
1.3 14 + 3 4.3 26 + 4
1.4 14 + 6 4.4 27 + 1
1.5 15 + 1 4.5 27 + 4
1.6 15 + 4 4.6 28 + 0
1.7 15 + 6 4.7 28 + 4
1.8 16 + 1 4.8 29 + 0
1.9 16 + 4 4.9 29 + 3
2.0 17 + 0 5.0 29 + 6
2.1 17 + 3 5.1 30 + 3
2.2 17 + 6 5.2 30 + 6
2.3 18 + 1 5.3 31 + 3
2.4 18 + 4 5.4 31 + 6
2.5 18 + 6 5.5 32 + 3
2.6 19 + 2 5.6 32 + 6
2.7 19 + 5 5.7 33 + 3
2.8 20 + 1 5.8 33 + 6
2.9 20 + 4 5.9 34 + 4
3.0 21 + 0 6.0 34 + 6
3.1 21 + 3 6.1 35 + 3
3.2 21 + 6 6.2 35 + 6
3.3 22 + 1 6.3 36 + 4
3.4 22 + 4 6.4 37 + 0
3.5 23 + 1 6.5 37 + 4
3.6 23 + 4 6.6 38 + 0
3.7 23 + 6 6.7 38 + 4
3.8 24 + 3 6.8 39 + 1
3.9 24 + 6 6.9 39 + 5
9.857666+2.880867*TIB+0.208282*TIB^2+0.00374*TIB^3+–0.00534*TIB^4+0.0009669*TIB^5
Limits
MIN = 1.0 cm
MAX = 6.9 cm
Reference: Jeanty, P., et. al. February, 1984. Estimation of Gestational Age from Measurement of Fetal
Long Bones. Journal of Ultrasound Medicine. 3: 75-79.

Tibia Chart, Merz

13 - 42 weeks
Tibia Length Menstrual Age
(cm) (weeks)
0.9 13
1.0 14
1.3 15
1.6 16
1.8 17
2.2 18
2.5 19
2.7 20
3.0 21
3.2 22
3.6 23
3.7 24
4.0 25
4.2 26
4.4 27
4.5 28
4.6 29
4.8 30
5.1 31
5.2 32
5.4 33
5.7 34
5.8 35
6.0 36
6.1 37
6.2 38
6.4 39
6.5 40
6.6 41
6.8 42
4.672282+14.50270*TIB+–7.369976*TIB^2+2.178219*TIB^3+–0.2874230*TIB^4+0.0144052*TIB^5
Limits
MIN = 0.9 cm
MAX = 6.8 cm
Reference: Merz, E., et. al. Ultrasonic Mensuration of Fetal Limb Bones in the Second and Third
Trimester. J. Clin. Ultrasound. 15:175-183, March-April 1987.

Ob Charts
Transverse Trunk Diameter TTD Chart

Hansmann, Bonn, Germany
12-40 weeks
TTD Menstrual Age

(cm) Weeks
1.7 12
2.0 13
2.4 14
2.7 15
3.1 16
3.4 17
3.7 18
4.0 19
4.4 20
4.7 21
5.0 22
5.3 23
5.6 24
5.9 25
6.2 26
6.5 27
6.9 28
7.2 29
7.4 30
7.8 31
8.1 32
8.3 33
8.6 34
8.9 35
9.2 36
9.4 37
9.7 38
9.9 39
10.1 40
6.988861 + 3.294879*TTD + -0.3261528*TTD^2 + 0.1007768*TTD^3 + -0.0119333*TTD^4 +0.0005071*TTD^5
Limits
MIN = 1.7 cm
MAX = 10.1 cm
Reference: Hansmann, M., Ultrasound Diagnosis in Obstetrics and Gynecology

Springer-Verlag, pp.431, Appendix, Bonn, 1984.

TTD Chart, Persson

1986
11.4-39.4 weeks
TTD Menstrual Age

(cm) Weeks
1.83 11.3
2.43 13.3
3.48 16.2
4.98 20.2
6.58 24.3
7.90 28.2
9.14 32.3
10.15 35.2
10.71 37.3
11.29 39.3
7.285714 + 2.478571*TTD + 0.0272857*TTD^2
Limits
MIN = 1.83 cm
MAX = 11.29 cm
Reference: Persson, P.H.,“Normal range Growth Curves for Fetal Bipariental diameter,
Occipito-Frontal diameter, mean Abdominal diameters and Femur Length,”
ACTA Obstet. & Gyn. Scan 65:759-761,1986. Table 1.

Ob Charts
Ulna Chart, Jeanty

13.1 - 40.3 weeks
Ulna Length Menstrual Age Ulna Length Menstrual Age
1.0 13 + 1 3.8 25 + 1
1.1 13 + 4 3.9 25 + 4
1.2 13 + 6
1.3 14 + 1 4.0 26 + 1
1.4 14 + 4 4.1 26 + 5
1.5 15 + 0 4.2 27 + 1
1.6 15 + 3 4.3 27 + 5
1.7 15 + 5 4.4 28 + 2
1.8 16 + 1 4.5 28 + 6
1.9 16 + 4 4.6 29 + 3
4.7 29 + 6
2.0 16 + 6 4.8 30 + 4
2.1 17 + 2 4.9 31 + 1
2.2 17 + 5
2.3 18 + 1 5.0 31 + 4
2.4 18 + 4 5.1 32 + 1
2.5 19 + 0 5.2 32 + 6
2.6 19 + 3 5.3 33 + 3
2.7 19 + 6 5.4 34 + 0
2.8 20 + 2 5.5 34 + 4
2.9 20 + 6 5.6 35 + 1
5.7 35 + 6
3.0 21 + 1 5.8 36 + 3
3.1 21 + 5 5.9 37 + 1
3.2 22 + 1
3.3 22 + 5 6.0 37 + 5
3.4 23 + 1 6.1 38 + 2
3.5 23 + 4 6.2 39 + 0
3.6 24 + 1 6.3 39 + 4
3.7 24 + 4 6.4 40 + 2
MA: 9.7973180+3.2535710*ULA+0.0428870*ULA^2+0.0713840*ULA^3+–0.0092650*ULA^4+0.0004399*ULA^5
SD: 3.0372120+0.0026310*ULA
Limits
MIN = 1.0 cm
MAX = 6.4 cm


APPENDIX B
AIUM MEDICAL ULTRASOUND SAFETY
This appendix contains a reprint of the AIUM Ultrasound Medical Safety

brochure, published by the American Institute of Ultrasound in Medicine
(AIUM). The AIUM brochure provides a detailed explanation of potential
bioeffects and suggestions for conducting examinations according to the
As Low As Reasonably Achievable (ALARA) principle. The AIUM is
located in Laurel, Maryland, U.S.A., at (301)498-4100 and on the Internet
at http://www.aium.org.

Medical Ultrasound Safety
Part One: Bioeffects and Biophysics
Part Two: Prudent Use
Part Three: Implementing ALARA
American Institute of Ultrasound in Medicine

Copyright 1994 by the American Institute of Ultrasound in Medicine.
No part of this publication may be reproduced or transmitted in any form by any means including photo-
copying or recording without written permission of the copyright owner. Printed in the U.S.A.
The A.I.U.M. Executive Office is located at 14750 Sweitzer Lane, Suite 100, Laurel, MD 20707–5906.
Table of Contents
Preface ................................................................................................................................................ iv
Introduction ......................................................................................................................................... v
Acknowledgements ............................................................................................................................ vi
Part One: Bioeffects and Biophysics ......................................................................... 1

Chapter One: Is It Safe?........................................................................................................... 3
Chapter Two: Thermal Bioeffects ........................................................................................... 7
Chapter Three: Nonthermal Bioeffects.................................................................................. 14
Part Two: Prudent Use ............................................................................................. 17

Chapter Four: Benefits and Risks .......................................................................................... 19
Chapter Five: ALARA .......................................................................................................... 23
Part Three: Implementing ALARA ........................................................................ 25

Chapter Six: Knobology ........................................................................................................ 27
Chapter Seven: The Output Display ...................................................................................... 33
Conclusion ............................................................................................................................. 40
iii
Preface
With the availability of an output display in some present and in future diagnostic ultrasound
equipment and the potential for higher output capabilities within these devices, it is incumbent upon the
user to be knowledgeable of the uses of this equipment and the potential for ultrasound-induced bioef-
fects. The responsibility for patient safety is falling more heavily upon the ultrasound equipment user’s
shoulders and the need for an educational background in these uses and bioeffects is evident. In other
words, there is a shift in responsibility for patient safety from the manufacturer to the user. In this
regard, this tripartite brochure has been generated to provide the user with a working background and
general principles that will provide for the understanding of the purpose and use of the Output Display
Standard and how this display can be used to obtain diagnostic information with ultrasound exposure as
low as reasonably achievable. The user education requirement represents a new level of responsibility
that will permit increased ultrasound diagnostic capabilities within the context of user controlled ultra-
sound exposure. Information regarding ALARA and possible ultrasound bioeffects described in this
brochure also applies to equipment without an output display.
—Michael S. Tenner, M.D.

AIUM President
iv
Introduction
A new feature, called an output display, is becoming available on some recently introduced and
future diagnostic ultrasound equipment. The output display provides the user an indication of the poten-
tial for bioeffects that might be caused by the ultrasound energy being emitted. With this information,
users can better control the diagnostic ultrasound equipment and examination to assure that needed
diagnostic information is obtained with a minimum of risk to the patient.
To get the most benefit from the output display, the user should have a basic understanding of the
nature of ultrasound-induced bioeffects, how to conduct an exam that minimizes the potential for bioef-
fects, and how to operate the controls of the equipment used in the exam.
This brochure is divided into three parts. Part One describes ultrasound-induced bioeffects and
why we should be concerned about them. Part Two describes the risks and benefits of conducting diag-
nostic examinations and introduces the concept of ALARA, that is, ultrasound exposure As Low As
Reasonably Achievable. Using ALARA, we can obtain needed diagnostic information with minimum
risk to the patient. Part Three describes how to implement ALARA on equipment with and without an
output display. With an output display, we have the best information about the potential for bioeffects
and can make the best decisions.
Each manufacturer’s equipment has somewhat different control features. This brochure can only
provide general principles about ALARA and diagnostic ultrasound equipment. Please refer to the user
documentation for your particular equipment to learn the details of its particular controls and output
displays.
v
Acknowledgements
The development of this Ultrasound Education Program brochure went through a number of style
and format changes and involved dedicated professionals from a number of organizations over the past
three years. Initially, three videotapes were planned with the creation of three scripts. What finally
emerged is this brochure. There are many individuals to thank. Special recognition is given to Mr. Chas
Burr for his extensive revisions to the final content of the text. Without their assistance, this brochure
would not have been possible.
American College of Cardiology Betty Halloway, MD

Jannet Lewis, MD
American College of Obstetricians and Gynecologists Michael Greene, MD
Harold Kaminetsky, MD
Federico Mariona, MD
American College of Radiology Albert Goldstein, PhD
Marvin Ziskin, MD
American Institute of Ultrasound in Medicine Peter Doubilet, MD
Christopher Merritt, MD
William D. O’Brien, Jr., PhD
Samuel Ritter, MD
American Society of Echocardiology Steve Goldstein, MD
Mary-Etta King, MD
Food and Drug Administration Mel Greberman, MD
Jerry Harris, PhD
Hector Lopez, PhD
Robert Phillips, PhD
Robert Sibley
Mel Stratmeyer, PhD
National Electrical Manufacturers Association Robert Britain
Chas Burr
Chuck Hottinger, PhD
Sheila Pickering, PhD
Ray Powis, PhD
Mark Schafer, PhD
Terry Sweeney
Kai Thomenius, PhD
Sandy Warner, RDMS
Society of Diagnostic Medical Sonographers Kari Boyce, RDMS
Kristin LaConte, RDMS, RVT
Society of Vascular Technology Phil Bendick, PhD
Marsha Neumyer, RVT
— William D. O’Brien, Jr., PhD

— Terrence J. Sweeney
Co–Editors
September 1994
vi
Part One
Bioeffects and Biophysics
“Diagnostic ultrasound has proven to be a valuable tool in medical prac-

tice. An excellent safety record exists in that, after decades of clinical use,
there is no known instance of human injury as a result of exposure to
diagnostic ultrasound. Evidence exists, however, to indicate that at least a
hypothetical risk for clinical diagnostic ultrasound must be presumed.”
Radiological Health Bulletin,
Vol XXIV, No. 8,
August 1990
1
2
Chapter One
Is It Safe?
Issues Addressed:
• Why it is important to know ultrasound physics
• What dose-effect studies tell us
• Mechanisms of ultrasound-induced biological effects
• History of ultrasound
• Prudent use
Q. Everyone thinks that ultrasound is safe. We keep hearing, “no known Everyone thinks ultrasound is
instance of human injury as a result of exposure to diagnostic safe.
ultrasound.” So why do we have to learn about biophysics and
bioeffects?
A. When ultrasound propagates through human tissue, there is a potential There is a potential risk.
for tissue damage. There has been much research aimed at
understanding and evaluating the potential for ultrasound to cause
tissue injury. Through these studies, we are trying to learn what
causes ultrasonic bioeffects and apply that information to diagnostic
ultrasound. Many studies are dose-effect studies. These laboratory
studies give us two things: First, they provide an opportunity to use
much higher dosage levels than those currently used in a diagnostic
ultrasound exam to really test the safety of ultrasound, and second,
they permit a detailed study of mechanisms thought to be responsible
for bioeffects.
Q. So dose-effect studies are performed at higher intensities than Dose-effect studies

diagnostic ultrasound?
A. Much higher levels. In fact, virtually all ultrasonically induced

adverse biological effects have occurred at these higher intensity
levels.
Q. What’s been learned from the dose-effect studies?
A. So far, we’ve deduced that two mechanisms are known to alter Thermal Mechanism
biological systems. One, called the “Thermal Mechanism,” refers to Nonthermal Mechanism
heating of soft tissue and bone. The other, “Nonthermal,” involves
mechanical phenomena such as cavitation, although nonthermal
mechanisms are more than cavitation alone. You can think of
cavitation as the interaction of ultrasound with tiny bubbles in tissue
and liquids.
3
History of ultrasound Q. How long have we known of the potential hazards of ultrasound?
A. In 1880, two French scientists, Jacques and Pierre Curie, discovered

piezoelectricity, the basis for ultrasonic transducers. About thirty-five
years later, another French scientist named Paul Langevin developed
one of the first uses of ultrasound, underwater sound-ranging of
submerged objects known today as sonar. In the process he discovered
and reported that very high intensity ultrasonic levels could have a
detrimental effect on small aquatic animals.
Ten years later, scientists Wood and Loomis conducted experiments

that substantiated Langevin’s observation. Then, in 1930, Harvey
published a paper about the physical, chemical, and biological effects
of ultrasound, reporting that alterations were produced in a variety of
organisms, cells, tissue, and organs. Long before anyone even thought
of using ultrasound to produce images of the human body, it was
already known that high levels of ultrasound were hazardous. With
this in mind, early pioneering engineers and clinicians who were
designing ultrasound imaging devices knew about the potential for
disrupting biological tissue.
Thus, there has been concern about potential harmful effects

throughout the entire period of diagnostic instrumentation
development.
If there’s a potential for Q. If there’s a potential for bioeffects, why do we use ultrasound?
bioeffects . . .
No patient injury has ever A. Most important, we use ultrasound because of its many diagnostic uses
been reported from and benefits. Although there may be a risk, there has never been a
diagnostic ultrasound. documented instance of a patient being injured from this diagnostic
modality.
Q. If there is a potential for ultrasound-caused bioeffects, why has there

been such a good safety record?
Diagnostic ultrasound A. As the uses of medical devices have grown and more application areas
equipment is regulated by and equipment have been developed, regulations have been enacted to
the FDA. provide for patient safety concurrent with equipment development. In
1976, the Medical Device Amendments to the Food, Drug, and
Cosmetic Act were enacted requiring the Food and Drug
Administration (FDA) to regulate all medical devices, including
diagnostic ultrasound equipment. The FDA has required manufacturers
of diagnostic ultrasound equipment to keep acoustic output below that
of machines on the market before 1976, the year the amendments were
enacted. Manufacturers bringing new products to market must
compare the various performance characteristics of ultrasound
equipment, including acoustic output, to devices previously approved
for marketing.
4
Within these “limits,” ultrasound has shown itself to be a safe and
effective diagnostic tool for medical application. But it is important
BIOEFFECTS & SAFETY
of Diagnostic Ultrasound
to remember that the pre-1976 output levels are based in history, not
on scientific safety evaluations.
In March 1993, the American Institute of Ultrasound in Medicine

approved the Official Statement on Clinical Safety:
“Diagnostic ultrasound has been in use since the late 1950s. Given its
known benefits and recognized efficacy for medical diagnosis,
including use during human pregnancy, the American Institute of
Ultrasound in Medicine herein addresses the clinical safety of such
use: No confirmed biological effects on patients or instrument
operators caused by exposure at intensities typical of present “. . . the benefits to patients of
the prudent use of diagnostic
diagnostic ultrasound instruments have ever been reported. Although ultrasound outweigh the risks,
the possibility exists that such biological effects may be identified in if any, that may be present.”
the future, current data indicate that the benefits to patients of the
prudent use of diagnostic ultrasound outweigh the risks, if any, that
may be present.”
(From Bioeffects and Safety of Diagnostic Ultrasound, published in

1993 by the American Institute of Ultrasound in Medicine)
Q. Why is there more discussion of ultrasound safety now than in the History of ultrasound in
past? medicine
A. The question of safety is being discussed more because more and Higher outputs bring
more applications are being found, and the industry is producing potentially greater risk.
technically sophisticated devices that provide more diagnostic
information. Current dialogue among the medical community,
manufacturers, and the FDA suggests that new standards recently
developed should allow higher outputs for greater diagnostic
capability. This will improve some imaging and Doppler situations,
but with greater risk and greater operator responsibility.
Just because we haven’t detected bioeffects on humans at diagnostic Prudent use

levels, doesn’t mean that they don’t exist. We know the potential for
risk exists. It’s important for ultrasound users to know about
biophysics and bioeffects so they can make informed decisions about
the use of ultrasound and can reduce the chances of bioeffects
occurring. In the future, more and more decisions about the use of
ultrasound output levels will be made by equipment operators.
The use of ultrasound in medicine began in the 1950s. At that time,

the number of applications was rather limited. The uses for ultrasound
grew in the 1950s, adding applications such as cardiology, obstetrics,
gynecology, vascular, ophthalmic, and the imaging of regions of the
5
body, such as the female breast and male pelvis. By the early 1960s
most of the basic ultrasound applications used today had been
attempted, although with much less diagnostic content than today.
Clinical use continued to grow during the 1970s with the introduction
of real-time scanning.
Early exams were conducted entirely through the skin surface, but
intracavitary and intraoperative applications have undergone a recent
surge as manufacturers and clinicians seek to expand the diagnostic
potential of ultrasound. Today, the clinical uses for ultrasound are
many and varied, and diagnostic ultrasound is one of the fastest
growing imaging techniques in medicine. Surveys in the United States
indicate that a very high percentage of pregnant women are scanned
to obtain fetal health information. There are about 100 thousand
medical ultrasound scanners in use worldwide. This equipment
handles millions of examinations each year. And, the number
continues to grow.
6
Chapter Two
Thermal Bioeffects
Issues Addressed:
• Focused and unfocused ultrasound fields
• Spatial and temporal considerations
• Attenuation, absorption, and scattering
• Soft tissue, layered and fetal bone models
• Soft tissue, layered and fetal bone heating
• Axial temperature increase profiles
Q. If ultrasound causes tissue temperature to rise, where is the largest

temperature rise found?
A. The highest temperatures tend to occur in tissue in the region between

where the ultrasound beam enters tissue and the focal region.
Because the temperature elevation is related to both ultrasonic power

and the volume of exposed tissue, we need to keep in mind whether
the beam is scanned or unscanned, in other words, whether the
equipment moves the beam or keeps it stationary. Scanned modes,
Unfocused and focused
such as B-mode imaging and color flow Doppler, distribute the energy
ultrasound fields.
over a large volume. In scanned modes, the highest temperature is
frequently at the surface where the ultrasound enters the body.
Unscanned modes, such as spectral Doppler and M-mode, concentrate

the power along a single line in the patient and deposit energy along
the stationary ultrasound beam. Energy is distributed over a much
smaller volume of tissue than in the scanned case. In unscanned Line drawing 12-1
modes, the highest temperature increase is found between the surface

and the focus. In other words, the hottest point is along the center axis
of the beam and proximal to the focal point, but not at the focal point.
The exact location depends on the tissue attenuation and absorption
properties and the beam’s focal length. For long focal lengths, the
location of the maximum temperature elevation may lie closer to the
surface, but for short focal lengths, it is generally closer to the focus.
Q. Focusing the ultrasound beam increases the temperature? Spatial considerations
A. Focusing concentrates the power in the beam on a small area, thereby Power
Intensity =
improving image lateral resolution, but also causing higher intensities Area
and the potential for higher temperatures.
Q. What other aspects of the ultrasound beam affect the temperature?
7
Temporal considerations A. An important aspect is time.
Ultrasonic waves can be emitted in pulsed wave form. There’s a burst

of energy, then, there’s a period of silence. Then, there’s another pulse
pressure
and more silence, and on and on. During the pulse the acoustic
intensity is high, but during the silence the intensity is zero.
time
If we take the entire repeating time period, both the pulse and the
silence, and average the intensity of the ultrasound over time, we come
Pulsed pressure waveform
up with a temporal-average intensity that may be a thousand times
smaller than the instantaneous or temporal-peak intensity that occurs
once during the pulse. Bioeffects resulting from temperature increases
depend, in part, on the temporal-average intensity.
intensity
The intensity at the location of the greatest temporal-average intensity

time
is referred to as the spatial-peak temporal-average intensity: SPTA.
Pulsed intensity waveform The SPTA is often used as a specification of ultrasound output.
In addition to time averaging, there’s another time concept that affects

Line drawing 14-1
TP temperature increase: duration of the ultrasound exposure, or how long
one location is imaged during an examination. It takes time for tissue
intensity
temperature to rise, and the longer the exposure duration, the greater
TA
the possibility of a biological effect.
time
Temporal-average (TA) Q. What causes the temperature rise in tissue during ultrasonic exposure?
and temporal-peak (TP)
intensities A. The absorption of energy. During an exam, much of the ultrasound
Ultrasound exposure duration energy is absorbed by body tissue. If the rate of energy deposition in a
Line drawing 14-2
particular region exceeds the body’s ability to dissipate the heat, the
local temperature will rise.
Attenuation Absorption and attenuation are often confused. Attenuation is the loss
1. Absorption = energy of energy from the propagated ultrasound wave. There are two causes
converted to heat for attenuation: Absorption and scattering. Absorption is the
2. Scattering = redirection of
ultrasound
conversion of ultrasonic energy into heat; whereas, scattering is the
redirection of the ultrasound away from the direction it was originally
Line drawing 15-1
traveling.
Absorption of acoustic energy by tissue results in the generation of

heat in the tissue. This is what is referred to as the thermal mechanism.
There are a number of physical and physiological variables that play a
role in absorption and the generation of temperature increases. Some,
of course, are the operating characteristics of the equipment. For now,
let’s concentrate on physical parameters.
Q. What are some of the physical parameters that affect absorption?
A. The ultrasound energy is absorbed by tissue, at least to some extent.
8
The extent depends on the tissue, on what we call tissue absorption Attenuation coefficient and
characteristics. absorption coefficient have
the same units—dB/cm or dB/
cm-MHz
A specific way in which tissue absorption characteristics are
quantified is with the “Absorption Coefficient.” The absorption
coefficient is expressed in decibels per centimeter. Since absorption
coefficient is directly proportional to ultrasonic frequency, the
Increasing Attenuation
coefficient is often normalized to frequency and represented as Coefficient
decibels per centimeter per megahertz. Absorption coefficients are Water
very dependent on the organ or tissue type that is being imaged. Biological fluids
Soft tissues
Q. Let’s get some examples. What’s the absorption coefficient of, say, Skin and cartilage
Fetal bone
fluids, like amniotic fluid, blood, and urine? Adult bone
A. Almost zero. These fluids absorb very little ultrasonic energy. That
means the ultrasound goes through the fluid with very little decrease.
And there’s little temperature elevation in the fluid.
Q. Which body tissue absorbs the most energy?
A. Bone. Its absorption coefficient is very high. Dense bone absorbs the
energy very quickly and causes the temperature to rise rapidly. Adult
bone absorbs nearly all of the acoustic energy impinging on it. Fetal
bone absorption coefficients vary greatly depending on the degree of
ossification.
Q. Now what’s between fluid and bone?
A. Soft tissue. Tissues vary in density depending on the particular organ, Homogeneous soft tissue
but the density doesn’t vary much within a organ. We call it soft to model
distinguish it from hard tissue such as bone. It’s also true that the
tissue density within a particular organ is not always the same. But,
for our purposes we assume that attenuation and absorption are
uniform throughout the organ. We call this a homogeneous soft tissue
model.
Q. How does frequency affect absorption?
A. The higher the frequency, the higher the absorption. What that means
to operators is that a higher-frequency transducer will not allow us to
“see” as far into the body.
Q. Does that mean that higher-frequency transducers create more heat? Higher Frequency = Increased
Absorption, Reduced
Penetration, Possible Near
A. Not necessarily. There are many factors that contribute to creating Surface Heating
heat. However, if all other factors are equal, the ultrasound energy of
higher-frequency transducers is absorbed more rapidly than that of
9
lower-frequency transducers, thereby causing reduced penetration. In
some cases, this may introduce increased heating near the skin surface.
However, due to the rapid absorption of higher-frequency ultrasound,

there’s another indirect effect that might occur. If we’re not getting
deep enough, we might choose to increase the output, and the
increased intensity could also increase temperature.
Q. Now let’s talk about what all this means in practical terms. What is the
situation of most interest?
A. The situation of greatest interest involves the fetus with ossified bone
(second and third trimester) and a mother with a thin abdominal wall.
Because there would be little absorption of energy between the
transducer and the fetus, nearly all of the energy would be absorbed by
a fetal bone, if the beam is focused on or close to it.
Q. What can we as operators do to minimize temperature rise?
A. First, temperature increases depend on intensity, duration of exposure

at the same location, transducer focal point size and location, and
absorption of the energy by the tissue. In general, intensity is alterable,
and depends on the particular equipment we’re using. As the operator,
we can also control duration, or exposure time. The transducer is
typically moved frequently during the exam, which will naturally
reduce the exposure duration at a specific tissue location.
Let’s look at the other two factors: transmit focal point and absorption.
A highly focused beam whose focal point is in the amniotic fluid will
Fixed-focus transducer not cause significant heating of the fluid, because its absorption
coefficient is low. If the focus is in tissue, all things being the same,
the temperature rise is a little higher. However, the same beam will
cause an even higher temperature rise time if it focuses on bone, which
has a much higher absorption coefficient. Be aware that there are
fixed-focused transducers whose focus we can’t change and multi-
element array transducers whose focus we can change.
Multi-element array
transducer
The other important determinant of local temperature rise is absorption
Line drawing 21-1 of ultrasound energy in tissue layers in front of the point of interest.
Increased absorption in these layers decreases the ultrasound energy
available at the point of interest. For example, an obstetrical
examination of a patient with a thick abdominal wall is less likely to
cause a significant temperature increase in the fetus than an
examination through a thin abdominal wall.
Q. What are some examples of temperature increase calculations?
Line drawing 21-2
10
A. We have computer models that predict the relationship between
transducer focus and changes in the temperature curve.
Computer Tissue Models

• Homogeneous Soft Tissue Model
• Layered Tissue (Fluid-filled Bladder) Model
• Fetal Bone Model
Assumptions
• Speed of Sound Is Uniform Throughout
• Attenuation Is Uniform Throughout
• Absorption Is Uniform Throughout
• Absorption Equals Attenuation (Scattering is negligible)
Modeling various tissue layers is difficult since there are so many. We

focused on two simplified models. In the first, ultrasound travels
through homogeneous soft tissue. In the second, ultrasound travels
through a fluid-filled bladder. We assumed that the speed of sound,
acoustic impedance, attenuation, and absorption are uniform
throughout the volume of interest.
Transducer
• 3.0 MHz
• 19 mm diameter
• 6 cm transmit focal length
• 100 mW output ultrasonic power
We also selected a 3.0 MHz, 19 mm diameter transducer with a 6 cm 1.5

Temperature Increase (˚C)
transmit focal length. For convenience, we have used an ultrasonic 1.0

output of 100 mW for our example. This is a relatively high output
level for today’s diagnostic equipment, only found in some Doppler 0.5
and color Doppler modes. Keep in mind, these models are for 0
0 2 4 6 8 10
educational purposes and may not reflect actual clinical situations. Range (cm)
Homogeneous soft tissue

Homogeneous Tissue Model: Abdominal Exam model: axial temperature
First, let’s look at the homogeneous tissue model. This model is increase profile for a transmit
focal length of 6 cm
similar to the situation in an abdominal exam involving soft tissue
only. The temperature increase in degrees Celsius goes up the left side
of the figure. The range in centimeters goes across the bottom of the
figure. 1.5
1.0
We’ll see that the temperature increase exhibits a maximum at about 0.5
five centimeters.
0
0 2 4 6 8 10
Range (cm)
For the next scenario, all we’ll change is the focal point location. We
Homogeneous soft tissue
just saw the 6 cm focal length. Now, let’s see what the same model: axial temperature
transducer does in the same tissue with a 10 cm focal length. It increase profile for a transmit
flattens out quite a bit, doesn’t it? focal length of 6 and 10 cm
Line drawing NEW 24-1 11

1.5
But look at what happens if the focal length is 2 cm. The temperature
1.0 goes way up to about 1.3˚C at a range of about 2 cm. What does that
mean? It means that a significant increase in temperature near the
0.5
beam’s focus is more likely with shorter focal lengths because less
0
0 2 4 6 8 10
overall attenuation of the beam has occurred.
Range (cm)
Homogeneous soft tissue Now, let’s look at this in a situation similar to an obstetrical exam.
model: axial temperature
increase profiles for
transmit focal lengths of 2, 6, Layered Tissue Model: Obstetrical Scan
and 10 cm • Abdominal wall thickness = 1 cm
• Bladder fluid path = 5 cm
0.9
For this situation, we have a layered tissue model based on an

0.6 obstetrical scan through the abdominal wall and through the fluid-
0.3 filled bladder to the fetus. For the scenario, we assumed a patient with
a thin abdominal wall of 1 cm and a 5 cm fluid path. The transducer
0
0 2 4 6 8 10 and its ultrasonic power are the same as those used in the
Range (cm)
homogeneous tissue cases. The transmit focal length of 6 cm is at the
Layered tissue model: axial
temperature increase profile location of the far side of the bladder and note that the temperature
for a transmit focal length of goes up to about 0.8˚C at this range. Also note, the increase in
6 cm temperature in the abdominal wall is about 0.4˚C. There’s almost no
absorption of ultrasound in the bladder fluid, so little heat is produced
0.9 Line drawing NEW 24-3 there.
0.6
Now here’s the axial temperature increase profile in the layered tissue
0.3
model for a longer focal length of 10 cm. The temperature rise at the
0 far side of the bladder is about 0.5˚C, a drop from when the ultrasound
0 2 4 6 8 10
Range (cm) beam was focused at that location.
temperature increase profile Let’s look at a situation where the beam focuses in front of the far side
for transmit focal lengths of 6 of the bladder, at a 4 cm transmit focal length. The temperature rise at
and 10 cm.
the far side of the bladder is about 0.3˚C, also a drop from when the
ultrasound beam is focused at that location. Note that the increase in
Line drawing NEW 25-1
temperature in the abdominal wall is about 0.4˚C for all three focal
0.9
length conditions.
0.6
That means if the transmit focus location occurs before the target, then
0.3 the temperature rise at the far side of the bladder, at a range of 6 cm
for this layered tissue model, is less than if the focus is at or beyond
0
0 2 4 6 8 10 the target, where the temperature elevation at the target is higher.
Range (cm)

temperature increase profile Fetal Bone Model
for transmit focal lengths of 4, • Homogeneous Soft Tissue Parameters
6 and 10 cm. • Bone Location at 6 cm in Range
• 100 mW Output Ultrasonic Power
12
Let’s see what happens when we focus near bone. For this model, 4

we’ll use the homogeneous soft tissue parameters for the tissues 3
through which the beam passes, but our reflective surface is bone that 2
is perpendicular to the beam at a range of 6 cm. We will also use the 1
same output ultrasonic power of 100 mW. When the transmit focal 0
0 2 4 6 8 10
range is beyond the location of bone, focal range of 10 cm, there is a Range (cm)
peak in the temperature increase to about 1.9˚C at the bone location. Fetal bone model: axial
temperature increase
profile for a transmit focal
Here’s what happens with a transmit focal length of 6 cm, that is, the length of 10 cm
ultrasound beam is focused on the bone surface: a theoretical
temperature rise of about 4.2˚C. 4

3
Q. How does all this apply to actually scanning a patient? Is this 2
dangerous? 1
0
0 2 4 6 8 10
A. Potentially dangerous. The examples we looked at are for educational Range (cm)
purposes and do not necessarily occur in clinical situations. For Fetal bone model: axial
example, the output power used for the calculation would not be temperature increase
commonly used, but it is within the capability of many systems. profile for transmit focal
lengths of 6 and 10 cm
Temperature rise during an actual examination depends on many Abdominal wall thickness,
factors. For example, very few patients have as thin an abdominal Focal length and location,
wall as we assumed in this model. In addition, the exposure to bone Exposure duration,
Bone attenuation,
must be continuous over time for local temperatures to rise. That Tissue attenuation,
seldom happens in actual exams. Plus, some heating is lost due to the Bone absorption, and
cooling effect of local blood flow. To date, there is no evidence of any Tissue absorption
harm in humans from thermal effects at the output levels of current
ultrasonic devices.
Q. But if it’s potentially dangerous, why hasn’t there been an incident?
A. The combined conditions required to produce these heating effects are

unlikely to occur. In addition, the control parameters on current
equipment are designed to limit the temporal-average intensity. By
minimizing temporal-average intensity, significant thermal effects in
the body are not likely to occur. However, it is unclear what output
levels will be used in future applications and equipment.
The goal is to get an image that provides necessary diagnostic The goal is to get an image
information. If we are overly cautious, we may end up with poor that provides necessary
diagnostic information.
image quality or inadequate Doppler signals. For operators to
minimize the risk, we need to understand the factors that contribute to
temperature rise, for example, the thickness of the mother’s
abdominal wall, the beam focal length and location, exposure
duration, and the attenuation and absorption characteristics of tissue
and bone.
13
Chapter Three
Nonthermal Bioeffects
Issues Addressed:
• Onset of cavitation
• Peak compressional pressure
• Peak rarefactional pressure
• Stable cavitation and transient cavitation
• Microstreaming
• Nucleation site
• Threshold phenomenon
Q. Nonthermal bioeffects means bioeffects not caused by temperature

rise. That tells us what they are not. Exactly what are nonthermal
bioeffects?
A. Nonthermal bioeffects are not as well understood as thermal effects.

They are sometimes referred to as mechanical bioeffects because they
seem to be caused by the motion of tissue induced when ultrasound
pressure waves pass through or near gas. The majority of the
nonthermal interactions deal with the generation, growth, vibration,
and possible collapse of microbubbles within the tissue. This behavior
is referred to as cavitation.
Cavitation was first discovered around the turn of the century, not in
tissues, but at the surface of a ship’s propellers. Researchers found that
the low-pressure region immediately behind a ship’s propellers caused
bubbles to be produced in the water. The collapsing bubbles damaged
the propellers. The bubbles collapsed violently, generating shock
waves that eroded the propeller blades.
What is cavitation—bubbles? Q. So cavitation is bubbles?
A. With diagnostic ultrasound, cavitation refers to ultrasonically induced

activity occurring in tissues or body liquids that contain bubbles or
pockets containing gas or vapor. These bubbles originate within
materials at locations termed “nucleation sites,” the exact nature and
source of which are not well understood in a complex medium such as
tissue or blood.
Positive pressure = A sound wave has positive pressure and negative pressure. Positive
Compressional pressure pressure is also called compressional pressure; negative pressure is
Negative pressure =
also called rarefactional pressure. If the rarefactional pressure is
Rarefactional pressure sufficiently large, microbubbles may be produced, or existing
microbubbles may be enlarged.
14
Q. When does cavitation occur? p
pressure
c
A. The occurrence of cavitation and its behavior depend on many factors,

including the ultrasonic pressure and frequency, the focused or time
unfocused and pulsed or continuous ultrasonic field, the degree of
standing waves, and the nature and state of the material and its
boundaries. p
r
Peak compressional pressure
Q. Is cavitation related to SPTA intensity? (pc) and peak rarefactional
pressure (pr)
A. No. The correlation is not with temporal-average intensities, but rather

with pressure. Cavitation is most closely related to peak negative Cavitation depends on
pressure, or peak rarefactional pressure, during the pulse. • frequency
• pressure
• focused/unfocused beams
Peak negative pressure is roughly related to the pulse-average • pulsed/continuous
intensity. So, the spatial-peak pulse-average intensity, the SPPA ultrasound
intensity, is loosely related to cavitation. This relationship is useful to • degree of standing waves
us because many existing ultrasound systems use SPPA intensity as a • nature and state of material
specification or control. • boundaries

Q. Are there different types of cavitation?
A. Cavitation can be discussed in terms of two categories: stable

cavitation and inertial (or transient) cavitation.
Stable cavitation is associated with vibrating gaseous bodies. In stable Cavitation is related to the
cavitation a gaseous body remains stabilized and, because of the peak rarefactional pressure.
ultrasonic field, oscillates or pulsates. As the oscillations become
established, the liquid-like medium around the gas bubble begins to
flow or stream; we call this “microstreaming.” Microstreaming has
been shown to produce stress sufficient to disrupt cell membranes. Cavitation
1. Stable
During inertial cavitation, pre-existing bubbles or cavitation nuclei 2. Inertial (or Transient)
expand from the pressure of the ultrasonic field and then collapse in a
violent implosion. The whole process takes place in a very short time
span that is on the order of microseconds. The implosion can produce
huge local temperature rises that may be thousands of degrees Celsius,
and pressures equal to hundreds of atmospheres all in an area that is
less than one square micrometer. The implosion can damage cells and
tissue, ultimately leading to cell death. In addition, bubble implosion
can generate highly reactive chemical species. All of these effects,
microstreaming, implosion, and reactive chemicals occur in a very
small space around the bubble, affecting only a few cells.
Q. Is it really possible for cavitation to occur at the amplitudes and Oscillating bubble and
frequencies used for diagnostic ultrasound? microstreaming
15
A. Perhaps, if nuclei sites are available. There is ample theoretical and
some experimental evidence to support this conclusion, and that
biological alterations can occur. We are fortunate to have this evidence
because it documents the levels above which cavitation is thought to
occur, and because there is a lot of scientific evidence to suggest that
the onset of transient cavitation is a threshold phenomenon.
There’s a combination of rarefactional pressure values, ultrasonic

frequency, and cavitation nuclei that are required for cavitation to
occur. If, as evidence suggests, cavitation is a threshold phenomenon,
then exposure to pressure levels below the threshold for cavitation will
never induce cavitation, no matter how long the exposure lasts.
Can cavitation be produced
by diagnostic ultrasound Q. Do we know of any incidence of cavitation occurring in human tissue
equipment? or fluids resulting from diagnostic ultrasonic exposure?
A. Currently, there is no evidence that diagnostic ultrasound exposure has

caused cavitation in humans.
In addition, the control parameters on current equipment limit the peak

output. However, limits may be raised or eliminated in future
equipment.
Q. But, theoretically, it can happen?
A. Yes. But since cavitation would probably affect only a single cell, or a
few cells, it is extremely difficult to detect an adverse biological effect,
unless the cavitation events were widespread among a large volume of
tissue.
16
Part Two
Prudent Use
“Although the possibility exists that such biological effects may be

identified in the future, current data indicate that the benefits to the patient
of the prudent use of diagnostic ultrasound outweigh the risks, if any, that
may be present.”
American Institute of Ultrasound in Medicine
Official Statement On Clinical Safety
March 1993
17
18
Chapter Four
Benefits And Risks
Issues Addressed:
• Risks versus benefits
• Diagnostic ultrasound benefits
• Risk of not performing the study
• Prudent use
• New technology and applications
• High output, potentially greater risk
• High output, potentially greater diagnostic capability
• Shifting responsibility
Q. “Risks versus benefits.” What do we mean by that in terms of Risks vs. benefits
ultrasound?
A. The risks are the potential for adverse bioeffects caused by heating or
cavitation. Although there has not been a reported incident of serious
bioeffects on humans at diagnostic ultrasound levels, we do know that
heating of the tissue may occur and there may be the potential for
cavitation to occur.
The benefit is the diagnostic information ultrasound provides. And

ultrasound imaging provides very good data, data that allow
physicians to make clinical decisions. With information from an
ultrasound exam, physicians can weigh alternative courses of action
and select the best method for helping the patient.
Ultrasound imaging is popular first and foremost because it’s a superb

diagnostic modality. It provides tremendous diagnostic information
with great sensitivity and specificity. But it’s also a favorite imaging
technique because it appears safe, is widely accepted by patients, is
portable, and is relatively low in cost compared to other diagnostic
imaging modalities. Physicians must weigh the expected benefit from
a diagnostic ultrasound procedure against the potential risks of that
procedure.
Q. What are some examples of the benefits of diagnostic ultrasound? Examples of benefits from
diagnostic ultrasound: Cardiac
A. Let’s look at ultrasound in cardiac studies. The use of diagnostic studies
ultrasound for cardiac applications has increased dramatically over the
past ten years. From M-mode scans to transesophageal
echocardiography, ultrasound gives us the ability to image the
structure and function of the heart and great vessels in exquisite detail.
Ultrasound also has the ability to follow the normal and abnormal
course of blood flow within the heart.
19
Q. How about potential bioeffects with some of the new cardiac
applications?
A. Diagnostic ultrasound has an excellent safety record over the years that
it’s been used to study the heart. The nature of many cardiac
ultrasound techniques, the variety of imaging windows, and the fact
that the heart is filled with moving blood means that the duration of
the exposure of any one area of the heart is reduced.
It’s a real risk not to perform Newer applications of ultrasound through the esophagus and within
the study. the vascular space may result in bioeffects we’ve not previously
known about. We need more research before we can define all the
risks. But remember, the physician should weigh potential bioeffects
against the real risks of not doing the study and missing important
timely diagnostic information.
Q. What other medical specialties benefit from ultrasound?
Example of benefits from A. Ultrasound has had a huge impact on the area of obstetrics. The use of
diagnostic ultrasound: ultrasound examinations during pregnancy has increased dramatically
Obstetrical exams since the 1970s. The use of ultrasound in obstetrics is a principal area
of concern for potential bioeffects. Ongoing studies may provide
accurate information related to potential effects of ultrasound on the
embryo–fetus. In fact, the combination of the increase in use and the
concern for safety led to the National Institutes of Health consensus
development conference in the early 1980s. The conference discussed
the use of diagnostic ultrasound in pregnancy. The committee did not
recommend routine ultrasound examinations during pregnancy, but
they did suggest a number of appropriate clinical indications for the
use of ultrasound imaging during pregnancy.
Balancing benefits and risks Q. How do you balance the benefits and risks?
Ultrasound benefits: A. Ultrasound imaging during pregnancy is important because it provides

• Many diagnostic uses a considerable amount of information. On the one hand, ultrasound
• Replaces or used with offers lots of diagnostic uses, may be used to replace some procedures,
other procedures
• Cost effective
can be used in conjunction with other procedures, is cost effective, is
• Patient acceptance accepted by patients, and provides a great deal of high quality clinical
• High quality information information.
Prudent use On the other hand, we have the risks: thermal and nonthermal
bioeffects. But there’s another risk that must be considered: the risk of
not doing the ultrasound exam and either not having the information or
having to get it in a less desirable or invasive way. As the American
Institute of Ultrasound in Medicine statement says, “. . . the benefits to
patients of the prudent use of diagnostic ultrasound outweigh the risks,
if any, that may be present.”
20
Q. What about the benefits of new ultrasound technology and New technology and
applications? applications
A. There has been a virtual explosion of technology and applications

over the past few years: new manufacturers, new products, new
medical specialties, and more and more medical applications. Now we
have everything from small hand-held Doppler systems that follow
blood flow in peripheral vessels to more general imaging systems that
display nearly all of the body’s soft tissues in detail.
But it’s more than technology; it’s what that technology gives us; for Users assume more
instance, better quality images and more diagnostic information. Still, responsibility
all the operating modes and the varying output levels mean that more
responsibility must be assumed by the users.
Diagnostic ultrasound is widely accepted because it is a superb

diagnostic tool with an excellent history of safety. We want to keep it
that way. But with more and different types of equipment, larger
numbers of patients, and all the new applications, there’s increased
concern about potential bioeffects.
Q. Now that we understand the potential for ultrasound-induced

bioeffects, should we change how we use the equipment?
A. We must learn to balance the risks and the benefits. We have learned
about bioeffects: thermal effects, or tissue heating; and mechanical
effects, such as cavitation. We learned how intensity, exposure time,
focal properties, and pressure are associated with the risk for
bioeffects. Using too much intensity can increase the risks, but using
too little intensity for the clinical situation can lead to poor images
and the loss of essential information.
When we use ultrasonic devices, we should remember the safety

concerns. Ultrasound should neither be used as a “toy” or without
clinical need, nor should it be considered as “perfectly safe.” We
know and have known for more than 75 years that ultrasound, at
certain levels, can alter biological systems. There will always be a
need for continued awareness of future research findings. But we also
know that one should not hesitate to have a diagnostic ultrasound
examination when there is clinical benefit to be derived.
Q. In the future, might there be increased risk as well as increased Future benefit vs. risk
benefit?
A. The future may be quite different. If existing acoustic output limits

were removed, the primary responsibility for the safety of acoustic
output would shift from design restrictions, as on current diagnostic
21
ultrasound devices, to the judgement of the users. In return for
potentially enhanced diagnostic capabilities, we will have to balance
the clinical need against the risk of an adverse bioeffect. We will need
a knowledge of the thermal and mechanical mechanisms, the
bioeffects of ultrasound, the ultrasound output levels being used, and
the relationship of output level to image quality.
22
Chapter Five
ALARA
Issues Addressed:
• The ALARA principle
• Controlling ultrasonic energy
• Controlling exposure time
• System capability and ALARA
• Operating mode and ALARA
• Transducer capability and ALARA
• System setup and ALARA
• Scanning technique and ALARA
Q. Knowing that ultrasound energy is related to potential bioeffects, how

can we reduce the risks?
A. We have a simple principle that we can apply to the use of ultrasound ALARA, or As Low As
energy. It’s called ALARA, which stands for “As Low As Reasonably Reasonably Achievable
Achievable.” Following the ALARA principle means that we keep
total ultrasound exposure as low as reasonably achievable, while
optimizing diagnostic information.
With new ultrasound equipment, the output display lets us determine Users control the total
the exposure level in terms of the potential for bioeffects. For exposure to the patient.
equipment that does not have an output display, we depend on
whatever output information, such as intensity, dB, or percentage of
power that the system provides.
Because the threshold for diagnostic ultrasound bioeffects is

undetermined, it becomes our responsibility to control the total
exposure to the patient. Controlling the total exposure depends on
output level and exposure time. The output level required for an exam
depends on the patient and the clinical need. Not all diagnostic exams
can be performed at very low levels. In fact, using too low a level may
result in poor data and the need to repeat the examination. Using too
high a level may not increase the quality of the information, but it will
expose the patient to unneeded ultrasound energy.
Q. If output level depends on the patient and the clinical need, what What determines exposure
determines exposure time? time?
A. Ultimately, the exposure time depends on the person conducting the

exam. Primarily, it’s our training, education, and experience that
determine how quickly we can obtain a useful image, and thus, the
length of the exam and the amount of exposure. So, the question is,
“How much time do we need to obtain the desired diagnostic
information?”
23
System Capabilities: But there are also some other factors that might affect the length of
Operating mode time that any particular tissue is exposed. One is the mode, whether
Transducer capabilities
System setup
it’s a moving or a stationary beam; and another is the choice of
Scanning techniques transducer. Other factors include the patient’s body characteristics, the
Knowledge and experience operator’s understanding of the controls on the system and how they
affect output levels, and whether it’s continuous wave or pulsed
Doppler, or color flow Doppler. To achieve ALARA, we need a
thorough knowledge of the imaging mode, transducer capabilities,
system setup, and operator scanning techniques.
Operating mode: System capabilities include the following: mode, transducer

B-mode capabilities, system setup, and scanning techniques. Let’s talk about
M-mode each. First, the mode we select, such as M-mode, B-mode, or Doppler,
Doppler
depends on what we’re looking for. B-mode imaging gives anatomical
Color flow Doppler
information while Doppler and color flow Doppler modes give
information about blood flow through vessels. M-mode gives
information about how anatomical structures move in time.
Transducer capabilities:
Frequency Second, transducer capabilities relate to penetration at the frequency
Penetration chosen, resolution, and the field of view that we can obtain with the
Resolution selected transducer.
Field of view
System setup: Third, system setup and control settings depend on where we start on
Starting output power the output scale and on our knowledge of which combination of
Starting intensity outputs controls gets the best results.
Scanning results
Scanning techniques: Fourth, the scanning technique we use is based on our knowledge of
Anatomy and pathology anatomy and pathology, of ultrasound physics, and of the equipment’s
Ultrasound physics
Signal processing features
signal processing features, plus our experience with a given scanning
Recording and playback modality, such as sector, linear, and so forth. A system’s recording and
features playback features let us reduce exposure time to just the time
necessary to obtain a useful image. Analysis and diagnosis can be
performed using recorded images rather than lengthy live imaging
sessions.
ALARA is a simple concept and easy to understand. Implementing

ALARA well, however, requires all of our knowledge and skills as
diagnostic ultrasound users. In Part Three we will learn how many of
the controls found on diagnostic ultrasound equipment can affect
ultrasound output. Without an output display standard we must rely on
that knowledge to estimate a patient’s ultrasound exposure. With an
output display standard we have a real-time indication of the exposure
in terms of the potential for bioeffects. Either way, we implement
ALARA by minimizing the exposure level and duration while being
sure to obtain the necessary diagnostic information.
24
Part Three
Implementing ALARA
25
26
Chapter Six
Knobology
Issues Addressed:
• Basis of knobology
• Tradeoff between in situ intensity and image depth
• Operator controls and ALARA
• Prudent use
• Know the user’s guide
• An example of implementing ALARA
Q. What should we know about equipment control features,

“knobology”, to implement ALARA?
A. Whether or not a diagnostic ultrasound system has an output display,

the same types of controls are used to obtain the needed diagnostic
images. We should understand how these controls affect acoustic
output levels so we can use them to get the best image with the least
exposure. In this chapter, we will learn about types of controls that are
available on most ultrasound imaging equipment.
Q. How can the operator control ultrasound output? Operator controls and ALARA
A. There are several external system controls the operator can adjust to
improve the quality of the image and to minimize the output intensity.
To understand how these controls are related to ALARA, let’s divide
them into three broad categories: First, controls that directly affect
intensity. Second, controls that indirectly affect intensity. These are
controls such as Mode, Pulse Repetition Frequency and others. When
you change the setting for one of these controls, you may also be
changing the intensity. Third, controls that do not affect intensity. We
can think of the third category as “receiver controls.” These are
controls that affect the processing of ultrasonic echoes returned from
the body.
These aren’t “official” categories, but they help us understand how the
knobs affect ALARA. In fact, each equipment manufacturer provides
somewhat different sets of controls. By reviewing the user’s guide for
the equipment, we can determine the particular controls that perform
the functions described here.
Let’s look at controls that directly affect intensity. They are Controls directly affecting
application selection and output intensity. intensity
Application selection
Output intensity
27
Application selection With application selection, we may choose from applications such as
peripheral vessel, cardiac, ophthalmic, fetal imaging, and others. There
may be different “ranges” of intensity output based on these
applications. Selecting the right application range is the first thing you
can do. For example, cardiac intensity levels are not generally
recommended for performing a fetal scan. Some systems automatically
select the proper range for a particular application, while others require
a manual selection.
For equipment that does not have an output display, the maximum
intensity for each application is regulated by the FDA. The FDA
regulation is meant to limit ultrasonic output levels to ranges
historically used for each application. But users have some choice in
the matter; we are responsible for the proper selection of an
application range.
For equipment with an output display, FDA currently regulates only

the maximum output for the system. Manufacturers establish intensity
ranges appropriate for typical patient examinations. However, within
the system limits, users may override the application specific limits.
We are responsible for being aware of the output level that is being
used. We know the output level from the system’s real-time output
display.
Output intensity or power Another control that has a direct effect on intensity is, of course,
output intensity. This control also may be called transmit, power, or
output. Once the appropriate application range has been selected, the
transmit intensity control increases or decreases the output intensity
within the range. Most equipment allows you to select intensity levels
less than maximum, say 25 or 50 percent. ALARA implies that you
select the lowest output intensity that is consistent with good image
quality.
Controls indirectly affecting Q. Which controls indirectly affect intensity?

intensity:
System mode
A. The second group of controls is intended to change aspects of the
Pulse repetition frequency
Focusing depth transmitted ultrasonic field other than the intensity. However, because
Pulse length they change the field, the intensity is affected. Whether the intensity
Transducer choice increases or decreases and by how much is difficult to predict.
System mode The choice of B-mode, M-mode, or Doppler, for example, determines
whether or not the ultrasound beam is stationary or in motion, which
greatly affects the energy absorbed by the tissue. If the beam is
moving, then each targeted tissue volume experiences the beam only
for a fraction of the time, except near the transducer for sector scans. If
the beam is stationary, then the period of time a targeted tissue volume
in the beam receives ultrasound is increased.
28
Q. What about the pulse repetition frequency—PRF?
A. The number of ultrasound pulses in one second is referred to as the Pulse repetition frequency
(PRF)
pulse repetition frequency. The higher the pulse repetition frequency,
the more output pulses per second, increasing the temporal average
intensity. There are several controls which have an effect on the pulse
repetition frequency. For example, with some diagnostic ultrasound
systems, if we decrease the focal range, then the system may
automatically increase the PRF.
Q. Next on the list is focusing. How would focusing affect intensity? Focusing depth
A. In focusing, the beam is narrowed in order to get a better lateral

resolution, increasing the temporal average intensity. Most systems
adjust their output to offset the effects of focusing, so they tend to
maintain the same intensities. As an operator, we need to set the
transducer focus at the depth of the structure we’re examining.
Different exams require different focal depths. Setting the transducer
focus at the proper depth improves the resolution of that structure, and
we don’t need to increase intensity to see it better.
Q. What about pulse length? Pulse length
A. Pulse length, sometimes called burst length or pulse duration, is the

time the pulse is on. Often the longer the pulse, the greater the
temporal-average intensity value, which both raises the temperature in
the tissue and slightly increases the likelihood for cavitation. In pulsed
Doppler, increasing the Doppler sample volume length usually
increases the pulse length.
Q. Transducer choice is another factor that indirectly affects intensity. Transducer choice
How?
A. Tissue attenuation increases with transducer frequency. The higher the

frequency, the higher the attenuation. That is, a higher-frequency
transducer requires more output intensity to ‘see’ at a greater depth. In
order to scan deeper at the same output intensity, a lower transducer
frequency must be used. So, for deeper structures, if we find ourselves
maximizing output and gain without obtaining good image quality, we
may have to switch to a lower frequency.
Q. We are calling the third category Receiver Controls. We use these to Receiver Controls that affect
improve image quality. They have no effect on output; they only the image only
Receiver gain
affect how the ultrasound echo is received and processed. The TGC
controls include gain, TGC, video dynamic range, and post Video dynamic range
processing. Let’s just look at one of these . . . system gain. How can Post processing
we use receiver gain to implement ALARA?
29
Always increase the receiver A. The receiver gain controls amplification of the return echo signal. To
gain first. obtain good diagnostic information, we need a high return signal
amplitude. This can be attained either by higher output, similar to
talking louder, or by higher receiver gain, similar to a hearing aid with
volume control. The need for gain is determined by tissue attenuation,
that is, how much of the ultrasound is lost as it passes to the reflective
surface and back to the transducer. In some cases, we control the
receiver gain by setting the gain control or TGC. But in other cases,
gain is automatically adjusted by the system when the user adjusts the
output control. If the equipment has a receiver gain control, and we are
searching for a weak signal, we should always increase the system’s
receiver gain first, then increase the power output. That way, we
reduce the output required and make it less likely to use high acoustic
intensities in the patient’s body tissue. Remember, a low receiver
gain may necessitate using a higher output, or result in suboptimal
image quality.
Q. What is an example of the use of ALARA in a clinical exam?
A. Imagine we are getting ready to do a liver scan. It will involve the use
of B-mode, color, and Doppler. Let’s see how we would follow the
ALARA principle to set up and conduct the exam.
Select transducer The first thing we need to do is select the appropriate transducer
Check output transmit frequency. Next, we adjust the output intensity (or power) transmit
setting setting. We check to make sure it is positioned at the lowest possible
Adjust focus
setting to produce an image. We adjust the focus to the area of interest,
Increase receiver gain
Adjust output transmit then increase the receiver gain to produce a uniform representation of
again the tissue. If we can obtain a good image by increasing the gain, we
can lower the output and continue to increase the gain. Only after
making these adjustments and if tissue penetration or echo amplitude
levels are inadequate should we increase the output to the next
higher level.
Minimize exposure time After we have achieved a good B-mode image, then we can use color
to localize the blood flow so we can position the Doppler sample
volume. This allows us to locate the vessel of interest faster and that
minimizes exposure time. Now that we have an image of the vessel,
we position the range gate (or sample volume gate) over the vessel.
Adjust output transmit setting Now we check the Doppler trace. We adjust the power setting by
again setting the Doppler transmit intensity at the lowest possible level to
produce a clear signal. We will make a few more adjustments, for
example, adjusting the velocity scale. Now we increase the receiver
gain to get a diagnostic signal. If maximum gain adjustments are
inadequate, then we raise the output to the next higher level.
30
That basically is how we implement ALARA. Select the right
transducer, start with a low output level, and obtain the best image
possible by using focusing, receiver gain, and other imaging controls.
If that is not adequate for diagnostic purposes, then increase the
output level.
We can further implement ALARA by reducing total ultrasonic

exposure time. That is, using our skill, experience, and knowledge of
the patient, we can structure the exam to find and obtain useful images
quickly. Recording and playing back parts or all of the exam for later
measurement and analysis can further minimize the duration of the
exposure.
Q. There are many different types of ultrasound systems with different Some systems do not have an
controls and displays. Does ALARA change from system to system? output control.
Different systems have
different controls and
A. ALARA remains the same. Keep ultrasound output “As Low As displays.
Reasonably Achievable.” How we do that will change somewhat from
system to system. For example, virtually all medical diagnostic
ultrasound equipment has some type of acoustic output control.
However, we may occasionally see a single purpose device that
doesn’t have an output adjustment. In this case, we practice ALARA
by minimizing exposure time.
If the machine has an output control, we use it and the other controls Acoustic output control:
to achieve ALARA. But remember, there are a variety of different percentage
types of intensity settings on ultrasound equipment, depending on the decibel (dB)
Direct unit
manufacturer’s design. For example, some equipment may have a (mW/cm2 or mW)
separate control on the keyboard or console that has discrete Thermal index
increments. Other equipment may have the intensity level adjustment Mechanical index
accessed through the system presets. And, output settings may be
displayed in a variety of different ways. For example, acoustic output
may be expressed as a percentage of total power, in decibels, in
intensity units of milliwatts per square centimeter, or in thermal or
mechanical indices.
In addition to the technical aspect of ALARA, there’s the

philosophical aspect. This includes minimizing scan time, performing
only required scans, and never compromising quality by rushing
through an examination.
Q. We’re responsible for patient care, and we must use diagnostic

ultrasound prudently. What’s the rule for prudent use?
A. We want the best diagnostic information with minimal exposure to the

patient. And because the threshold at which ultrasound energy causes
bioeffects is not known, our goal must be to adjust the intensity output
of the equipment so as to get the most information at the lowest
possible output level.
31
That’s what we mean by ALARA. Using settings that are “As Low As
Reasonably Achievable” allow for the best quality ultrasound data for
diagnosis.
32
Chapter Seven
The Output Display Standard
Issues addressed:
• Purpose of the Output Display Standard
• Mechanical Index (MI)
• Thermal Index (TI)
• Soft Tissue Thermal Index (TIS)
• Cranial Bone Thermal Index (TIC)
• Bone Thermal Index (TIB)
• When an Index is displayed
• What the Indices mean
• How to implement ALARA by using the Indices
Q. What is the output display standard?
A. One of many advances now being made in ultrasound equipment Standard for Real–Time
Display of Thermal and
technology is the introduction of output display indices that relate to Mechanical Acoustic
Output Indices on
the potential for ultrasound bioeffects. These indices are specified in a Diagnostic Ultrasound
Equipment
standard developed in a cooperative effort by the National Electrical
Manufacturers Association, the U.S. Food and Drug Administration,
the American Institute of Ultrasound in Medicine, and many other
medical and basic science societies.
Q. What is displayed?
A. Two types of indices may be displayed: a Thermal Index, or TI, which Output Display
provides an estimate of the temperature increase; and a Mechanical • Thermal Index (TI)
Index, or MI, which provides an indication of the potential of • Mechanical Index (MI)
nonthermal or mechanical bioeffects, such as cavitation.
Q. What is the purpose of the output display standard?
A. The goal of the output display standard is to make users aware of the
actual output of their ultrasound equipment as it is being used. The TI
and MI provide real-time information about the potential for bioeffects
that can be used to help implement ALARA easily and efficiently. As
users, we can quickly learn how different control settings change the
indices. We implement ALARA by obtaining needed information while
keeping the indices, the potential for bioeffects, “as low as reasonably
achievable.”
33
MI is a relative indicator of Q. What is the Mechanical Index?
the potential for mechanical
effects
A. Scientific evidence suggests that mechanical, or nonthermal,
bioeffects, like cavitation, are a threshold phenomenon, occurring only
when a certain level of output is exceeded. However, the threshold
level varies, depending on the tissue. The potential for mechanical
effects is thought to increase as peak pressure increases, but to
decrease as the ultrasound frequency increases. The Mechanical Index
automatically accounts for both pressure and frequency. When
interpreting the Mechanical Index, remember that it is intended to
estimate the potential for mechanical bioeffects. The higher the index
reading, the larger the potential. However, neither MI = 1, nor any
other level, indicates that a bioeffect is actually occurring. We should
not be alarmed by the reading, but we should use it to implement the
ALARA principle.
Q. What is the Thermal Index?
Scanned
Mode
Unscanned
Mode
A. Actually, there are three Thermal Indices that are used for different
Soft TIS
TIS combinations of soft tissue and bone in the area to be examined. The
Small Aperture
Tissue at Surface
Large Aperture purpose of the Thermal Indices is to keep us aware of conditions that
Bone
at Focus
TIS
at Surface
TIB may lead to a temperature rise whether at the surface, within the
Bone tissues, or at the point where the ultrasound is focusing on bone. Each
TIC TIC
at Surface
Thermal Index estimates temperature rise under certain assumptions.
Three Thermal Indices The Soft Tissue Thermal Index, known as TIS, provides information
• Soft Tissue Thermal Index on temperature increase within soft homogeneous tissue. The Cranial
(TIS)
• Cranial Bone Thermal Index
Bone Thermal Index, called TIC, indicates temperature increase of
(TIC) bone at or near the surface, such as may occur during a cranial exam.
• Bone Thermal Index (TIB) The Bone Thermal Index, or TIB, provides information on temperature
increase of bone at or near the focus after the beam has passed through
soft tissue. For example, TIB is appropriate when focusing near fetal
bone during a second or third trimester exam.
TI is a relative indicator The Thermal Index is a relative indicator of temperature rise. Thus, a
of temperature increase TI reading of 2 represents a higher temperature rise than a TI reading
of 1. However, a TI of 1 should not be taken literally to mean an actual
increase in temperature of 1°C, nor should a TI of 2 be taken to mean
an increase of 2°C. The actual increase in temperature in the patient is
influenced by a number of factors such as tissue type, blood perfusion,
mode of operation, and exposure time. Those who developed the
standard deliberately chose the term “Index” to avoid a literal
association between the TI reading and actual temperature increase.
The TI does, however, provide important information to the user:
itindicates that the possibility for an increase in temperature exists, and
it provides a relative magnitude that can be used to implement
ALARA.
34
Q. How and when are the output indices displayed?
A. The output display must be located so as to be easily seen by the No display of any index value
operator during an exam. An output display is not required if the is required if the transducer
transducer and system are not capable of exceeding an MI or TI of 1. and system are not capable
However, if the transducer and system are capable of exceeding an MI of exceeding an MI or TI of 1
or TI of 1, then it must display values as low as 0.4 to help the user
implement ALARA.
The standard only requires that a single index be displayed at any one 1
0.8 2
time. For some modes and application presets the user may be able to 3
choose which index shall be displayed. For example, the Mechanical 0.6 4
Index will appear for B-mode imaging if no other mode is active. A 0.4 5
Thermal Index will be shown for all other modes, including modes
where B-mode imaging is combined with something else such as M-
mode, Doppler, or color flow imaging. The standard makes an
exception for transducers that have no B-mode imaging. In that case,
A display of an index value
the Mechanical Index must be available in the Doppler mode. as low as 0.4 is required if
the transducer and system
The Mechanical Index is required for B-mode imaging because the are capable of exceeding an
mechanical effects, such as cavitation, are more likely to be significant MI or TI of 1.
than thermal effects. Similarly the rationale for using a Thermal Index
in the other modes is that the potential for heating is the greater
concern.
Q. Are there other system features required by the output display

standard?
A. The output display standard requires manufacturers to provide default Manufacturers are required to
settings on their equipment. These settings establish the output level provide default settings
that will be used automatically at power-up, entry of new patient
information, and a change from nonfetal to fetal application presets.
Once the exam is under way, the user should adjust the output level as Figure NEW Ch7-1
needed to achieve clinically adequate images while keeping the output
index as low as possible.
Q. Is it really that simple? All we need to know is the output index value?
A. Yes and no. A high index value does not always mean high risk, nor
does it mean that bioeffects are actually occurring. There may be
modifying factors which the index cannot take into account. But, high
readings should always be taken seriously. Attempts should be made
to reduce index values but not to the point that diagnostic quality is
reduced.
The indices do not take time into account. Exposure time is an Minimizing exposure time
important factor users must keep in mind, especially if the index is in a will help reduce risk
35
range that might be considered high. Exposure time is the ultrasound
exposure time at a particular tissue region. In all cases, minimizing
ultrasound exposure time will help reduce risk.
Every patient is different. The tissue characteristics assumed in the

formulas for the output display indices may differ significantly from
the characteristics of the patient or exam type. Important
characteristics we should consider include
• body size
• blood flow (or perfusion)
• the distance the organ of interest is from the surface
• where the bone is in relation to the beam axis and focal point, and
• factors, such as the presence or absence of fluid, that affect the
attenuation of ultrasound.
Q. Tell us in more detail how to use the output display to help implement
ALARA.
A. Let’s look at the basic principles to follow. To begin, we determine if

we are displaying the appropriate index. The Mechanical Index and
Thermal Index are mode-specific, so that index selection is automatic.
However, there may be cases when we can override the system’s
choice. When displaying a Thermal Index, we should ask four
questions.
Thermal Index Tissues Typical Examinations

TIS Soft tissue Cardiac, first trimester fetal
TIB Bone near focus Second and third trimester fetal
TIC Bone near surface Transcranial
First, “Which Thermal Index is appropriate for the study we are

performing—TIS, TIC, or TIB?” TIS is appropriate when imaging
soft tissue and is used, for example, during first trimester fetal exams
or in cardiac color flow imaging exams. TIC is used during
transcranial examinations. And TIB is used when the focus is at or
near bone and may be appropriate for second and third trimester fetal
exams or certain neonatal cephalic exams.
The second question to ask is, “Are there modifying factors that might
create either an artificially high or low reading?” These modifying
factors include the location of fluid or bone and blood flow. For
example, is there a low attenuation path so that the actual potential for
local heating is greater than the TI display? This could be caused by
an unusually long distance of amnioti, or other fluid through which
the ultrasound must travel. Another example is that a highly perfused
tissue area may have a lower temperature than indicated because
blood flow transports heat away from the tissue.
36
Third, even if the index value is low, we should ask, “Can I bring it
down?” Because there is uncertainty about how high is “too high,” we
should always be alert to ways to adjust the system to reduce the
indices. In many cases, an index reading can be reduced without
decreasing the quality of the image.
Finally, we should ask, “How can we minimize ultrasound exposure

time without compromising diagnostic quality?” This does not mean
that we rush through the exam and take the chance of not getting
information necessary for an accurate diagnosis. It means that we
should get the best image possible with as little exposure time as
necessary. There are a number of ways to reduce exposure time. For
example, if the system does not disable pulsing during freeze frame,
remove the transducer from the patient while working with a frozen
image on the ultrasound display. Don’t scan obstetrical patients twice,
once to obtain necessary diagnostic information and again to show
images to the patient’s family and friends. Only scan areas of the body
that are necessary to the diagnosis. And don’t use additional modes,
such as Doppler or color, unless they benefit the diagnosis.
Q. Please give us some examples that show how the indices can be used
to implement ALARA.
A. We will look at several examples. When we consider the Mechanical

Index, the MI might be reduced by selection of appropriate transducer
type, ultrasonic frequency, focal zone, and receiver gain.
Because there are three Thermal Indices, it is not so simple. As we go Implementation of ALARA
through the examples, remember the four questions we should ask by using the Indices
related to the Thermal Index:
• Which TI?
• Are there modifying factors?
• Can we reduce the index value?
• Can we reduce the exposure time?
The first example is a color flow scan of the portal vein of the liver.
TIS is the appropriate selection for nonobstetrical abdominal
examinations. Possible modifying factors include capillary perfusion
and body size. High perfusion in the imaged tissue will reduce thermal
effects while conversely, a lack of perfusion may increase them. With
increasing body size, extra tissue attenuation decreases mechanical and
thermal effects at the focus. Also, when considering the focus for a
soft tissue exam, remember that the potential for maximum heating
might occur at the surface, at the focal point, or somewhere in
between. For scanned modes, such as B-mode imaging and color
flow, and for sector transducers, the maximum heating is usually close
to the surface.
37
The second example is a pulsed Doppler cardiac exam. Again, TIS is
the appropriate thermal index. The cooling effect of cardiac blood
flow is a very important modifying factor. Actual increase in cardiac
temperature is almost certainly less than the TIS indicates.
The next example is a second trimester pulsed Doppler fetal exam. In

most cases with unscanned modes, like pulsed Doppler, the Thermal
Index indicates heating near the surface. If bone is not present,
maximum heating is likely to occur between the surface and the focus
or sample volume, and the TIS is the relevant index. But, if bone is
present, maximum heating will occur at the location of the bone. In
this example, the TIB is the relevant index, although it will
overestimate the actual temperature rise, unless the bone is located
within the focal zone or sample volume.
The presence of fetal bone near the focal zone is the important factor.
If the pulsed Doppler is used to measure umbilical blood flow, and we
are sure there is no bone near the sample volume, the TIS is
appropriate. However, because the transducer may be moved, it is
usually best to make the more conservative choice and select TIB for
all second and third trimester exams. Of direct concern are the fetus’s
developing neural tissues, such as the brain and spinal cord, that may
be in a region of heated bone.
Other modifying factors include the type of overlying tissue, whether

fluid or soft tissue, and the exposure time at the particular tissue
region. The presence of fluid is important, because if more than half
of the path is fluid-filled then the actual temperature rise may be
higher than the TIB value displayed. To reduce the potential
temperature rise, consider aiming the transducer to miss most of the
bone structure without losing the region of interest, if possible, and
optimize receiver gain and sample volume controls.
An additional consideration is whether heating is likely to be near the

surface (in the mother’s tissues) or deeper (in the fetal tissues). This
depends mostly on whether we are using a scanned (2D or color) or
unscanned (M-Mode or Doppler) mode. For scanned modes, heating
tends to be near the surface; for unscanned modes, closer to the focal
zone. However, in most cases where bone is along the beam axis,
maximum heating occurs at the location of the bone.
Another example is a transcranial examination, where TIC is the

appropriate Thermal Index. The presence of bone near the surface is
the important factor in this case. To reduce the TIC reading, consider
scanning through a thinner part of the skull, so that a lower output
setting can be used.
38
The final example is a neonatal cephalic exam. The choice of
Thermal Index depends on the location of bone. Generally, in an
exam through the fontanelle TIB is the appropriate index because of
the chance of focusing near the base of the skull. TIS might be
appropriate if the focal zone will always be above the base of the
skull. If the exam is through the temporal lobe, the temporal bone
near the surface makes the TIC the appropriate index.
39
Conclusion
In more than three decades of use, there has been no report of injury to
patients or to operators from medical ultrasound equipment. We in the
ultrasound community want to keep that level of safety.
In the past, application-specific output limits and the user’s knowledge

of equipment controls and patient body characteristics have been the
means of minimizing exposure. Now, more information is available.
The Mechanical and Thermal Indices provide users with information
that can be specifically applied to ALARA. Mechanical and Thermal
Indices values eliminate some of the guesswork and provide both an
indication of what may actually be happening within the patient and
what occurs when control settings are changed. These make it possible
for the user to get the best image possible while following the ALARA
principle and, thus, to maximize the benefits/risk ratio.
40
Index
INDEX
Numerics Sabbagha 163

Numerics Yale 164
2-D options brightness, adjusting video 126
23
image size C
22
linear scale cables
RES box 23 for VCR installation 127
2-D Setup 22 IBM PC-compatible printer intercon-
A nect cable 132
abbreviations 114–123 Quick Disconnect cable 129
AC chart connecting printers with 130
calculation formulas
Campbell 149–151
cardiac 78–84
Hadlock 152–154
vascular 74
Jeanty 155
Campbell
ACUSON
AC chart 149–151
manuals, in this set xi
BPD chart 157
AEGIS 2–8
FL chart 183
customizing 2
HC chart 194
AEGIS protocol
cardiac
free-form 3–5
calculation formulas 78
staged 6–7
Cerebellum chart
stress echo 8
Goldstein 165
AFI measurements 55
Hata 166
AIUM Ultrasound Medical Safety bro-
chure 213 McLeary 167
ALARA principle 213 circumference measurement 55
annotation keys setup 25 cleaning, printers 129
B Color Doppler Imaging (CDI)
backup 136 setup 32
Binocular Distance chart color levels, adjusting video 126
Jeanty 156 comment pages, OB worksheet 55
biometry measurements 55 Comments 56
Biophysical Profile 56 contrast, adjusting video 126
Body Markers 30 CRL chart
body markers setup 30 Hadlock 168
BPD chart Hansmann 169
Campbell 157 Jeanty 170
Doubilet 158 Nelson 171
Hadlock 159 Robinson 1975 172
Hansmann 160 Robinson 1988 173
Jeanty 161 customer information 138
Kurtz 162 customizing

Index
cardiac calculations 76 Queenan 189

customizing. See setup Foot chart
D Mercer 190
Gestational Sac chart
Doubilet
Hansmann 191
BPD chart 158 Hellman 192
E Nyberg 193
EFW chart HC chart
Shepard 174–181 Campbell 194
EFW equations 58 Hadlock 195–197
Hansmann 198
Exam Categories 51–52 Hoffbauer 199
Exam Presets Jeanty 200
creating new 49 Humerus chart
recalling 48 Jeanty 201
Merz 202
setting default 50 Queenan 203
F Outer Orbits chart
Fetal parameter charts Mayden 204
AC chart Thoracic Circumference chart
Campbell 149–151 Romero 205
Hadlock 152–154 Thoracic Diameter chart
Jeanty 155 Hansmann 206
Binocular Distance chart Tibia chart
Jeanty 156 Jeanty 207
BPD chart Merz 208
Campbell 157 Fetal parameter charts FL chart
Doubilet 158 Hadlock 184
Hadlock 159
foot switch
Hansmann 160
Jeanty 161 setup 33
Kurtz 162 formulas
Sabbagha 163 vascular calculations 74
Yale 164
Cerebellum chart Free-form Comments 56
Goldstein 165 free-form protocol 3–5
Hata 166 G
McLeary 167 gestational age, versus menstrual age 145
CRL chart
Gestational Sac chart
Hadlock 168
Hansmann 191
Hansmann 169
Jeanty 170 Hellman 192
Nelson 171 Nyberg 193
Robinson 1975 172 Goldstein, Cerebellum chart 165
Robinson 1988 173
EFW chart
GYN calculations 61
Shepard 174–181 2-D Calculations 68
Fibula chart 2-D Measurements 66
Jeanty 182 Doppler Calculations 69
FL chart Doppler Measurements 67
Campbell 183 Setup 62
Hansmann 185 Setup Pages 63–65
Holher 186
Jeanty 187 Comments 65
O’Brien 188 Doppler Sites 64

Index
Right Ovary 63 VCRs

Uterus 63 Sony SVO-9500MD 127–
Setup Soft keys 62 129
H J
Hadlock Jeanty
AC chart 152–154 AC chart 155
BPD chart 159 Binocular Distance chart 156
CRL chart 168 BPD chart 161
FL chart 184 CRL chart 170
HC chart 195–197 Fibula chart 182
Hansmann FL chart 187
BPD chart 160 HC chart 200
CRL chart 169 Humerus chart 201
FL chart 185 Tibia chart 207
Gestational Sac chart 191 K
HC chart 198 key conventions, in this manual xiii
Thoracic Diameter chart 206 Kurtz, BPD chart 162
Hata, Cerebellum chart 166 L
HC chart languages, converting system to other xiii
Campbell 194 laser printers, connecting 132
Hadlock 195–197 lighting, system 42
Hansmann 198 M
Hoffbauer 199 manuals, in this set xi
Jeanty 200 Mayden
Hellman Outer Orbits chart 204
Gestational Sac chart 192 McLeary, Cerebellum chart 167
Hoffbauer Mercer
HC chart 199 Foot chart 190
Holher Merz
FL chart 186 Humerus chart 202
Humerus chart Tibia chart 208
Jeanty201 monitor brightness 34
Merz 202 monitor contrast 34
Queenan 203 Multi-Imager printer, installing 131
I N
IBM PC-compatible printers, installing Nelson
132 CRL chart 171
Image Presets network configuration 138
creating new 49 Nyberg
recalling 48 Gestational Sac chart 193
ing 127 O
installing O’Brien
printers 129–132 FL chart 188
IBM PC-compatible printer OB calculations
132
Multi-Imager printer 131
AFI measurements 55
using Quick Disconnect cable biometry measurements 55
130 comment page 55

Index
composite MA 55 CRL chart 173

customizing 54 Romero
EFW equation 58 Thoracic Circumference chart 205
references 148 S
report heading 55 Sabbagha, BPD chart 163
Outer Orbits chart safety issues, ultrasound213
Mayden 204 Service User Interface 134
P setup 19–43
Presets 46–52 2-D controls 22
creating new 49 2-D options 22
Exam Annotation Keys 25
recalling 48 B-color 22
setting default 50 body markers 30
Image
cardiac calculations 76–78
recalling 48
clock time 41
printers 129–132
cleaning 129
Color Doppler Imaging (CDI) 32
installing
color parameters 32
converting system to other languages
connecting printers with Quick
Disconnect cable
xiii
130 foot switch 33
IBM PC-compatible printers 54–60
OB calculations
132 printers 129–132
installation overview 129
Multi-Imager printer 131 See also printers
laser, connecting 132 Service User Interface 133–140
placement, recommended 129 Setup menu 20
safety precautions system lighting 42
for IBM PC-compatible printers vascular calculations 72
132 VCR and external video 43
for Multi-Imager 131 VCRs 127–129
Q
See also VCRs; video
Queenan Setup menu 20
FL chart 189 Shepard
Humerus chart 203 EFW chart 174–181
Quick Disconnect cable 129 Sony SVO-9500MD VCR
connecting printers with 130 settings
R adjusting 127–129
R 129 recommended 129
reference articles 91–113 staged protocol 6–7
references stress echo protocol 8

for OB calculations 148 Super VHS video format 127
regression programs and equations, OB symbols, in this manual xiii
145 SYSTEM 41
RES BOX 23 system clock 41
restoring data 137 SYSTEM LIGHTING 42
Robinson 1975 system setup 19–43
CRL chart 172 T
Robinson 1988 TEXT 25

Index
Thoracic Circumference chart

Romero 205
Thoracic Diameter chart
Hansmann 206
Tibia chart
Jeanty207
Merz 208
U
ultrasound safety 213
V
vascular 72
vascular calculations 72
formulas 74
report 73
72
selecting studies
[VASCULAR RPT] 73
VCR and external video, setup 43
VCR/EXT-VIDEO 43
VCRs (video cassette recorders) 127–
129
Sony SVO-9500MD, installing
127–129
video
controls
adjusting brightness, color lev-
els, and contrast 126
setting up the VCR counter 126
formats, supported 127
Y
Yale, BPD chart 164

Index

ACUSON Sequoia
Administrator Manual
Part Number: 08268710
Rev. 1
Language: English

Manual Administrador Ecografo SIEMENS ACUSON SEQUOIA C256 - C512 - 512

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ACUSON Sequoia™ 512 Ultrasound System

ACUSON Sequoia™ C512 Echocardiography System

Siemens Medical Solutions USA, Inc.

TRADEMARKS ACUSON AcuNav, ACUSON Aspen, ACUSON Aspen Advanced, ACUSON

0403 Administrator Manual iii

iv ACUSON Sequoia System 0403

About Your Siemens System Manuals . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Chapter 1 Customizing AEGIS Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 2 Customizing System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Chapter 3 Customizing Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

0503 Administrator Manual v

Chapter 4 Customizing OB Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Chapter 5 Customizing Gynecology Calculations . . . . . . . . . . . . . . . . . . . . 61

Chapter 6 Customizing Vascular Calculations . . . . . . . . . . . . . . . . . . . . . . . 71

Chapter 7 Customizing Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . 75

Chapter 8 VCR and Printer Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Chapter 9 Using the Service User Interface . . . . . . . . . . . . . . . . . . . . . . . . 133

vi ACUSON SequoiaSystem 0503

0503 Administrator Manual vii

Figure 1-1 AEGIS Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

0403 Administrator Manual ix

Siemens is pleased to welcome you to the ACUSON Sequoia ultrasound

0403 Administrator Manual xi

Administrator This Administrator Manual is organized in two parts.

xii ACUSON Sequoia System 0403

◆ A diamond-shaped bullet indicates steps to follow to

Siemens provides special alphanumeric keys and annotation terms for

0403 Administrator Manual xiii

xiv ACUSON Sequoia System 0403

CUSTOMIZING AEGIS SOFTWARE

Customizing AEGIS Protocols 2

0403 Administrator Manual 1

Figure 1-1 AEGIS Setup

2 ACUSON Sequoia System 0403

NOTE: An ACUSON Sequoia system that is running In-Progress Store

SAVE ON SAVE ON RESULT

5. Select a Protocol Type: Free-form or Staged, and click Define next to

0403 Administrator Manual 3

2. Use the Capture Type Control options, Capture Type Settings

Figure 1-2 AEGIS Free-form Protocol

Remove Removes the current Capture Type from the protocol.

If a button is disabled, its function is not currently available. For example,

4 ACUSON Sequoia System 0403

0403 Administrator Manual 5

Figure 1-3 AEGIS Staged Protocols

Remove Removes the current Stage from the protocol.

6 ACUSON Sequoia System 0403

If a button is disabled, its function cannot currently be carried out. For

0403 Administrator Manual 7

Customizing a Stress A stress echo protocol is a type of staged protocol.

8 ACUSON Sequoia System 0403

0403 Administrator Manual 9

Figure 1-4 Network Printing Screen

10 ACUSON Sequoia System 0403

AEGIS AUTO AUTO SOFT KEYS

Servers — OFF Copy to server.

Printers OFF — [PRINT STUDY]

Printers OFF OFF [DICOM SERVICES] which accesses:

OFF ON [PRINT STUDY]

0403 Administrator Manual 11

12 ACUSON Sequoia System 0403

2. Power Cycle – Upon power on or shut down, Auto Retry attempts

0403 Administrator Manual 13

Figure 1-5 Network Server Setup