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3 FUJIFILM SonoSite, Inc th Drive SE Bothell, WA Emergo Europe Molenstraat BH, FUJIFILM SonoSite Australasia Pty Ltd Suite 9, 13a Narabang Way Belrose, New South Wales 2085 Edge SiteLink SonoCalc SonoHD2 SonoMB SonoMBe SonoSite SonoSite FUJIFILM SonoSite, Inc. DICOM (National Electrical Manufacturers Association) US 8,439,840; US 8,398,408; US 8,355,554; US 8,216,146; US 8,213,467; US 8,147,408; US 8,137,278; US 8,088,071; US 8,066,642; US 8,052,606; US 7,819,807; US 7,804,970; US 7,740,586; US 7,686,766; US 7,604,596; US 7,591,786; US 7,588,541; US 7,534,211; US 7,449,640; US 7,169,108; US 6,962,566; US 6,648,826; US 6,575,908; US 6,569,101; US 6,471,651; US 6,416,475; US 6,383,139; US 6,364,839; US 6,203,498; US 6,135,961; US 5,893,363; US 5,817,024; US 5,782,769; US 5,722,412; AU:730822; AU:727381; CA:2,372,152; CA:2,371,711; CN ; CN: ; CN: ; DE: ; DE: ; DE: ; DE: ; DE: ; DE: ; DE: ; EP: ; EP: ; EP: ; EP: ; EP: ; EP ; EP ; ES: ; ES:159878; ES: ; ES: ; FR:158978; FR: ; FR: ; FR: ; FR: ; FR: ; GB:158978; GB: ; GB: ; GB: ; GB: ; GB: ; GB: ; IT: ; IT: ; IT: ; IT: ; JP: ; KR:532359; KR:528102; NO:326814; NO: P / FUJIFILM SonoSite, Inc ii

4 ...vii...vii USB A & B Event log Annotations...16 Audio Battery...16 Cardiac Calculations...17 Connectivity...17 Date and Time...17 Display information...17 IMT Calculations IMT...18 Network Status...18 iii

5 OB Calculations...18 OB Custom Measurements...18 OB Custom Tables...19 Presets...19 System Information...20 USB Devices USB...20 JPEG...21 efilm Lite M MBe MBe ECG M EMED iv

6 (Gyn)...58 IMT TCD EMED MSK ECG v

7 EMC DICOM HIPAA ALARA ALARA MI TI vi

8 vii

9 viii

10 Edge Edge FUJIFILM SonoSite FUJIFILM SonoSite FUJIFILM SonoSite FUJIFILM SonoSite FUJIFILM SonoSite FUJIFILM SonoSite [email protected] vii

11 viii

12 1 Edge 82 FUJIFILM SonoSite USB USB (1) (2) (3) I/O (4) ECG PATIENT 4 2DM MODE M COLOR DOPPLER (1) (2) (3) (4) USB (5)

13 V

14 4 5 6 FUJIFILM SonoSite 5 16 Audio Battery

15 USB USB USB PC USB PC USB USB USB USB USB USB 81 USB USB USB 1 1 USB USB 20 USB Devices USB USB USB 1 USB 2 USB USB USB USB USB USB USB 4

16 NEAR FAR GAIN 5 AUTO GAIN 6 7 Zoom 100% 1 5

17 8 SET CALIPER 9 CALCS FREEZE 12 SAVE 19 Presets 13 SAVE CALC CLIP 14 A & B 15 M Mode M DOPPLER COLOR MMode M M-line M MMode M Doppler D-line D Doppler CPD Color 2D 16 UPDATE MMode M Doppler D-line Doppler 17 SELECT 18 PATIENT EXAM REVIEW REPORT EMED 19 6

18 Gen Res THI PW Display Information 10 USB

19 CPD SELECT 16 AudioBattery SELECT SELECT 5 8

20 TAB SHIFT

21 LastFirstMiddle Patient ID Accession Indication Procedure ID UserReading Dr. Referring Dr. Institution DICOM SiteLink Alias AE Title AE A & B Key A & B Footswitch Annotation 21 CFR FUJIFILM SonoSite FUJIFILM SonoSite FUJIFILM SonoSite FUJIFILM SonoSite Symbols 2 3 OK FUJIFILM SonoSite Aquasonic 10

22 FUJIFILM SonoSite SonoSite Education Key 1 Education Key USB USB 2 REVIEW 3 List 4 Videos 5 USB a Select USB USB b Select USB device for media playback dialog box USB Education Key USB Training Type Select View 4 0 Back 10 Pause Play Forward 10 List Done 1 11

23 31 (ECG) CPD Color (PUBS) (IVF) CPD Color (IUGR) (Orb) (Oph) FDA (Orb) (Oph) (Orb) (Oph) FDA (Orb) (Oph) 12

24 2 FUJIFILM SonoSite 1 SETUP 2 Setup Pages Done Reset A & B A & B Key, Footswitch A & B A B A Print B none Save Clip Freeze Save Image Print 1 USB USB 2 A & B Key, Footswitch A & B Administration 1996 (Health Insurance Portability and Accountability Act, HIPAA) (European Union Data Protection Directive, 95/46/EC) HIPAA Setup 2 13

25 1 Administration Name Administrator 2 Password FUJIFILM SonoSite vii FUJIFILM SonoSite 3 Login User Login 1 2 User Login On On Off 1 2 User List Administrator 3 User Information Password Confirm 16 Password changes 4 Save 1 2 New 3 User Information NamePassword Confirm 16 4 User User 5 Administration Access 6 Save 1 2 User List 3 User Information 4 Save 1 2 User List 3 Delete 4 Yes 1 2 User List 3 Password Confirm 4 Save 14

26 1 USB 2 3 Export USB 4 USB Export USB 1 USB 2 3 Import 4 USB Import 5 Event log Event log DICOM (log.txt) USB log.txt 1 USB 2 Log Export USB 3 USB Export Event log Microsoft Word Event log 1 Event log 2 Clear 3 Yes User Login 14 Setup Event log Event log USB PC Event log 1 2 Log Event log Back 1 2 User Login OK 1 2 User Login Guest 2 15

27 1 2 User Login Password 3 OK (A-Z) (a-z) (0-9) Annotations Annotations Anntations Exam 2 Group A B C 3 Text Add Text Rename Delete 10 Annotations Unfreeze Keep All Text Keep Home Text Clear All Text Keep All Text 34 1 USB 2 Annotations Export USB 3 USB Export USB 1 USB 2 Annotations Import 3 USB Import 4 Done USB Audio Battery Audio Battery On Off On Off 16 Annotations

28 Off 5 10 Off Cardiac Calculations Cardiac Calculations Tissue Doppler Imaging (TDI) 2 3 (RS-232) Connectivity Internal Storage Capacity Alert DICOM 49 Cardiac Calculations TDI Walls TDI Connectivity Connectivity USB SiteLink Image Manager DICOM SiteLink SiteLink Image Manager DICOM MPPS SonoSite DICOM 1 2 Connectivity Printer PC ASCII PC PC FUJIFILM SonoSite 67 1 Serial Port Connectivity Computer Date and Time Date and Time Date Time 24 Display information Display Information Patient Header Mode Data System Status Setup 2 17

29 IMT Calculations IMT IMT Calculations IMT IMT 58 IMT IMT IMT Calculations IMT IMT Calculations IMT None Region width (mm) Network Status Network Status IP Location MAC OB Calculations OB Calculations 60 1 OB Calculations Gestational Age Growth Analysis None 2 More 1 USB 2 OB Calculations Export USB 3 USB Export USB 1 USB 2 OB Calculations Import 3 USB Import 4 OK OB Custom Measurements OB Custom Measurements OB Custom Measurements 60 1 OB Custom Measurements New 2 Name 18 IMT Calculations IMT

30 3 Type 4 Save 1 OB Custom Measurements Custom Measurements 2 Delete Last 3 Yes OB Custom Tables OB Custom Tables Gestational Age Table Measurements GS CRL BPD OFD HC TTD APTD AC FTA FL EFW Tibia HL 5 Growth Analysis Table Measurements BPD HC AC FL EFW HC/AC 1 OB Calculations OB Custom Measurements Tables 2 1 OB Calculations OB Custom Measurements Tables 2 Gestational Age [] Growth Analysis [ ] 3 Measurement 4 New 5 Author 6 7 Save 18 1 OB Calculations OB Custom Measurements Tables 2 3 Edit Save Delete Yes Presets Presets Doppler Scale cm/s khz Duplex M 1/3 2D, 2/3 Trace 1/3 2/3 1/2 2D, 1/2 Trace 1/2 1/2 Full 2D, Full Trace Setup 2 19

31 Live Trace Peak Mean Thermal Index TIS TIB TICOB TIB TCD TIC TIS Save KeySAVEImage Only Image/Calcs Dynamic Range Units in/ft/lbs cm/m/kg Color Scheme Auto save Pat. Form System Information System Information 82 System Information Patents USB Devices USB USB Devices USB USB USB 38 USB 1 USB Devices USB Export 2 USB Export USB SiteLink SiteLink H.264 MP4 FUJIFILM SonoSite QuickTime 7.0 DICOM DICOM DICOM 3 JPEG JPEG JPEG SiteLink DICOM 4 SiteLink Sort By Devices DICOM FUJIFILM SonoSite USB Devices USB Include private tags FUJIFILM SonoSite Edge DICOM 20 System Information

32 JPEG JPEG lossy compression BMP SonoCalc IMT BMP SonoCalc IMT Physics in Medicine and Biology, Quality Assessment of DSA, Ultrasound and CT Digital Images Compressed with the JPEG Protocol, D Okkalides et al 1994 Phys Med Biol doi: / /39/9/008 Canadian Association of Radiologists, CAR Standards for Irreversible Compression in Digital Diagnostic Imaging within Radiology, Approved:June pdf efilm Lite 1 USB 2 USB 3 [efilmlite.bat] efilmlite.bat efilmlite efilmlite efilm Lite efilmlite efilm Lite Setup efilm Lite efilm Lite DICOM USB efilm Lite Windows DICOM efilm Lite efilm Lite FUJIFILM SonoSite efilm Lite 2 21

33 22 USB Devices USB

34 D 2 2D 2D (2D) Optimize Res Gen Pen Dynamic -3, -2, -1, 0, +1, Range +2, +3. Dual LVO On LVO LVO Off LVO Orientation Dual UPDATE UPDATE Dual 2D LVO On LVO LVO Off LVO LVO (MI) U/RU/L D/L D/R Brightness

35 Guide Sector SonoMB (MB) MBe ECG Clips THI Guide A B C Back A B C Guide ECG SonoMB On Sector Full MB on MB MB OFF MB SonoMB SonoMB MB SonoMB ECG FUJIFILM SonoSite ECG 36 THI THI M (M Mode) M 1 M MODE M M 2 M 3 M 23 2D M 1 M MMODE M Slow [ ] Med [ ] Fast [ ] UPDATE M M MMODE M M 19 Presets Page x/x 24

36 CPD Color CPD Color 1 COLOR ROI 2 CPD Color Color Color 3 ROI SELECT ` ROI ROI 4 CPD Color CPD Color CPD Color Color CPD Color Suppress Flow Sensitivity PRF Scale PRF Wall Filter Steering Variance Invert Show Hide Low Med High (PRF) PRF LowMed High ROI PW Doppler 3 25

37 Sector Page x/x PW CW PW CW PW/CW CPD/Color CPD/Color ROI SELECT ROI ROI PW PW CW 1 DOPPLER D 2 27 PW Doppler PW SELECT SELECT DOPPLER UPDATE DOPPLER 19 Presets 26

38 PW Doppler PW PW CW Angle Correction Scale [PRF] cm/s khz 19 Presets Line Live Trace Gate Size TCD Orb TDI On TDI TDI On TDI TDI TDI Off TDI TDI off TDI Steering Page x/x Invert Volume Wall Filter Live Trace Invert (0-10) LowMed High Sweep SlowMed Speed Fast Live Trace 19 Presets Page x/x 3 27

39 UP DEPTH DOWN DEPTH AUTO GAIN NEAR 2D FAR 2D GAIN CPD Color GAIN (ROI) PW CW GAIN FREEZE LEFT ARROW RIGHT ARROW 2D Color 1 ZOOM ROI 2 ROI 3 ZOOM ROI 100% 4 ZOOM Near Far (TGC) 28

40 MBe MBe MBe MBe C60x, HFL38x, HFL50x, L25x, L38xi L25x L25x MBe MBe SonoMBe 29 1 MBe MBe MBe

41 MBe MBe MBe MBe L/R Flip 23 2D Shallow Medium Steep (curved array transducer) 30 Shallow Medium 40 Steep Off MBe MBe Back MBe MBe MBe MBe MBe MBe MB 30

42 MBe Gain MBe MBe 13 A & B (Orb) (Oph) FDA (Orb) (Oph) 1 2 M CPD 3 Color 3 PW Doppler CW Doppler C8x Pro C11x Abd Neo Nrv Vas C60x Abd Gyn EXAM Exam Type 34 Msk Nrv OB D2x Crd HFL38x Bre IMT Msk Nrv SmP Vas Ven 3 31

43 1 2 M CPD 3 Color 3 PW Doppler CW Doppler 1 2 M CPD 3 Color 3 PW Doppler CW Doppler HFL50x Bre MSK Nerve SmP ICTx Gyn OB L25x Msk Nrv Oph Sup Vas Ven L38x Bre IMT Nrv SmP Vas L38xi Bre IMT Msk Nrv SmP Vas Ven P10x Abd Crd Neo P11x* Vas Ven P21x Abd Crd OB Orb TCD Ven 32

44 1 2 M CPD 3 Color 3 PW Doppler CW Doppler SLAx Msk Nrv Sup Vas Ven TEEx Crd * P11x P11x P11x 1. Abd = Bre = Crd = Gyn = IMT = Intima Media ThicknessMsk = Neo = Nrv = OB = Oph = Orb = Pro = SmP = Sup = TCD = Vas = Ven = 2. ResGen Pen 3. CPD Color Color PRF 4. PW TDI 27 PW Doppler 16 Annotations 1 TEXT 2 Home 34 3 DELETE Word Symbols 10 4 Label 16 Annotations TEXT 3 33

45 1 TEXT 2 3 Home/Set 1 2 SELECT SELECT 3 4 Hide 1 PICTO 2 x/x SELECT 3 4 SELECT 5 U/L D/LD/R U/R Dual Hide 67 1 PATIENT 2 New/End Done 37 ID Connectivity Bar Code Auto Lookup 37 1 PATIENT 2 3 Cancel Done 34

46 PATIENT 3 New/End Symbols 10 Patient Last First Middle ID Accession Date of birth Gender Indications User Procedure DICOM SonoSite DICOM Back Exam Type 31 LMP Estab. DD LMP Estab. DD Twins Twins Twin A A Twin B B A B Previous Exams A/B A B Twin A/B (Back) (Twins) Back BP IMT HR Height 19 Presets Weight 19 Presets BSA Ethnicity IMT Reading Dr. Referring Dr. Institution Department ID ID 3 35

47 Beep Alert 16 AudioBattery SAVE SAVE SAVE 19 Presets CLIP Prev/Off Prev/On (1x, 1/2x, 1/4x) Pause Left: x x Right: x x x Save Delete 1 Clips 2 Time Time ECG ECG Time ECG Preview On Preview Off PrevOn PrevOff Prev/On Prev/Off Prospective Pro Retro Retrospective Pro CLIP Retro CLIP 36

48 FUJIFILM SonoSite vii FUJIFILM SonoSite USB Clear All ID 1 2 Edit 3 OK 1 2 Append 4 1 REVIEW 2 List Select All 1 2 Review 3 x/x 4 Play Pause 1x 1/2x 1/4x 5 x/x List Done 3 37

49 Print A A A B 19 Presets USB USB USB USB Print Print USB 35 USB 20 USB Devices USB 1 USB 2 3 Exp. USB USB USB 4 USB Include patient information on images and clips USB 5 Export USB USB Cancel Export Delete DICOM SiteLink Image Manager DICOM SiteLink Image Manager SiteLink Image Manager DICOM 1 2 Archive 1 2 Info 38

50 ECG ECG FUJIFILM SonoSite ECG ECG FUJIFILM SonoSite ECG ECG ECG Show/Hide Gain ECG ECG 0-20 ECG FUJIFILM SonoSite FUJIFILM SonoSite 1 ECG ECG ECG ECG ECG ECG ECG 2 ECG ( ECG ECG 3 Position Sweep Speed Delay Line ECG Slow Med Fast Line Save 36 ECG Save ECG Delay 3 39

51 40 ECG

52 M HR 44 1 CALCS SELECT Switch Delete CALIPER 4 41

53 3 SELECT D CALIPER 2 SELECT D CALIPER 2 Ellipse Ellipse 1 2D CALIPER 2 Manual Manual 3 4 SELECT 5 SET 41 M M Distance Time Heart Rate (HR) (bpm) 200 M 1 MMode M CALIPER 2 3 SELECT

54 M 1 MMode M CALIPER 2 HR 3 4 SELECT M +/x cm/s 19 Presets 1 Doppler CALIPER /x RI ACC 1 Doppler CALIPER 2 3 SELECT Doppler CALIPER 2 Time 3 SELECT 4 SELECT 1 Doppler CALIPER 2 Manual 3 SELECT 4 Undo 5 SET

55 43 1 Doppler CALIPER 2 Auto 3 4 SELECT 5 6 SET 41 (VTI) (Vmax) (PGmean) (Vmean) (PGmax) (CO) (PSV) (TAM)* +/ (S/D) (PI) (EDV) (AT) (TAP) (...) 1 CALCS 2 Next Prev (...) SELECT 3 SELECT CALCS CALIPER (RI) 44

56 SAVE CALC Save 36 SAVE Image/Calcs SAVE 19 Presets 1 2 Delete 67 EMED EMED EMED EMED SELECT CALIPER SAVE CALC EMED 1 CALCS 2 EMED EMED Calcs

57 C11x C60x HFL38x HFL50x L25x L38x L38xi P10x P21x SLAx IMT IMT IMT (Abdomen) (Abdomen) b SELECT c Undo d SET e D CALCS 2 D 1 D 2 a Dia Red b 41 c D CALCS 2 A 1 A 2 a Area Red 34 46

58 C8x C11x C60x HFL38x HFL50x 34 ICTx Gyn L25x L38x L38xi P10x P21x SLAx (Abdomen) D 1 D 2 D 3 a 2D CALCS b i Volume Volume Gyn Volume ii 41 iii 45 C11x C60x HFL38x L25x L38x L38xi P10x P21x SLAx (Abdomen) Vascular Vascular Vascular Vascular (Abdomen) 159 d (Abdomen) Vascular D * TAM TAP * VF ml/ 4 47

59 2D (gate) 19 Presets C11x C60x P10x (mm) HFL38x L25x SLAx (mm) L38x (mm) L38xi (mm) P21x (mm) Allan, Paul L. et al.clinical Doppler Ultrasound, 4th Ed., Harcourt Publishers Limited, (2000) D a 2D CALCS b Vol Flow D c 41 d 45 2 Doppler a Doppler CALCS b Vol Flow TAM TAP c d SELECT e f SET g 45 48

60 CardiacGynecology IMT OBOrbitalSmall PartsTranscranial Doppler Vascular 34 LV LVd LVs RVW RVD IVS LVD LVPW RVW RVD IVS LVD LVPW HR a CO CI CO EF SV LVESV LVEDV IVSFT LVPWFT LVDFS CI SI D2x P10x P21x TEEx (Cardiac) (Cardiac) (Cardiac) (Cardiac) 159 Ao / LA Ao M AAo LA M LVOT D Ao LA/Ao AAo LA LA/Ao LVOT D LVOT ACS M ACS LVET M LVET MV EF:Slope M EF EPSS M EPSS 4 49

61 LV LVd LVs HR Area LV Vol EF LV mass RVW M RVD M IVS M LVD M LVPW M RVW M RVD M IVS M LVD M LVPW M HR a AV MV A4Cd A4Cs A2Cd A2Cs Epi Endo Apical CO EF SV LVESV LVEDV IVSFT LVPWFT LVDFS CI SI LV AV MV LV LV EF CO SV CI SI Biplane LV Epi Endo D Apical PISA Qp/Qs CO TDI Ann D MR/VTI MV/VTI LVOT D RVOT D LVOT VTI RVOT VTI LVOT D e a e a e a e a e a PISA ERO MV D VMax AV AI Vmean PGmean SV Qp/Qs CO SV CI SI HR LVOT D E(MV)/e 50

62 P. Vein A VMax AV Vmax Vmax AV AI Adur S D VMax S/D VTI Vmax AV AI Vmean PGmean MV E A E E PG A A PG E:A AV VTI Vmax AV VTI Vmax AVA Adur PHT PHT MVA Ao / LA LVOT D AV VTI SV VTI Vmax AV AI Vmean PGmean Ao / LA LVOT D AV VTI CO MV MR IVRT dp:dt b dp:dt Ao / LA LVOT D HR HR a 4 51

63 LVOT Vmax Vmax AV AI PV Vmax Vmax AV AI AV AI VTI PHT Vmax AV AI Vmean PGmean AI PHT AI VTI AT Vmax AV AI Vmean PGmean AT a. 56 (HR) M 43 M b c. 67 TV TRmax E A PHT VTI RA c Vmax AV AI E E PG A A PG E:A PHT MVA Vmax AV AI Vmean PGmean RVSP LVd LVs 1 2D MMode M CALCS SELECT 5 SELECT 6 SELECT SELECT

64 Ao LA AAo LVOT D 1 2D MMode M CALCS LV 1 2D CALCS 2 a b c d e SELECT (LV) Undo SET 45 MV AV 1 2D CALCS 2 Area MV AV 3 SELECT 4 Undo 5 SET 6 45 LV 1 2D CALCS 2 LV Mass LV 3 EPI Endo a b c d e SELECT Undo SET 45 4 Apical Doppler CALCS 2 MV TV TDI P. Vein 3 10 a b

65 c 45 (VTI) VTI 49 1 Doppler CALCS 2 MV AV TV PV LVOT VTI 3 SELECT 4 Undo 5 SET (RVSP) 1 Doppler CALCS 2 TV TRmax RA 67 RA 5 RVSP MV AI AV (PHT) 1 Doppler CALCS 2 MV AV TV PHT 3 SELECT 4 MV EF AV 5 45 (PISA) PISA 1 Ann D a b c 2D CALCS PISA Ann D 41 d 45 2 a b c Color CALCS Radius d 3 Doppler CALCS 4 MR VTI MV VTI a PISA MR VTI MV VTI 54

66 b SELECT c Undo d SET e 44 (IVRT) 1 Doppler CALCS 2 MV IVRT 3 4 SELECT (dp:dt) (dp:dt) CW Doppler CW CALCS 2 MV dp:dt SELECT (AVA) AVA 1 LVOT a b c 2D CALCS LVOT D 41 d 45 2 LVOT AV Vmax 53 AV Vmax VTI 54 (VTI) AV VTI Qp/Qs Qp/Qs 1 2D CALCS 2 LVOT D RVOT D a Qp/Qs LVOT D RVOT D 4 55

67 b 41 c 45 3 Doppler CALCS 4 LVOT VTI RVOT VTI a b c d e Qp/Qs LVOT VTI RVOT VTI SELECT Undo SET (SV) (SI) SV SI SI Body Surface Area 1 SI Height Weight BSA 34 2 LVOT a b 2D CALCS LVOT D c 41 d (VTI) AV VTI 44 (HR) Heart Rate ECG 1 Doppler CALCS 2 HR 3 4 SELECT (CO) (CI) CO CI Stroke Volume Heart RateCI Body Surface Area 1 CI Height Weight BSA 34 56

68 2 SV 56 (SV) (SI) 3 HR 56 (HR) 1 1L/min 1L/min 2 LVOT a 2D CALCS b CO LVOT D c 41 d 45 3 Presets Live Trace a b Trace Above Below c SELECT SET Trace d (TDI) 1 TDI 27 PW Doppler 2 Doppler CALCS 3 TDI a b c

69 (Gyn) (Gyn) UterusOvary Follicle Volume 46 C60x ICTx 1 2D CALCS 2 Gyn 3 10 a b c 34 Gyn Gyn D CALCS 2 Follicle 3 10 a b c IMT Right Fol Left Fol IMT IMT (CCA) (ICA) 58

70 L38x L38xi HFL38x 34 IMT IMT IMT IMT 1 2D CALCS 2 3 IMT 4 59 IMT 5 45 IMT IMT IMT IMT IMT 18 IMT Calculations IMT IMT Hide Show Right-IMT IMT Left-IMT IMT Ant N Ant F Lat N Lat F Post N Post F IMT 1 IMT 2 IMT 3 IMT 4 IMT 5 IMT 6 IMT 7 IMT 8 Move Width Edit Smooth 1 Smooth Adven Lumen IMT Edit (Plaque) 4 59

71 Adven Lumen IMT Edit IMT Edit IMT 1 2D CALCS 2 3 Edit Manual Sketch Trace 4 a SELECT b SELECT Undo c SET 5 45 IMT IMT 1 2D CALCS 2 3 Edit Manual Sketch 4 a b c d e SELECT SELECT Undo SET 59 IMT 45 EFW EDD EFW 61 OB 60

72 34 OB a YS GS CRL Hansmann, Nyberg, Tokyo U. Hadlock, Hansmann, Osaka, Tokyo U. C60x ICTx P21x OB OB OB OB OB Calculations 18 OB Custom Measurements 19 OB Custom Tables BPD OFD HC TTD APTD AC FTA FL Chitty, Hadlock, Hansmann, Osaka, Tokyo U. Hansmann Chitty, Hadlock, Hansmann Hansmann, Tokyo U. b Tokyo U. b Hadlock, Hansmann, Tokyo U. Osaka Chitty, Hadlock, Hansmann, Osaka, Tokyo U. HL Tibia Jeanty Jeanty TCD CM Lat V CxLen 4 61

73 HC AC FL Hadlock 1 (EFW) c BPD AC FL Hadlock 2 AC FL Hadlock 3 BPD TTD Hansmann BPD FTA FL Osaka U. BPD AC Shepard BPD TTD APTD FL Tokyo U. HC/AC Campbell (Amniotic Fluid Index) FL/AC FL/BPD FL/HC Q 1, Q 2, Q 3, Q 4 Hadlock Hohler Hadlock Jeng d BPD Chitty, Hadlock, Jeanty HC AC FL EFW HC/AC Chitty, Hadlock, Jeanty Chitty, Hadlock, Jeanty Chitty, Hadlock, Jeanty Brenner Hadlock, Jeanty Campbell a. AUA b. Tokyo U. APTD TTD EFW c. Estimated Fetal Weight EFW 18 OB Calculations Hadlock EFW d. Report Graphs Growth Analysis LMP Estab. DD AFI 1 LMP Estab.DD Twins 2 2D CALCS 3 10 a b c Twin A A Twin B B M 1 MMode M CALCS 2 FHR 3 4 SELECT 62

74 c 45 S/D, RI S/D, RI, PI S/D, RI SD RI Umb A PI MCA/UmbA 1 LMP Estab.DD 2 Doppler CALCS 3 a b S/D, RI, PI* S/D, RI * S/D, RI, PI* SD RI PI SD RI SD RI PI MCA UmbA S/D, RI SELECT S/D RI PI SELECT SET Small Parts d:d 46 HFL38x HFL50x L38x L38xi (Small Parts) (Small Parts) (Small Parts) (Small Parts) 1 2D CALCS 2 Right Left 3 Hip Angle Baseline 4 SET 41 Line A A Line A A 5 Line A A 45 Line B B Line B B 6 Line B B 4 63

75 d:d 1 2D CALCS 2 Right Left 3 d:d Ratio d:d Fem Hd 4 SELECT 5 SET (Orb) 34 TT MCA TT TO TCD Orb Dist Mid Prox Bifur* ACA ACoA* TICA PCAp1 PCAp2 PCoA OA Siphon TAP PSV EDV PI RI S/D TAP PSV EDV PI RI S/D SM ECICA TAP PSV EDV PI RI S/D P21x (TCD) (Orb) (TCD) (Orb)

76 FM VA TAP FM BA Prox Mid Dist PSV EDV PI RI S/D AL ECVA TAP PSV EDV PI RI S/D * 4 10 a b Next Prev SELECT Undo BACKSPACE Auto SELECT (Orb) (Oph) FDA 1 Orbital (Orb) Transcranial (TCD) 31 2 Doppler CALCS c d SET Left Right 4 65

77 C11x HFL38x L25x Vascular Vascular Vascular. CCA Prox s d L38x L38xi SLAx Vascular Vascular Vascular Mid Dist s d s d 159 Bulb s d ICA Prox s d Mid Dist s d s d ECA Prox s d Mid Dist VArty s d s d s d ICA/CCA 1 Doppler CALCS 2 Left Right 66

78 3 10 a b c SELECT d e 45 (###) 1 REPORT 2 1/x Details Summary 3 SAVE Done 1 17 PC FUJIFILM SonoSite 2 Send Rep. 1 Details 2 Delete ICA/CCA Ratio ICA/CCA RA Summary RA RA 5 RVSP TCD TAP TCD 1 TCD Details TAP 2 Delete 4 67

79 Twin A/B A/B Compare 1 2 Delete SELECT Delete Anatomy Checklist TAB 2 BPP NST LMP Estab.DD 1 Graphs 2 Graphs 1/x 3 SAVE 4 Report Done EMED MSK EMED EMED EMED 1 REPORT 2 EMED 3 Worksheet x/x MSK MSK 1 REPORT 2 MSK 3 Worksheet x/x SAVE 68

80 D a < ±2% 1% < ±2% 1% < ±2% 1% b (cm) c < ±4% + 2% * % d < ±3% + 1.4% * % a. b. 0.7 db/cm MHz RMI 413a c. % = 1 + * * % d. % = 2 2 * % 5 69

81 2 M M < +/- 2% 1% a < +/- 2% 1% c (Heart Rate) < +/- 2% + c * / 100 % b 0-26 d d bpm a. b. 0.7 db/cm MHz RMI 413a c. d. FUJIFILM SonoSite 3 < +/- 2% 1% b < +/- 2% 1% b < +/- 2% 1% c a a. FUJIFILM SonoSite b. c. 70

82 AIUM (ACC) Zwiebel, W.J. Introduction to Vascular Ultrasonography. 4th ed., W.B. Saunders Company, (2000), 52. ACC = abs Δ Δ (AT) Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999), 219. (AVA) Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 393, 442. A 2 = A 1 * V 1 /V 2 A 2 = Ao A 1 = LVOT V 1 = LVOT V 2 = Ao LVOT = AVA (PV LVOT /PV AO ) * CSA LVOT (CI) Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd Edition, Boston: Little, Brown and Company, (1999), 59. CI = CO/BSA CO = BSA = (CO) Oh, J.K., J.B. Seward, A.J. Tajik The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999), 59. CO = (SV * HR)/1000 CO = SV = HR = (CSA) Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 383. CSA = * D 2 D = Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 453. AVA (VTI LVOT /VTI AO ) * CSA LVOT (BSA) Grossman, W. Cardiac Catheterization and Angiography. Philadelphia:Lea and Febiger, (1980), 90. BSA = * * = = a - b (dp:dt) Otto, C.M. Textbook of Clinical Echocardiography. 2nd ed., W.B. Saunders Company, (2000), 117, E:A E:A = E A 5 71

83 E/Ea Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 225. E Ea E = E Ea = E E (ERO) Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 455. ERO = 6.28 (r 2 ) * Va/MR Vel r = Va = (EF) Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999), 40. EF = ((LVEDV LVESV)/LVEDV) * 100% EF = LVEDV = LVESV = (ET) msec ET = msec (HR) bpm HR = M 3 (IVS) Laurenceau, J. L., M.C. Malergue. The Essentials of Echocardiography. Le Hague: Martinus Nijhoff, (1981), 71. IVSFT = ((IVSS IVSD)/IVSD) * 100% IVSS = IVSD = (IVRT) msec Reynolds, Terry. The Echocardiographers Pocket Reference. School of Cardiac Ultrasound, Arizona Heart Institute, (1993), 146. a - b (LA/Ao) Feigenbaum, H. Echocardiography. Philadelphia: Lea and Febiger, (1994), 206, Figure (Teichholz) ml Teichholz, L.E., T. Kreulen, M.V. Herman, et. al. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. American Journal of Cardiology, (1976), 37:7. LVESV = (7.0 * LVDS 3 )/(2.4 + LVDS) LVESV = LVDS = LVEDV = (7.0 * LVDD 3 )/(2.4 + LVDD) LVEDV = LVDD = 2D gm Schiller, N.B., P.M. Shah, M. Crawford, et.al. Recommendations for Quantification of the Left Ventricle by Two-Dimensional Echocardiography. Journal of American Society of Echocardiography.September-October 1998, 2:364. LV = 1.05 * {[(5/6) * A1 * (a + d + t)] - [(5/6) * A2 * (a + d)]} A1 = (Epi) A2 = (Endo) a = d = t = 72

84 M gm Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd Edition, Boston: Little, Brown and Company, (1999), 39. LV = 1.04 [(LVID + PWT + IVST) 3 LVID 3 ] * LVID = PWT = IVST = 1.04 = 0.8 = ml Schiller, N.B., P.M. Shah, M. Crawford, et.al. Recommendations for Quantitation of the Left Ventricle by Two-Dimensional Echocardiography. Journal of American Society of Echocardiography. September-October 1989, 2:362. V = V = a = b = n = (n=20) L = i = ml Schiller, N.B., P.M. Shah, M. Crawford, et.al. Recommendations for Quantitation of the Left Ventricle by Two-Dimensional Echocardiography. Journal of American Society of Echocardiography. September-October 1989, 2:362. π V = -- 4 n π -- 4 L a i b -- i n i = 1 n i = 1 2 a -- L i n V = a = n = (n=20) L = i = (LVD) Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. Boston: Little, Brown and Company, (1994), LVDFS = ((LVDD LVDS)/LVDD) * 100% LVDD = LVDS = (LVPWFT) Laurenceau, J. L., M.C. Malergue. The Essentials of Echocardiography. Le Hague: Martinus Nijhoff, (1981), 71. LVPWFT = ((LVPWS LVPWD)/LVPWD) * 100% LVPWS = LVPWD = (Vmean) cm/s Vmean = (MVA) Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 391, 452. MVA = 220/PHT PHT = 220 MV cc/sec Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 396. = 6.28 (r 2 ) * Va r = Va = 5 73

85 (PGr) mmhg Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999), 64. PGr = 4 * ( ) 2 E (E PG) EPG = 4 * PE 2 A (A PG) APG = 4 * PA 2 (PGmax) PGmax = 4 * PV 2 (PGmean) PGmean = (PHT) msec Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 391. PHT = DT * 0.29 DT = (PISA) Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Boston: Little, Brown and Company, (1999), 125. PISA = 2π r 2 2 π = 6.28 r = Qp/Qs Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 400. Qp/Qs = SV Qp SV Qs SV (RF) Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. Boston: Little, Brown and Company, (1999), 125. RF = RV/ MV SV RV = MV SV = (RV) cc Reynolds, Terry. The Echocardiographers Pocket Reference. School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 396, 455. RV = ERO * MR VTI (RVSP) mmhg Reynolds, Terry. The Echocardiographers Pocket Reference. School of Cardiac Ultrasound, Arizona Heart Institute, (1993), 152. RVSP = 4 * (Vmax TR) 2 + RAP S/D RAP = Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 217. S D S = S D = D (SI) Mosbys Medical, Nursing, & Allied Health Dictionary, 4th ed., (1994), SI = SV/BSA SV = BSA = (SV) Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999), 40, 59,

86 SV = (CSA * VTI) (TVA) CSA = LVOT VTI = Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 393, 391. TVA = 220 / PHT M (SV) ml Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Boston: Little, Brown and Company, (1994), 44. SV = (LVEDV LVESV) SV = LVEDV = LVEDSV = (VTI) Reynolds, Terry. The Echocardiographers Pocket Reference. 2nd ed., School of Cardiac Ultrasound, Arizona Heart Institute, (2000), 383. VTI = abs ( [n]) (AFI) Jeng, C. J., et al. Amniotic Fluid Index Measurement with the Four Quadrant Technique During Pregnancy. The Journal of Reproductive Medicine, 35:7 (July 1990), (AUA) (EDD) EDD = AUA (LMP) (EDD) LMP EDD = LMP (EFW) Hadlock, F., et al. Estimation of Fetal Weight with the Use of Head, Body, and Femur Measurements, A Prospective Study. American Journal of Obstetrics and Gynecology, 151:3 (February 1, 1985), Hansmann, M., et al.ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 154. Osaka University.Ultrasound in Obstetrics and Gynecology. (July 20, 1990), Shepard M.J., V. A. Richards, R. L. Berkowitz, et al. An Evaluation of Two Equations for Predicting Fetal Weight by Ultrasound. American Journal of Obstetrics and Gynecology, 142:1 (January 1, 1982), University of Tokyo, Shinozuka, N. FJSUM, et al. Standard Values of Ultrasonographic Fetal Biometry. Japanese Journal of Medical Ultrasonics, 23:12 (1996), 880, Equation 1. (LMP) (GA) LMP (AUA) AUA GA(LMP) = LMP 5 75

87 (Estab. DD) (LMPd) (GA) (Estab. DD) (GA) Established Due Date LMP GA(LMPd) = LMPd (Estab. DD) (LMPd) LMPd(Estab. DD) = Estab. DD (AC) Hadlock, F., et al. Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters. Radiology, 152:(1984), Hansmann, M., et al.ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 431. University of Tokyo, Shinozuka, N. FJSUM, et al. Standard Values of Ultrasonographic Fetal Biometry. Japanese Journal of Medical Ultrasonics, 23:12 (1996), 885. FUJIFILM SonoSite (AC) AC AC (BPD) Chitty, L. S. and D.G. Altman. New charts for ultrasound dating of pregnancy. Ultrasound in Obstetrics and Gynecology 10: (1997), , Table 3. Hadlock, F., et al. Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters. Radiology, 152:(1984), Hansmann, M., et al.ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 440. Osaka University. Ultrasound in Obstetrics and Gynecology. (July 20, 1990), 98. University of Tokyo, Shinozuka, N. FJSUM, et al. Standard Values of Ultrasonographic Fetal Biometry. Japanese Journal of Medical Ultrasonics, 23:12 (1996), 885. (CM) Mahony, B.; P. Callen, R. Filly, and W. Hoddick. The fetal cisterna magna. Radiology, 153: (December 1984), (CRL) Hadlock, F., et al. Fetal Crown-Rump Length: Re-evaluation of Relation to Menstrual Age (5-18 weeks) with High-Resolution, Real-Time Ultrasound. Radiology, 182: (February 1992), Hansmann, M., et al.ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 439. Osaka University.Ultrasound in Obstetrics and Gynecology. (July 20, 1990), 20 and 96. Tokyo University. Gestational Weeks and Computation Methods. Ultrasound Imaging Diagnostics, 12:1 (1982-1), 24-25, Table 3. 76

88 (FL) Chitty, L. S. and D.G. Altman. New charts for ultrasound dating of pregnancy. Ultrasound in Obstetrics and Gynecology 10: (1997), , Table 8, 186. Hadlock, F., et al. Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters. Radiology, 152:(1984), Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 431. Osaka University.Ultrasound in Obstetrics and Gynecology. (July 20, 1990), University of Tokyo, Shinozuka, N. FJSUM, et al. Standard Values of Ultrasonographic Fetal Biometry. Japanese Journal of Medical Ultrasonics, 23:12 (1996), 886. (FTA) Osaka University.Ultrasound in Obstetrics and Gynecology. (July 20, 1990), (GS) Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986). Nyberg, D.A., et al. Transvaginal Ultrasound. Mosby Yearbook, (1992), 76. Nyberg Tokyo University. Gestational Weeks and Computation Methods. Ultrasound Imaging Diagnostics, 12:1 (1982-1). (HC) Chitty, L. S. and D.G. Altman. New charts for ultrasound dating of pregnancy. Ultrasound in Obstetrics and Gynecology 10: (1997), , Table 5, 182. Hadlock, F., et al. Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters. Radiology, 152:(1984), Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 431. (HL) Jeanty, P.; F. Rodesch; D. Delbeke; J. E. Dumont. Estimate of Gestational Age from Measurements of Fetal Long Bones. Journal of Ultrasound in Medicine, 3: 3: (February 1984), (OFD) Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 431. Jeanty, P.; F. Rodesch; D. Delbeke; J. E. Dumont. Estimate of Gestational Age from Measurements of Fetal Long Bones. Journal of Ultrasound in Medicine, 3: 3: (February 1984), (TTD) Hansmann, M., et al. Ultrasound Diagnosis in Obstetrics and Gynecology. New York: Springer-Verlag, (1986), 431. (AC) Chitty, Lyn S. et al. Charts of Fetal Size: 3. Abdominal Measurements. British Journal of Obstetrics and Gynaecology 101: (February 1994), 131, Appendix: AC-Derived. Hadlock, F., et al. Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters. Radiology, 152:(1984),

89 Jeanty P., E. Cousaert, and F. Cantraine. Normal Growth of the Abdominal Perimeter. American Journal of Perinatology, 1: (January 1984), Hansmann, Hackeloer, Staudach, Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 179, Table 7.13.) (BPD) Chitty, Lyn S. et al. Charts of Fetal Size: 2. Head Measurements. British Journal of Obstetrics and Gynaecology 101: (January 1994), 43, Appendix: BPD-Outer-Inner. Hadlock, F., et al. Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters. Radiology, 152:(1984), Jeanty P., E. Cousaert, and F. Cantraine. A Longitudinal Study of Fetal Limb Growth. American Journal of Perinatology, 1:(January 1984), , Table 5. Hansmann, Hackeloer, Staudach, Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 176, Table 7.8.) (EFW) Brenner, William E.; D. A. Edelman; C. H. Hendricks. A standard of fetal growth for the United States of America, American Journal of Obstetrics and Gynecology, 126: 5 (November 1, 1976), ; Table II. Hadlock F., et al. In Utero Analysis of Fetal Growth: A Sonographic Weight Standard. Radiology, 181:(1991), Jeanty, Philippe, F. Cantraine, R. Romero, E. Cousaert, and J. Hobbins. A Longitudinal Study of Fetal Weight Growth. Journal of Ultrasound in Medicine, 3: (July 1984), , Table 1. Hansmann, Hackeloer, Staudach, and Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 186, Table 7.20.) (FL) Chitty, Lyn S. et al. Charts of Fetal Size: 4. Femur Length. British Journal of Obstetrics and Gynaecology 101: (February 1994), 135. Hadlock, F., et al. Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters. Radiology, 152: (1984), Jeanty P, E. Cousaert, and F. Cantraine. A Longitudinal Study of Fetal Limb Growth. American Journal of Perinatology, 1: (January 1984), , Table 5. Hansmann, Hackeloer, Staudach, Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 182, Table 7.17.) (HC) Chitty, Lyn S., et al. Charts of Fetal Size: 2. Head Measurements. British Journal of Obstetrics and Gynaecology 101: (January 1994), 43, Appendix: HC-Derived. Hadlock, F., et al. Estimating Fetal Age: Computer-Assisted Analysis of Multiple Fetal Growth Parameters. Radiology, 152: (1984), Jeanty P, E. Cousaert, and F. Cantraine. A longitudinal study of Fetal Head Biometry. American J of Perinatology, 1: (January 1984), , Table 3. Hansmann, Hackeloer, Staudach, Wittman. Ultrasound Diagnosis in Obstetrics and Gynecology. Springer-Verlag, New York, (1986), 176, Table 7.8.) 78

90 (HC) (AC) Campbell S., Thoms Alison. Ultrasound Measurements of the Fetal Head to Abdomen Circumference Ratio in the Assessment of Growth Retardation, British Journal of Obstetrics and Gynaecology, 84: (March 1977), FL/AC Hadlock F.P., R. L. Deter, R. B. Harrist, E. Roecker, and S.K. Park. A Date Independent Predictor of Intrauterine Growth Retardation: Femur Length/Abdominal Circumference Ratio, American Journal of Roentgenology, 141: (November 1983), FL/BPD Hohler, C.W., and T.A. Quetel. Comparison of Ultrasound Femur Length and Biparietal Diameter in Late Pregnancy, American Journal of Obstetrics and Gynecology, 141:7 (Dec ), FL/HC Hadlock F.P., R. B. Harrist, Y. Shah, and S. K. Park. The Femur Length/Head Circumference Relation in Obstetric Sonography. Journal of Ultrasound in Medicine, 3: (October 1984), HC/AC Campbell S., Thoms Alison. Ultrasound Measurements of the Fetal Head to Abdomen Circumference Ratio in the Assessment of Growth Retardation, British Journal of Obstetrics and Gynaecology, 84: (March 1977), (ACC) Zwiebel, W.J. Introduction to Vascular Ultrasonography, 4th ed., W.B. Saunders Company, (2000), 52. ACC = abs Δ Δ (ET) ET = msec d:d Graf, R. Fundamentals of Sonographic Diagnosis of Infant Hip Dysplasia. Journal of Pediatric Orthopedics, Vol. 4, No. 6: , Morin, C., Harcke, H., MacEwen, G. The Infant Hip: Real-Time US Assessment of Acetabular Development. Radiology 177: , December (IMT) Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA, et al. Carotid Artery Intima-Medial Thickness Distribution in General Populations As Evaluated by B-Mode Ultrasound. ARIC Investigators.Atherosclerosis Risk in Communities. Stroke.(1993), 24: O Leary, Daniel H., MD and Polak, Joseph, F., MD, et al. Use of Sonography to Evaluate Carotid Atherosclerosis in the Elderly. The Cardiovascular Health Study. Stroke. (September 1991), 22, Redberg, Rita F., MD and Vogel, Robert A., MD, et al. Task force #3 What is the Spectrum of Current and Emerging Techniques for the Noninvasive Measurement of Atherosclerosis? Journal of the American College of Cardiology. (June 4, 2003), 41:11, /x S/D +/x = abs ( A/ B) A = + B = x Taylor K.J.W., P.N. Burns, P. Breslau. Clinical Applications of Doppler Ultrasound, Raven Press, N.Y., (1988),

91 Zwiebel W.J., J.A. Zagzebski, A.B. Crummy, et al. Correlation of peak Doppler frequency with lumen narrowing in carotid stenosis. Stroke, 3: (1982), = (1 - A2 A1 * 100 A1 = A2 = Handa, Nobuo et al., Echo-Doppler Velocimeter in the Diagnosis of Hypertensive Patients: The Renal Artery Doppler Technique, Ultrasound in Medicine and Biology, 12:12 (1986), = (1 - D2 D1 ) * 100 D1 = D2 = (PGr) mmhg Oh, J.K., J.B. Seward, A.J. Tajik. The Echo Manual. 2nd ed., Lippincott, Williams, and Wilkins, (1999), * 2 E (E PG) EPG = 4 * PE 2 A (A PG) APG = 4 * PA2 (PGmax) PGmax = 4 * PV2 (RI) PSV = EDV = V = Kurtz, A.B., W.D. Middleton. Ultrasound-the Requisites. Mosby Year Book, Inc., (1996), 467. RI = abs (( A B) A) A = + B = x (TAM) cm/s TAM = ( ) (TAP) TAP = (Vol) Beyer, W.H. Standard Mathematical Tables, 28th ed., CRC Press, Boca Raton, FL, (1987), 131. cm 3 = (4/3) * π * /2 * /2 * /2 (VF) Allan, Paul L. et al. Clinical Doppler Ultrasound, 4th ed., Harcourt Publishers Limited. (2000), VF = CSA * TAM *.06 VF = CSA * TAP *.06 (PGmean) PGmean = 4 * Vmax 2 (PI) Kurtz, A.B., W.D. Middleton. Ultrasound-the Requisites. Mosby Year Book, Inc., (1996), 469. PI = (PSV EDV)/V 80

92 6 FUJIFILM SonoSite vii FUJIFILM SonoSite 10 C: FUJIFILM SonoSite FUJIFILM SonoSite USB USB USB ensure the USB device contains valid data. USB USB USB Incompatible power supply.. 96 CPD Color OB OB Connectivity 17 The external video is not functional.. Maximum number of procedure entries reached Unable to save image or clip. You have reached the maximum number of images/clips allowed for a single patient

93 FUJIFILM SonoSite FUJIFILM SonoSite vii FUJIFILM SonoSite 20 System Information System Software Transducer Software 1 2 Enter license number 3 Done FUJIFILM SonoSite vii FUJIFILM SonoSite Edge 84 FUJIFILM SonoSite vii FUJIFILM SonoSite ARM PCBA serial number PCBA (REF) C60x 82

94 FUJIFILM SonoSite (Association for Professionals in Infection Control and Epidemiology, APIC) (U.S. Food and Drug Administration, FDA) 21 CFR LCD LCD

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97 86

98 7 ALARA 8 (MSD) a,b,c. (MSD) MSD MSD MSD MSD d MSD e,f a. Magnavita, N., L. Bevilacqua, P. Mirk, A. Fileni, and N. Castellino. Work-related Musculoskeletal Complaints in Sonologists. Occupational Environmental Medicine.41:11 (1999), b. Craig, M. Sonography:An Occupational Hazard? Journal of Diagnostic Medical Sonography. 3 (1985), c. Smith, C.S., G.W. Wolf, G. Y. Xie, and M. D. Smith. Musculoskeletal Pain in Cardiac Ultrasonographers: Results of a Random Survey. Journal of American Society of Echocardiography. (May1997), d. Wihlidal, L.M. and S. Kumar. An Injury Profile of Practicing Diagnostic Medical Sonographers in Alberta. International Journal of Industrial Ergonomics. 19 (1997), e. Habes, D.J. and S. Baron. Health Hazard Report University of Medicine and Dentistry of New Jersey. (1999). f. Vanderpool, H.E., E.A. Friis, B.S. Smith, and K.L. Harms. Prevalence of Carpal Tunnel Syndrome and Other Work-related Musculoskeletal Problems in Cardiac Sonographers. Journal of Medicine. 35:6 (1993),

99 88

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117 C 15-95% hpa C 35 C C 15-95% hpa C 15 95% hpa V 50/60 Hz 100 VAC 2.0 A #1 15 V 5.0 A #2 12 V 2.3 A 75 W 106

118 AAMI/ANSI ES :2005, Medical Electrical Equipment Part 1 CAN/CSA C22.2, No , Canadian Standards Association, Medical Electrical Equipment Part 1. General Requirements for Safety CAN/CSA C22.2, No :08:2008 (3rd Edition), Medical Electrical Equipment Part 1 CAN/ CSA C22.2, No :08: General Requirements for Safety IEC :1988, International Electrotechnical Commission, Medical Electrical Equipment Part 1. General Requirements for Safety IEC :2005, Medical Electrical Equipment Part 1 IEC :2000, Medical Electrical Equipment Part 1-1. General Requirements for Safety-Section 1-1. Collateral Standard Safety Requirements for Medical Electrical Systems IEC :2001, International Electrotechnical Commission, Particular Requirements for the Safety of Ultrasonic Medical Diagnostic and Monitoring Equipment IEC :2007, Medical Electrical Equipment Part IEC 61157:2007 (3rd Edition), International Electrotechnical Commission, Requirements for the Declaration of the Acoustic Output of Medical Diagnostic Ultrasonic Equipment IEC 61157: JIS T0601-1:2013 (3rd Edition), Japanese Industrial Standard, General Requirements for Safety of Medical Electrical Equipment. JIS T0601-1: EMC CISPR 11, International Electrotechnical Commission, International Special Committee on Radio Interference - Industrial, Scientific, and Medical (ISM) Equipment Radio-Frequency Disturbance Characteristics Limits and Methods of Measurement (ISM) Group 1, Class A 1 A IEC :2001, Medical Electrical Equipment Part : 7 107

119 NEMA UD , Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment NEMA UD , Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment, American Institute of Ultrasound in Medicine AAMI/ANSI/ISO :2009, Biological evaluation of medical devices Part 1 (2009) AAMI/ANSI/ISO , Biological evaluation of medical devices Part 5 (2009) AAMI/ANSI/ISO , Biological evaluation of medical devices Part 10 (2002) AAMI/ANSI/ISO , Biological evaluation of medical devices Part 11 (2006) AAMI/ANSI/ISO , Biological evaluation of medical devices Part 12 (2007) RTCA DO-160E, Radio Technical Commission for Aeronautics, Environmental Conditions and Test Procedures for Airborne Equipment, Section 21.0 Emission of Radio Frequency Energy, Category B. 118 RTCA DO-160E B.118 DICOM NEMA PS 3.15, Digital Imaging and Communications in Medicine (DICOM) Part 15 (DICOM) HIPAA Health Insurance and Portability and Accountability Act, Pub.L. No CFR 160, General Administrative Requirements 45 CFR 164, Security and Privacy 108

120 8 ALARA ALARA ALARA ALARA ALARA 2D CPD Color THI 2D ALARA EN

121 (ISPTA) 720 mw/cm 2 ISPTA 50 TI 1.0 MI 0.23 (MI) (TI) 1.0 MI TI 111 MI TI ALARA MI TI MI TI BS EN :2001:Annex HH HH PRF Kremkau, Frederick W. Diagnostic Ultrasound: Principles and Instruments. 7th ed., W.B. Saunders Company, (Oct. 17, 2005). 110

122 MI TI MI TI MI TI MI TI MI TI P11x MI TI P11x P11x 1 MI C8x C11x C60x HFL38x HFL50x ICTx L25x L38x L38xi P10x P21x SLAx TEEx MI MI 8 111

123 2 TI TIS TIC TIB PRF PW C8x C11x C60x HFL38x HFL50x ICTx L25x L38x L38xi P10x P21x SLAx TEEx TI TI 112

124 MI TI AIUM TI MI 1.0 D2x (CW) TI MI 3 TI MI 1.0 2D / MMode M CPD/ Color PW Doppler CW Doppler C8x MI TIC TIB TIS C11x/8-5 MI TIC TIB TIS C60x/5-2 MI TIC TIB TIS D2x/2 MI TIC TIB TIS HFL38x/13-6 MI TIC TIB TIS HFL50x/15-6 MI TIC TIB TIS ICTx/8-5 MI TIC TIB TIS L25x/13-6 MI TIC TIB TIS L38x/10-5 MI TIC TIB TIS 8 113

125 3 TI MI 1.0 2D / MMode M CPD/ Color PW Doppler CW Doppler L38xi/10-5 MI TIC TIB TIS P10x/8-4 MI TIC TIB TIS P21x/5-1 MI TIC TIB TIS SLAx/13-6 MI TIC TIB TIS TEEx/8-3 MI TIC TIB TIS P11x P11x P11x MI MI TI 0.1 TI ALARA TI FUJIFILM SonoSite AIUM TI % 95% MI MI +18% -25% % 95% TI TI +21% -40% dB 3dB MI TI

126 158 MI TI Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers, FDA, Medical Ultrasound Safety, American Institute of Ultrasound in Medicine (AIUM), 1994 Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment, NEMA UD Acoustic Output Measurement and Labeling Standard for Diagnostic Ultrasound Equipment, American Institute of Ultrasound in Medicine, Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment, NEMA UD Guidance on the interpretation of TI and MI to be used to inform the operator, Annex HH, BS EN reprinted at P

127 4 5 (23 C ± 3 C) EN P11x P11x P11x 4 ( C) C8x C11x C60x D2 HFL38x HFL50x L25x L38x L38xi P10x P21x C ICTx SLAx TEEx (bioeffects) (AIUM) - Bioeffects Considerations for the Safety of Diagnostic Ultrasound, J Ultrasound Med., Sept. 1988:Vol. 7, No. 9 Supplement). Stowe (Bioeffects and Safety of Diagnostic Ultrasound) Acoustic Output Measurement Standard for Diagnostic Ultrasound Equipment (NEMA UD2-2004) Standard for Real-Time Display of Thermal and Mechanical Acoustic Output Indices on Diagnostic Ultrasound Equipment (NEMA UDe3-2004) 116

128 = [e -(0.23alf) ] = = e = a = (db/cm MHz) = 0.53 = 0.66 = 0.79 = 0.43 = 0.55 l = cm f = MHz 0.3 = [e -(0.069lf) ] 0.3 db/cm MHz 8 117

129 3 1dB/cmMHz 1990 MI MI 2.0 2D MMode M MI C 1.5 C 7 C I SPTA 500 mw/cm 2 (Bioeffects and Safety of Diagnostic Ultrasound (AIUM, 1993)

130 * P11x P11x P11x 6 C8x 2D ( ) TIS TIB TIC (MI) A aprt 1 A aprt >1 1.1 (a) (b) p r.3 (MPa) 2.48 W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 1.2 d eq (z sp ) (cm) f c (MHz) 5.53 # # A aprt X (cm) # # Y (cm) # # (PD) (μsec) (PRF) (Hz) 9524 p max (MPa) 3.11 d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) Pro 2 Pen MB (a) <1 (b) # / 8 119

131 7 C8x M TIS TIB TIC (MI) A aprt 1 A aprt >1 1.4 (a) (a) (b) p r.3 (MPa) 3.16 W 0 (mw) # # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 1.1 # d eq (z sp ) (cm) # f c (MHz) 5.07 # # # A aprt X (cm) # # # Y (cm) # # # (PD) (μsec) (PRF) (Hz) 800 p max (MPa) 3.83 d max (cm) # FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) 482 1Pro 2 Pen (a) <1 (b) # / 120

132 8 C8x TIS TIB TIC (MI) A aprt 1 A aprt >1 1.4 (a) (b) p r.3 (MPa) 3.18 W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 0.8 d eq (z sp ) (cm) f c (MHz) 4.82 # # A aprt X (cm) # # Y (cm) # # (PD) (μsec) (PRF) (Hz) 2548 p max (MPa) 3.63 d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) Pro 2 CVD 3 2D / Pen / / (PRF) / 5 / / (a) <1 (b) # / 8 121

133 9 C8x TIS TIB TIC (MI) A aprt 1 A aprt >1 1.2 (a) 2.0 (b) p r.3 (MPa) 2.59 W 0 (mw) # 36.0 # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) d eq (z sp ) (cm) 0.28 f c (MHz) 4.79 # 4.79 # A aprt X (cm) # 1.12 # Y (cm) # 0.40 # (PD) (μsec) (PRF) (Hz) 1008 p max (MPa) 3.10 d max (cm) 0.28 FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) Pro Pro 2 1 mm 1 mm (PRF) (a) <1 (b) # / 122

134 10 C11x CPD/Color TIS TIB TIC A aprt 1 A aprt >1 a a 1.0 p r.3 (MPa) # W 0 (mw) # 38.8 [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # d eq (z sp ) (cm) f c (MHz) # # 4.37 A aprt X (cm) # 1.12 Y (cm) # 0.50 PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) FL x (cm) # 4.29 FL y (cm) # 4.40 I max (W/cm 2 ) # 1 2 Abd 3 PRF (a) <1 (b) # 8 123

135 11 C11x PW Doppler TIS TIB TIC A aprt 1 A aprt >1 a p r.3 (MPa) # W 0 (mw) [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # 1.06 d eq (z sp ) (cm) 0.24 f c (MHz) # A aprt X (cm) Y (cm) PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) 0.23 FL x (cm) FL y (cm) I max (W/cm 2 ) # PRF (a) <1 (b) # 124

136 12 C60x TIS TIB TIC A aprt 1 A aprt >1 1.0 a (b) p r.3 (MPa) 1.69 W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 4.7 d eq (z sp ) (cm) f c (MHz) 2.84 # # A aprt X (cm) # # Y (cm) # # PD (μsec) PRF (Hz) 5440 p max (MPa) d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) Abd 2 Res/ Gen 3 11/ MB ( ) (a) <1 (b) # 8 125

137 13 C60x M TIS TIB TIC A aprt 1 A aprt >1 1.0 a a (b) p r.3 (MPa) 1.62 W 0 (mw) # # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 4.7 # d eq (z sp ) (cm) # f c (MHz) 2.85 # # # A aprt X (cm) # # # Y (cm) # # # PD (μsec) PRF (Hz) 800 p max (MPa) d max (cm) # FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) MB ( ) Pen 7.8 (a) <1 (b) # 126

138 14 C60x PW Doppler TIS TIB TIC A aprt 1 A aprt >1 a a 3.1 (b) p r.3 (MPa) # W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # d eq (z sp ) (cm) 0.51 f c (MHz) # # # A aprt X (cm) # # Y (cm) # 1.3 # PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) # 1 Abd 2 PRF (a) <1 (b) # 8 127

139 15 D2x CW Doppler TIS TIB TIC A aprt 1 A aprt >1 a a 2.6 (b) p r.3 (MPa) # W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # 1.1 d eq (z sp ) (cm) 0.66 f c (MHz) # # 2.00 # A aprt X (cm) # 0.8 # Y (cm) # 0.4 # PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) 0.54 FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) # 1 Crd 2 3 (a) <1 (b) # 128

140 16 HFL38x/13-6 MI TIC A aprt 1 A aprt >1 1.1 a (b) p r.3 (MPa) 2.56 W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) [email protected] 1.2 d eq (z sp ) (cm) f c (MHz) 5.33 # # A aprt X (cm) # # Y (cm) # # PD (μsec) PRF (Hz) 2450 p max (MPa) 3.19 d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) Nrv/Bre/ SmP/Msk cm 4 MBe TIS TIB (a) <1 (b) # 8 129

141 17 HFL38x CPD/Color MI TIC A aprt 1 A aprt > (b) p r.3 (MPa) W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 1.2 d eq (z sp ) (cm) f c (MHz) # A aprt X (cm) 0.44 # Y (cm) 0.4 # PD (μsec) PRF (Hz) 2597 p max (MPa) d max (cm) FL x (cm) 1.32 # FL y (cm) 2.5 # I max (W/cm 2 ) Color Color 2 Ven (a) <1 (b) # TIS TIB 130

142 18 HFL38x PW Doppler MI TIC A aprt 1 A aprt > (b) p r.3 (MPa) 2.37 W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) d eq (z sp ) (cm) 0.32 f c (MHz) # A aprt X (cm) # Y (cm) # PD (μsec) 1.29 PRF (Hz) 1008 p max (MPa) d max (cm) 0.21 FL x (cm) 3.72 # FL y (cm) 2.5 # I max (W/cm 2 ) TIS 1 Bre/SmP/ Msk/Nrv TIB Bre/SmP/ Msk/Nrv PRF (a) <1 (b) # 8 131

143 19 HFL50x MI TIC A aprt 1 A aprt >1 1.3 a (b) p r.3 (MPa) W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) [email protected] 1.2 d eq (z sp ) (cm) f c (MHz) 5.36 # # A aprt X (cm) # # Y (cm) # # PD (μsec) PRF (Hz) 2733 p max (MPa) 3.81 d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) MBe (a) <1 (b) # TIS TIB 132

144 20 HFL50x TIS M TIC A aprt 1 A aprt >1 1.2 a a (b) p r.3 (MPa) 3.14 W 0 (mw) # # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 1.4 # d eq (z sp ) (cm) # f c (MHz) 6.75 # # # A aprt X (cm) # # # Y (cm) # # # PD (μsec) PRF (Hz) 1600 p max (MPa) 4.35 d max (cm) # FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) Pen TIB (a) <1 (b) # 8 133

145 21 HFL50x CPD/Color TIC A aprt 1 A aprt >1 1.3 a (b) p r.3 (MPa) 3.05 W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 1.2 d eq (z sp ) (cm) f c (MHz) 5.36 # # A aprt X (cm) # # Y (cm) # # PD (μsec) PRF (Hz) 8233 p max (MPa) 3.81 d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) /3.3 4 PRF (a) <1 (b) # TIS TIB 134

146 22 HFL50x PW Doppler MI TIC A aprt 1 A aprt > (b) p r.3 (MPa) 2.69 W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) d eq (z sp ) (cm) 0.33 f c (MHz) # A aprt X (cm) # Y (cm) # PD (μsec) 1.29 PRF (Hz) 1008 p max (MPa) 3.23 d max (cm) 0.22 FL x (cm) 3.72 # FL y (cm) 2.44 # I max (W/cm 2 ) PRF TIS TIB (a) <1 (b) # 8 135

147 23 ICTx PW Doppler (a) <1 (b) # TIS A aprt 1 A aprt >1 TIB a a 1.2 a p r.3 (MPa) # W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # 1.6 d eq (z sp ) (cm) f c (MHz) # # 4.36 # A aprt X (cm) # 0.6 # Y (cm) # 0.5 # PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) # PRF 4 1 TIC 136

148 24 L25x TIS TIB TIC A aprt 1 A aprt >1 1.2 a (b) p r.3 (MPa) 2.87 W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 0.8 d eq (z sp ) (cm) f c (MHz) 6.11 # # A aprt X (cm) # # Y (cm) # # PD (μsec) PRF (Hz) 1061 p max (MPa) 3.39 d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) Nrv/Msk/ Ven/Vas MBe (a) <1 (b) # 8 137

149 25 L25x PW Doppler TIS TIB TIC A aprt 1 A aprt >1 a a 1.7 (b) p r.3 (MPa) # W 0 (mw) # 32.1 # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # 0.75 d eq (z sp ) (cm) 0.30 f c (MHz) # # 6.00 # A aprt X (cm) # 0.76 # Y (cm) # 0.30 # PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) 0.21 FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) # 1 Vas Ven Nrv 2 8 mm 3 PRF (a) <1 (b) # 138

150 26 L38x CPD/Color TIS TIB TIC A aprt 1 A aprt > (b) p r.3 (MPa) 2.89 W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 1.1 d eq (z sp ) (cm) f c (MHz) # A aprt X (cm) 0.54 # Y (cm) 0.4 # PD (μsec) PRF (Hz) 9547 p max (MPa) 3.48 d max (cm) FL x (cm) 1.5 # FL y (cm) 2.5 # I max (W/cm 2 ) Color CPD 2 Bre 3 PRF /3.1 /3.1 5 Def/Def/ Def (a) <1 (b) # 8 139

151 27 L38x PW Doppler TIS TIB TIC A aprt 1 A aprt > (b) p r.3 (MPa) W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) d eq (z sp ) (cm) f c (MHz) # A aprt X (cm) # Y (cm) # PD (μsec) 1.29 PRF (Hz) 1008 p max (MPa) d max (cm) FL x (cm) 5.54 # FL y (cm) 2.5 # I max (W/cm 2 ) Vas Vas PRF (a) <1 (b) # 140

152 28 L38xi/10-5 2D TIS TIB TIC A aprt 1 A aprt >1 1.5 a (b) p r.3 (MPa) 3.54 W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 1.0 d eq (z sp ) (cm) f c (MHz) 5.76 # # A aprt X (cm) # # Y (cm) # # PD (μsec) PRF (Hz) 7551 p max (MPa) 4.32 d max (cm) FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) / cm 4 MB / (a) <1 (b) # 8 141

153 29 L38xi/10-5 (a) <1 (b) # TIS M TIC A aprt 1 A aprt >1 1.5 a 1.2 (b) p r.3 (MPa) 3.54 W 0 (mw) # 37.1 # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) d eq (z sp ) (cm) 0.49 f c (MHz) 5.76 # 5.20 # A aprt X (cm) # 1.86 # Y (cm) # 0.40 # PD (μsec) PRF (Hz) 1600 p max (MPa) 4.32 d max (cm) 0.49 FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) Gen Pen TIB 142

154 30 L38xi/10-5 (CPD) TIC A aprt 1 A aprt > (b) p r.3 (MPa) 3.30 W 0 (mw) 47.5 # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 0.8 d eq (z sp ) (cm) f c (MHz) # A aprt X (cm) 0.66 # Y (cm) 0.40 # PD (μsec) PRF (Hz) 2885 p max (MPa) 3.79 d max (cm) FL x (cm) 1.86 # FL y (cm) 1.50 # I max (W/cm 2 ) CVD/CPD CVD 2 Bre cm TIS TIB (a) <1 (b) # 8 143

155 31 L38xi/10-5 PW Doppler TIS TIB TIC A aprt 1 A aprt > (b) p r.3 (MPa) 2.56 W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) d eq (z sp ) (cm) 0.49 f c (MHz) # A aprt X (cm) # Y (cm) # PD (μsec) 1.22 PRF (Hz) 1008 p max (MPa) 2.97 d max (cm) 0.45 FL x (cm) 5.54 # FL y (cm) 1.50 # I max (W/cm 2 ) Bre/Vas Bre/Vas Bre/Vas PRF (a) <1 (b) # 144

156 32 P10x TIS TIB TIC A aprt 1 A aprt >1 a a 1.1 p r.3 (MPa) # W 0 (mw) # 40.6 [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # d eq (z sp ) (cm) f c (MHz) # # 4.01 A aprt X (cm) # 0.99 Y (cm) # 0.7 PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) FL x (cm) # 5.16 FL y (cm) # 5.0 I max (W/cm 2 ) # 1 Abd 2 Pen MB (a) <1 (b) # 8 145

157 33 P10x Color TIS TIB TIC A aprt 1 A aprt >1 1.0 a 1.3 p r.3 (MPa) 2.02 W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 2.4 d eq (z sp ) (cm) f c (MHz) 3.90 # 3.91 A aprt X (cm) # Y (cm) # 0.7 PD (μsec) 0.70 PRF (Hz) 2772 p max (MPa) 2.80 d max (cm) FL x (cm) # 2.48 FL y (cm) # 5.0 I max (W/cm 2 ) Color Color 2 Neo Abd 3 4 / 3.7/ 772 (a) <1 (b) # / 2.0/

158 34 P10x PW Doppler TIS TIB TIC A aprt 1 A aprt > p r.3 (MPa) 2.03 W 0 (mw) [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) d eq (z sp ) (cm) f c (MHz) A aprt X (cm) Y (cm) PD (μsec) 1.28 PRF (Hz) 1563 p max (MPa) 2.70 d max (cm) 0.25 FL x (cm) FL y (cm) I max (W/cm 2 ) Crd Crd Crd Crd PRF/TDI 1563/ 5208/ 5208/ 15625/ (a) <1 (b) # 8 147

159 35 P10x CW Doppler TIS TIB TIC A aprt 1 A aprt >1 a a p r.3 (MPa) # W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # 0.7 d eq (z sp ) (cm) 0.36 f c (MHz) # # A aprt X (cm) # Y (cm) # PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) 0.27 FL x (cm) # 0.92 FL y (cm) # 5.0 I max (W/cm 2 ) # 1 Card (a) <1 (b) # Card

160 36 P21x 2D TIS TIB TIC A aprt 1 A aprt >1 1.5 a 2.3 p r.3 (MPa) 2.03 W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 3.4 d eq (z sp ) (cm) f c (MHz) 1.83 # 1.94 A aprt X (cm) # 1.9 Y (cm) # 1.3 PD (μsec) 1.03 PRF (Hz) 4444 p max (MPa) 2.53 d max (cm) FL x (cm) # FL y (cm) # 9.0 I max (W/cm 2 ) Card 4.7 Card Pen (a) <1 (b) # 8 149

161 37 P21x M TIS TIB TIC A aprt 1 A aprt >1 1.5 a p r.3 (MPa) 2.10 W 0 (mw) # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) d eq (z sp ) (cm) f c (MHz) 1.93 # A aprt X (cm) # Y (cm) # PD (μsec) PRF (Hz) 800 p max (MPa) d max (cm) FL x (cm) # FL y (cm) # 5.5 I max (W/cm 2 ) Abd Abd Abd /OB /OB 2 Gen/Res/ Pen (a) <1 (b) # Pen /13 32 cm 4 5 MB 150

162 38 P21x CPD/Color TIS TIB TIC A aprt 1 A aprt > p r.3 (MPa) 2.03 W 0 (mw) [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) 3.4 d eq (z sp ) (cm) f c (MHz) A aprt X (cm) Y (cm) PD (μsec) PRF (Hz) 2038 p max (MPa) 2.53 d max (cm) FL x (cm) FL y (cm) I max (W/cm 2 ) Color Color Color /CPD 2 Crd TCD TCD 3 / 2500/ / 4.7 / (a) <1 (b) # 8 151

163 39 P21x PW Doppler TIS TIB TIC A aprt 1 A aprt > p r.3 (MPa) 1.73 W 0 (mw) [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) 3.1 z bp (cm) 2.8 z sp (cm) d eq (z sp ) (cm) 0.52 f c (MHz) A aprt X (cm) Y (cm) PD (μsec) PRF (Hz) 1562 p max (MPa) 2.50 d max (cm) 0.52 FL x (cm) FL y (cm) I max (W/cm 2 ) Card Card Card Card PRF (a) <1 (b) # 152

164 40 P21x CW Doppler TIS TIB TIC A aprt 1 A aprt >1 a p r.3 (MPa) # W 0 (mw) [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) 1.20 z bp (cm) 1.31 z sp (cm) # 1.2 d eq (z sp ) (cm) 0.58 f c (MHz) # A aprt X (cm) Y (cm) PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) 0.56 FL x (cm) FL y (cm) I max (W/cm 2 ) # 1 Card Card Card (a) <1 (b) # 8 153

165 41 SLAx PW Doppler TIS TIB TIC A aprt 1 A aprt >1 a a 1.1 (b) p r.3 (MPa) # W 0 (mw) # 10.6 # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # 0.6 d eq (z sp ) (cm) 0.16 f c (MHz) # # 6.00 # A aprt X (cm) # 0.16 # Y (cm) # 0.30 # PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) 0.16 FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) # 1 Vas Nrv Ven 2 8 mm 3 PRF (a) <1. (b) # 154

166 42 TEEx PW Doppler TIS TIB TIC A aprt 1 A aprt >1 a a 1.7 (b) p r.3 (MPa) # W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # 0.6 d eq (z sp ) (cm) 0.34 f c (MHz) # # 3.84 # A aprt X (cm) # # Y (cm) # 0.9 # PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) 0.34 FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) # 1 Crd PRF (a) <1 (b) # 8 155

167 43 TEEx CW Doppler TIS TIB TIC A aprt 1 A aprt >1 a a 1.1 (b) p r.3 (MPa) # W 0 (mw) # # [W.3 (z 1 ),I TA.3 (z 1 )] (mw) z 1 (cm) z bp (cm) z sp (cm) # 1.1 d eq (z sp ) (cm) 0.39 f c (MHz) # # 4.00 # A aprt X (cm) # # Y (cm) # 0.9 # PD (μsec) # PRF (Hz) # p max (MPa) # d max (cm) 0.34 FL x (cm) # # FL y (cm) # # I max (W/cm 2 ) # 1 Crd (a) <1 (b) # 156

168 44 I SPTA.3 TI milliwatts/cm 2 TI MI I TIS TIB TIC MI W/cm 2 TIS TIS TIB A aprt P r.3 Wo W.3 (z 1 ) I SPTA.3 (z 1 ) cm 2 MI TIS z 1 z 1 /cm 2 z 1 [min(w.3 (z), I TA.3 (z) x 1 cm 2 )] z >zbp cm ( ) z bp 1.69 Aaprt cm z sp p r.3 z sp = z b.3 d eq (z) z ( 4 ( π) )(( Wo) ( ITA( z) )) I TA (z) z cm fc MHz A aprt PD (x) (y) MI 8 157

169 44 PRF p max d max MI Hz cm (x) (y) cm Output Display Standard % 95% Pr 1.9% +11.2% Pr.3 1.9% +12.2% Wo 3.4% +10% fc 0.1% +4.7% PII 3.2% % PII.3 3.2% % 158

170 Recommended Ultrasound Terminology, Second Edition1997 American Institute of Ultrasound in Medicine (AIUM) LCD MI/TI NTSC PAL SonoHD2 (SonoHD imaging technology) SonoMB SonoMBe (liquid crystal display) (MI) (TI) (National Television Standards Committee) PAL (Phase Alternating Line) NTSC variance (as low as reasonably achievable, ALARA) Color Doppler (skinline) (curved array transducer) (linear array transducer) (phased array) (in situ) C (60) mm C60x L (38) mm L38xi 159

171 (bone thermal index, TIB) (depth) (Tissue Doppler Imaging) (Tissue Harmonic Imaging) (soft tissue thermal index, TIS) (TI) (MI) (transducer) (cranial bone thermal index, TIC) TI 7 MI MI 7 160

172 +/ + ( + Caliper/ x Caliper Ratio) A A PG A2Cd A2Cs A4Cd A4Cs AAA AAo Abd abs AC ACA ACC ACoA ACS Adur AFI AI AI PHT A ( A Wave Peak Velocity) A ( A Wave Peak Pressure Gradient) 2 (Apical 4 Chamber diastolic) 2 (Apical 4 Chamber systolic) 4 (Apical 4 Chamber diastolic) 4 (Apical 4 Chamber systolic) (Ascending Aorta) (Abdomen) (Absolute value) (Abdominal Circumference) (Anterior Cerebral Artery) (Acceleration Index) (Anterior Communicating Artery) (Aortic Valve Cusp Separation) A (Amniotic Fluid Index) (Aortic Insufficiency) (Aortic Insufficiency Pressure Half Time) AL Ann D ANT F ANT N (Atlas Loop) (Annulus Diameter) (Anterior Far) (Anterior Near) 161

173 Ao AoD Apical APTD AT AUA AV AV Area AVA BA Bifur BP BPD BPM Bre BSA CCA CI CM CO CPD Crd CRL CW (Aorta) (Aortic Root Diameter) (Apical View) (Anteroposterior Trunk Diameter) (Acceleration (Deceleration) Time) (Average Ultrasound Age) AUA OB (Aortic Valve) (Aortic Valve Area) (Aortic Valve Area) (Basilar Artery) (Bifurcation) (Biparietal Diameter) (Beats per Minute) (Breast) (Common Carotid Artery) (Cardiac Index) (Cardiac Output) (Color Power Doppler) (Cardiac) (Crown Rump Length) (Continuous Wave Doppler) 162

174 CxLen D D Apical DCCA DECA DICA Dist dp:dt E E PG E:A E/e ECA (Cervix Length) (Diameter) (Distance Apical) (Distal Common Carotid Artery) (Distal External Carotid Artery) (Distal Internal Carotid Artery) (Distal) (Delta Pressure:Delta Time) E ( E Wave Peak Velocity) E ( E Wave Peak Pressure Gradient) E:A (E:A Ratio) E = E e (External Carotid Artery) ECICA (Electrocardiogram) (Extracranial Internal Carotid Artery) ECVA EDD EDD by AUA EDD by LMP EDV EF EF:SLOPE (Extracranial Vertebral Artery) (Estimated Date of Delivery) (Average Ultrasound Age) (Estimated Date of Delivery) (Last Menstrual Period) (Estimated Date of Delivery) (End Diastolic Velocity) (Ejection Fraction) E-F (E-F Slope) 163

175 EFW Endo Epi EPSS Estab.DD ET FH FHR FM FTA GA GA by LMP GA by LMPd Gate GS Gyn Brenner HL HR ICA (Estimated Fetal Weight) EFW EFW (Endocardial) (Epicardial) E ( E Point Septal Separation) (Established Due Date) LMPd (Elapsed Time) (Femoral Head) (Fetal Heart Rate) (Femur Length) (Foramen Magnum) SO (Fetal Trunk Area) (Gestational Age) (Gestational Age by Last Menstrual Period) (LMP) (Gestational Age by derived Last Menstrual Period) (Depth of Doppler Gate) (Gestational Sac) (Head Circumference) (Heart Rate) (Internal Carotid Artery) 164

176 IMT IVRT IVS IVSd IVSFT IVSs LA LA/Ao LAT F LAT N Lat V LMP LMP LMPd LV LV Area LV mass LV Volume LVd LVD LVDd LVDFS LVDs LVEDV (Intima Media Thickness) (Iso Volumic Relaxation Time) (Interventricular Septum) (Interventricular Septum Diastolic) (Interventricular Septum Fractional Thickening) (Interventricular Septum Systolic) (Left Atrium) (Left Atrium/Aorta Ratio) (Lateral Far) (Lateral Near) Lateral Ventricle (Last Menstrual Period) (Last Menstrual Period) (derived Last Menstrual Period) (Left Ventricular) (Left Ventricular Area) (Left Ventricular mass) (Left Ventricular Volume) (Left Ventricular diastolic) (Left Ventricular Dimension) (Left Ventricular Dimension Diastolic) (Left Ventricular Dimension Fractional Shortening) (Left Ventricular Dimension Systolic) (Left Ventricular End Diastolic Volume) 165

177 LVESV LVET LVO LVOT LVOT Area LVOT D LVOT VTI LVPW LVPWd LVPWFT LVPWs LVs MB MCA MCCA MECA MI MICA Mid MM MR PISA MR/VTI Msk MV (Left Ventricular End Systolic Volume) (Left Ventricular Ejection Time) (Left Ventricular Opacification) (Left Ventricular Outflow Tract) (Left Ventricular Outflow Tract Area) (Left Ventricular Outflow Tract Diameter) (Left Ventricular Outflow Tract Velocity Time Integral) (Left Ventricular Posterior Wall) (Left Ventricular Posterior Wall Diastolic) (Left Ventricular Posterior Wall Fractional Thickening) (Left Ventricular Posterior Wall Systolic) (Left Ventricular systolic) SonoMB (SonoMB technology) (Middle Cerebral Artery) (Mid Common Carotid Artery) (Mid External Carotid Artery) (Mechanical Index) (Mid Internal Carotid Artery) (Middle) M (Mitral Regurgitation Proximal Iso Velocity Surface Area) (Mitral Regurgitation/Velocity Time Integral) (Musculoskeletal) (Mitral Valve) 166

178 MV Area MV Regurgitant Fraction MV Regurgitant Volume MV/VTI MVA MV ERO MV PISA (Mitral Valve Area) (Mitral Valve Regurgitant Fraction) (Mitral Valve Regurgitant Volume) (Mitral Valve/Velocity Time Integral) (Mitral Valve Area) (Mitral Valve Effective Regurgitant Orifice) (Mitral Valve Proximal Iso Velocity Surface Area) MV Neo Nrv NST NTSC OA OB OFD Oph Orb PAL PCAp PCCA PCoA PECA PGmax PGmean (Mitral Valve Rate) (Neonatal) (Nerve) Non-stress test (National Television Standards Committee) (Ophthalmic Artery) (Obstetrical) (Occipital Frontal Diameter) Ophthalmic Orbital (Phase Alternating Line) (Posterior Cerebral Artery Peak) (Proximal Common Carotid Artery) (Posterior Communicating Artery) (Proximal External Carotid Artery) (Maximum Pressure Gradient) (Mean Pressure Gradient) 167

179 PGr PHT PI PICA PISA Plaq POST F POST N PRF Prox PSV PV (Pressure Gradient) (Pressure Half Time) (Pulsatility Index) (Proximal Internal Carotid Artery) (Proximal Isovelocity Surface Area) (Plaque) (Posterior Far) (Posterior Near) (Proximal) (Peak Systolic Velocity) (Pulmonic Valve) P. Vein Pulmonary Vein PW Qp/Qs RA RI RVD RVDd RVDs RVOT D RVOT VTI RVSP RVW RVWd (Pulsed Wave Doppler) (Pulmonary blood flow/systemic blood flow) (Right Atrial) (Resistive Index) (Right Ventricular Dimension) (Right Ventricular Dimension Diastolic) (Right Ventricular Dimension Systolic) (Right Ventricular Outflow Tract Diameter) (Right Ventricular Outflow Tract Velocity Time Integral) (Right Ventricular Systolic Pressure) (Right Ventricular Free Wall) (Right Ventricular Free Wall Diastolic) 168

180 RVWs S S/D SI Siphon SM SmP SO Sup SV TAM TAP TCD TDI THI TI TICA TO TRmax TT TTD TV TVA UA (Right Ventricular Free Wall Systolic) SonoHD (SonoMB technology) (Systolic/Diastolic Ratio) (Stroke Index) (Siphon) (Submandibular) (Small Parts) (Suboccipital) (Superficial) (Stroke Volume) (Time Average Mean) (Time Average Peak) OB (Tissue Doppler Imaging) (Tissue Harmonic Imaging) (Thermal Index) (Terminal Internal Carotid Artery) (Transorbital) (Tricuspid Regurgitation (peak velocity)) (Transtemporal) (Transverse Trunk Diameter) (Tricuspid Valve) Tricuspid Valve Area (Ultrasound Age) 169

181 Umb A VA VArty Vas Ven VF Vmax Vmean Vol VTI YS (Umbilical Artery) (Vertebral Artery) (Vertebral Artery) Vascular (Venous) (Volume Flow) (Peak Velocity) (Mean Velocity) Volume (Velocity Time Integral) (Yolk Sac) 170

182 +/x 43 A & B 13 ALARA 93 beeps 16 clips 24, 36 Color (Color) CPD (CPD) CW CW 26 DICOM 17 D-line 26 Doppler Duplex 19 DVD 17 Dynamic Range 20 EMED 68 errors Event log 15 gain gestational age images and clips 38 USB IMT (IMT) LCD LVO 23 M 24 MBe SonoMBe M-line M 24 MPPS 17 MSK 68 NTSC 159 OB , orientation 23 7 PAL 159 PC 17 PRF 25, 27 Probe PW PW 26 PW 26 SAVE 20 Scanhead SonoHD 159 SonoMB 24, 159 SonoMBe 24, 29, 159 USB 38 variance

183 (MV/AV) (IMT) 18, (AAo) 53 Color (CI) (HR) 43, 56, 62 (SV) 56 24, 39 (CO) 56, AAo 53 Ao 53 AVA 55 CI 56 CO 56, 57 dp:dt 55 HR 56 IVRT 51 LA 53 LV 53 LVd 52 LVOT D 53 LVs 52 MV/AV 53 PHT 54 PISA 50 RVSP 54 SV 56 TDI , (Ao) 53 (AVA) 55 (ACC) , 159 (RVSP) (LA) 53 (LVOT D) 53 LV 53 (LVs) 52 (LVd)

184 (transducer) , vii 26, vii vii (PISA) 50 (RI) vii (FHR) (VTI) ECG (Gyn) , (CPD) 25 (Color) OB

185 34, 37 7, Doppler 27 M ECG 85 LCD (depth) IMT 58 OB , (Gyn) (TDI) 27, , /x Ratio +/x 43 Acceleration 43 Doppler 43 Elapsed Time 43 errors 70 M 42 Pressure Gradient 43 Resistive Index 43 Velocities , 62 42, D 42 M 42 41,

186 (IVRT) , M (ET) 43, (EFW) 75 (EDD) , 17 (TI) 20, 114, , (MI) 114, ,

187 (PHT) 54 (dp:dt) (in situ) vii 5, ECG 85 2 CPD 25 Doppler 27 (transducer)

188 P *P *