Musculoskeletal (MSK) Ultrasound

Orthopedics, Sports Medicine and Podiatry

Market Reference Guide

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Musculoskeletal (MSK) Ultrasound
Orthopedics, Sports Medicine and Podiatry

Table of Contents

General
Clinical Sales Demonstration Terminology
Information

MSK as a 4 Clinical Uses 6 Who is Buying? 10 Preparing for the 19 MSK Market 23
Specialty Demonstration Terminology

Why MSK 4 MSK Images 7 Why Are They 11 Performing the 20

Ultrasound? Buying? Demonstration

Additional 5 Key Needs and 11 Demonstrating 21

Resources Concerns Key Features

Competition 5 Key Buying 12

Criteria
Price
Workflow
Transducer Types
Image Quality
Advanced
Technology
Reliability
Measurement and
Reporting

Sales Qualifying 15
Questions

Typical System 16
Configurations

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 General Information Clinical
General Information
MSK as a Specialty
◾◾ Musculoskeletal (MSK) is an imaging specialty that
evaluates muscles, tendons, ligaments and joints,
nerves and soft tissues.
◾◾ MSK is a broad definition and involves many different
specialists.
-- Specialties include: Radiology, Sports Medicine,
Orthopedics, Physiatrists, Physical Therapy,
Rheumatology, Podiatry, Chiropractic, and Pain
Management
◾◾ This document will focus on Orthopedic, Sports
Medicine and Podiatry specialties.
◾◾ Review Musculoskeletal Market Terminology for
additional terms.
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Sales Demonstration Terminology
General Information
Why MSK Ultrasound?
In many parts of the world, evaluation of MSK anatomy
for evaluation of pathology has primarily been performed
using MRI, CT and X-ray. In recent years, Ultrasound
imaging has become one of the fastest growing
modalities. This is primarily due to physician training and
products suited in the price point that meets the clinical
needs. As healthcare providers look at more cost-effective
ways to treat and diagnosis their patients, ultrasound
offers many benefits.
Benefits include:
◾◾ Safe and non-invasive (no radiation)
◾◾ Cost-effective
◾◾ Patients with surgical hardware or pacemakers can
be imaged
◾◾ Real-time evaluation of movement with bilateral
comparisons
◾◾ The probe can be placed at the point of pain
◾◾ Doppler can provide blood flow information
◾◾ Field of view is very flexible
◾◾ Can be done in the physician office or the patient
bedside in hospital settings
Training is critical for these physicians as many do
their own scanning and many are new to ultrasound.
Medical schools are increasing their ultrasound training
throughout all specialties, but many will look for
guidance on how to get training to use in their practice.
In some larger practices, sonographers are becoming
more prevalent but require specific training in MSK
that is not typically part of routine training programs.
There are many sites for training through independent
programs and local societies. The American Registry
of Diagnostic Sonographers (ARDMS) and the Australian
Sonographers Accreditation Registry (ASAR) are examples
of the organizations offering a certification for MSK
ultrasound for sonographers.
 General Information Clinical
General Information
Additional Resources
There are well-established musculoskeletal, sports
medicine, orthopedic and podiatry societies throughout
the world that provide links to annual meetings,
conferences and training courses.
In some areas, dedicated training programs are well-
established. It is important to understand your local
opportunities and what is available. Many offer companies
the opportunity to participate in hands-on workshops.
These can be one of the best resources for sales leads.
Additional clinical information is available on
Sonoworld (www.sonoworld.com) or Aunt Minnie
(www.auntminnie.com).
Sales Demonstration Terminology
General Information
Competition
There are many competitors for this market and they vary
significantly regionally.
The major competitors for the M3 segment are General
Electric, Sonosite, Mindray, Esaote (Biosound), Terason,
Samsung Medison and Analogic (B&K and Ultrasonix).
Competitive products vary based on pricing and
portability.
For the M1 segment, Philips, General Electric, Toshiba,
and Supersonic Imaging may be more prevalent.
Siemens products are very competitive in this market
as they offer all the technology, features, image quality
and price that these physicians require in a system.
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 General Information Clinical Sales Demonstration Terminology

Clinical

What Are the Clinical

Uses for Ultrasound?

A patient referred for an MSK ultrasound usually presents
with pain or restriction of movement in a specific area,
a recent injury, or follow-up from a previous exam or
surgery.
Primary uses for ultrasound in these specialties include:
◾◾ Imaging the tendons, ligaments and nerves as well as
the joint space in the hands, wrists, elbows, knees,
feet, ankle, shoulder and hips.
◾◾ Pre- and post-operative evaluation of the patient for
injury diagnosis
◾◾ Evaluation of hip dysplasia and hip displacement in
neonates
◾◾ Peripheral nerve entrapment or ultrasound-guided
injections for spinal nerve root impingement
◾◾ Injury to, or pathology of, ligaments and other tendons
◾◾ Joint and soft-tissue injections
◾◾ Evaluation of inflammation, ganglions and foreign
bodies
◾◾ Needle guidance injections and aspirations
◾◾ Evaluation of Baker’s cysts, lipomas, lymph nodes, and
abscesses

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Clinical

MSK Images

ACUSON Freestyle ultrasound system ACUSON P300 ultrasound system

Deltoid
muscle
Biceps
tendon

Bicipital groove

Biceps tendon sheath with the L8-3 transducer ACUSON P300 system elbow to wrist imaging
with VPAN panoramic Imaging

ACUSON Freestyle ultrasound system ACUSON P300 ultrasound system

Anterior joint capsule

Femoral head

Femoral neck

Anterior/longitudinal view of the hip with the Medial collateral ligament of the knee with fluid
C5-2 transducer

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 General Information Clinical Sales Demonstration Terminology

Clinical

MSK Images

ACUSON P300 ultrasound system ACUSON X300 ultrasound system

MSK imaging of the shoulder with the IOE323 Longitudinal view of the Median Nerve with
intra-operative transducer Dynamic TCE technology

ACUSON X700 ultrasound system ACUSON X700 ultrasound system

Patellar tendon with the VF12-4 transducer Suprapatellar fossa effusion with the VF12-4
demonstrating advanced imaging technologies transducer

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General Information Clinical Sales Demonstration Terminology

ACUSON S2000 ultrasound system, ACUSON S2000 ultrasound system,

HELX Evolution HELX Evolution

Supraspinatus tendon of the shoulder with the Biceps tendon with the 18L6 HD transducer
18L6 HD transducer

ACUSON S2000 ultrasound system, ACUSON S2000 ultrasound system,

HELX Evolution HELX Evolution

Suprapatellar synovitis with the 18L6 HD Achilles tendon with the 18L6 HD transducer
transducer

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 General Information Clinical Sales Demonstration Terminology

Sales

Who Is Buying Ultrasound

for MSK Imaging?

Many of these physicians are purchasing for their private Podiatrists

office or clinic. In hospitals, MSK ultrasound imaging is
also done in Radiology usually with their premium system.
Physician fellowships in MSK Radiology are now offered
and these customers expect the highest performance in
image quality.
Many different departments may use ultrasound for
guidance in procedures.
Orthopedic Surgeons
These physicians may purchase a system for evaluating:
Podiatrists typically purchase systems for ultrasound
imaging of the foot and ankle, detecting tendon and
ligament pathology, foreign bodies and soft tissue lesions.
Some of the most common indications for ultrasound
include:
◾◾ Assessment of the Achilles tendon
◾◾ Evaluation of plantar fascia
◾◾ Evaluations of cysts and muscle injury
◾◾ Ultrasound-guided injections

◾◾ Real-time assessment of joint and tendon movements Sports Medicine

and stability
These physicians evaluate and treat sports-related injuries.
◾◾ Detection of fracture union and reunion
They are typically looking at ligaments, tendons and
◾◾ Structural abnormalities nerves but also evaluating the surface area of the bone.
◾◾ Infection
The real-time assessment of movement and stress can
◾◾ Injury to the ligaments provide an insight into an athlete’s extent and severity
◾◾ Nerve compression and mechanical impingement of injury.
between orthopedic hardware and soft tissue structures
Common applications include:
◾◾ Evaluate fluid collection
◾◾ Evaluation of sprains
◾◾ Guiding therapeutic interventions
◾◾ Nerve entrapments
◾◾ Evaluation of tears, motion limitation and scar tissue
◾◾ Guiding fluid aspirations and injections

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 General Information Clinical Sales Demonstration Terminology

Sales Sales

Why Are They Key Needs and

Buying? Concerns

Opportunities include: ◾◾ Although these physicians use MRI and CT regularly,

when purchasing ultrasound for their private offices
◾◾ No ultrasound currently in the office or practice
they may request a cost-effective system in the
◾◾ Replacement of older units or units needing service low- to mid-M3 market.
◾◾ Need to increase technology and performance
◾◾ There are some areas of the world where only a
The MSK ultrasound market is predicted to drive the premium M1 system is used for MSK ultrasound.
strongest market demand with €99 million in 2014 to Qualification is critical here. In large practices or in
€127 million in 2017. (Inmedica data 2013). This data hospital settings – especially where sonographers
covers all areas of MSK ultrasound, so the opportunity are performing the studies – they typically request
is excellent. an M1 premium system.
Physicians who do not currently have an ultrasound ◾◾ Portability can be the common driver as users
solution may have attended a recent conference or frequently move from room to room or manage many
training and received information from the various different facilities.
vendors. Colleague referrals can influence the sale
◾◾ In the last few years, the offerings of portable
significantly as they tend to be a close network of
and tablet models systems has increased, making
physicians.
ultrasound easier to obtain and use.
Many physicians may have initially purchased a system
◾◾ Many of the systems offer higher frequency transducers
to use as a guidance tool for injections or aspirations,
with advanced imaging technology at a value price.
but as training has developed and the need for less costly
alternatives to CT/MRI, the uses of ultrasound have ◾◾ Customers with clinical imaging expectations in the
expanded, increasing the need for more capabilities. premium M1 segment typically purchase a cart-based
system similar to those used in Radiology.
If they have an older system, make sure the system you
are positioning it with is better. Initially, they may have
purchased a used premium system or have been provided
with a system from another department. Although not
new, it may outperform a new M3 system. If you are not
familiar with older brands or models, ask your colleagues,
so the right system can be positioned.
Today, many are advancing to the next level of
performance using color Doppler and advanced imaging
technologies. Many new physicians who enter the market
have had exposure to ultrasound during their training.

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 General Information Clinical
Sales
Key Buying
Criteria
Price
The growth in this market has been driven by the
availability of portable, high performance systems and
training courses that addresses the needs of these
physicians.
If premium image quality is the driver and the expectation
for an M1 system, they expect to pay more, but will still
have high expectations for a value price.
For many orthopedic surgeons and sports medicine
physicians, a mid-M3 product is the product of choice as
long as it meets their clinical requirements and price.
Podiatrists typically buy low M3 to M4 systems and price
is the primary driver.
It is important to understand what the customer plans
to use the system for, their experience level and who the
competition is to choose the right product.
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Sales Demonstration Terminology
Workflow
While these physicians are experts in identifying anatomy
and the workings of joints, identifying the different
pathologies with ultrasound and obtaining the images
can be challenging and requires specialized training.
The real-time assessment provides assistance in
optimizing the imaging and understanding the anatomy.
For less experienced physicians, workflow is extremely
important. Setting up the system for their application
will be critical to success.
Customers purchasing a premium M1 system will benefit
from the full screen imaging offered on the ACUSON S
Family™ of products,with the HELX™ Evolution release.
For customers who primarily perform procedures, they
will expect the system to visualize the patient’s anatomy
with little or no manipulation of the controls.
Customers with more experience or who utilize
sonographers will optimize and utilize the controls.
The expectations will be high for image quality,
advanced technologies and ease of use.
 General Information Clinical Sales Demonstration Terminology

Transducer Types ◾◾ If the primary application is shoulders or hips, a lower

frequency may be needed. This is especially true in
◾◾ For most superficial MSK applications (i.e. wrist, hand,
Sports Medicine where many of the patients are
ankle, foot, elbow), a high frequency linear transducer
athletes.
(typical 12–18 MHz) will be needed to visualize the
subtle tissue differences and identify the tiny structures. ◾◾ For hips and spine, a curved transducer (2–5 MHz) is
needed or a lower frequency linear transducer.
◾◾ The ACUSON Freestyle system offers wireless
transducers for greater flexibility in the MSK exam and ◾◾ It is important to mention, the transducer frequency
for use in guided procedures. number or label does not always reflect the actual
image quality and detail resolution.
◾◾ The customer may request a hockey stick-type
transducer. Hockey-stick transducers, so called because -- Performance is driven by a combination of the
of their shape, are a type of linear array transducer that architecture of the system and technologies, along
have a small footprint (typically 25–30 mm) with a with the transducer.
small field-of-view. They are especially useful when -- Remember, the higher the frequency, the less
evaluating small, superficial structures at sites in which penetration.
the skin surface does not allow adequate contact with
larger transducers (i.e., soft tissues adjacent to bony ◾◾ Many of these patients may have fluid or swelling
prominences). That makes them ideal for imaging the which can make the exam more challenging.
ankle, foot, hand and elbow.
-- The 14L5sp transducer is available on the ACUSON S
Family™ of ultrasound systems.
-- The VF13-5sp transducer Is available on the ACUSON
X300™ ultrasound system, premium edition (PE)
-- The ACUSON P300™ ultrasound system has an
intra-operative transducer (IOE323) but it may not
provide the near field resolution for some superficial
anatomy as its primary design was for intra-operative
applications. It is important to demonstrate the probe
to ensure it will meet the needs of the customer prior
to selling it.
-- The ACUSON Freestyle™ ultrasound system has the
L13-5 transducer with a 25 mm footprint that can
be used as an alternative to the hockey stick-type
transducer. (For more details, please refer the
ACUSON Freestyle Demo to Win Guide – Objections
and Counters located on the Sales Intranet or
Healthcare Partner Portal.)
-- There is not a hockey stick-type transducer available
for the ACUSON X700™ ultrasound system.

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 General Information Clinical Sales Demonstration Terminology

Sales

Key Buying
Criteria

Image Quality Advanced Technology

Image quality expectation varies in this market depending Many of the systems purchased today have speckle
on the application. reduction or compounding as standard. These
technologies are very useful for MSK imaging and
In the mid- to high end market where evaluation of
provide the contrast and detail resolution to see subtle
ligaments, tendons and nerves is key, advanced
changes and identifying tiny structures.
technologies such as speckle reduction and compounding
is expected to provide the contrast and detail needed to Strain Elastography technology for MSK imaging is an
differentiate subtle changes. emerging technology and many clinical studies and
papers are being introduced.
For podiatry and customers focused on procedure
guidance, advanced technologies are less expected. Siemens offers a full suite of strain technologies, both
The ACUSON Freestyle and ACUSON P300 systems offer qualitative and quantitative, with the Virtual Touch™
these technologies as standard – this can provide a key technologies on the ACUSON S Family of products.
differentiator with some of the competitive systems.
The ACUSON Freestyle system offers wireless, cable-free
Needle visualization is critical for customers doing transducers for MSK ultrasound.
procedures.
The multi-modality review option provides a comparison
◾◾ Make sure you are prepared to demonstrate or show with MR/CT images side-by-side with the ultrasound
images. image and can be a key selling feature. This capability is
available on the ACUSON S Family systems.
◾◾ Although needle guides are available, the typical
approach is freehand.
◾◾ Some may ask about specialized needles or needle
tracking software.
-- Siemens products currently do not have this type of
software. In many cases it is an option on competitor
systems.
◾◾ Needle enhancement software can help visualize the
needle when just the edge of the needle is in-plane or
when used by the novice user. It does not benefit the
out-of-plane technique.
◾◾ When applying proper technique, the needle is usually
visualized without these enhancements.

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 General Information Clinical Sales Demonstration Terminology

Sales

Sales Qualifying
Questions

Reliability The purpose of the sales qualification is to understand

your customer and determine if Siemens products can
Physicians want to ensure that the system has excellent
address their needs and pain points.
proven reliability as they cannot afford downtime. A
Siemens product service plan is a good recommendation
Q Are you currently using Ultrasound for MSK imaging?
in this environment. To ensure uninterrupted coverage
when the product warranty expires, the service plan If so, what system are you currently using and how
should be included with the product offer at the initial are you utilizing it?
Point of Sale (POS). The product warranty and service
If not, is training an important factor?
plans leverage the use of Siemens Remote Service (SRS)
capability.
Q Do you plan to add new applications with this
SRS is a real-time remote service that connects the purchase?
customer’s ultrasound system with Siemens’ global team
of technical experts. Delivered through a secure, high- Q How many ultrasound guidance procedures do you
speed network, SRS is designed to save valuable clinical perform each week?
time and improve productivity and workflow. When
coupled with a Siemens service plan, SRS provides the Q Will this system support more than one facility?
highest level of system availability, so more patients can
be served without interruption. Q Who does the scanning today for your facility?

SRS is not available on the ACUSON Freestyle and Q Is reporting important for your facility?
ACUSON P300 systems.
Q How important is having the latest innovation of
Measurement and Reporting technology within your facility?
Primary generic measurements are used in this clinical
environment.
The Siemens’ systems do not have dedicated
measurement packages for MSK ultrasound except for
pediatric hip angle.
With the ACUSON P300 system, generic measurements
can be labeled and added to the report as the exam is
in progress. This is a nice feature to demonstrate if
reporting is key.
Adding images to a report with comments may also be
a nice feature to demonstrate.

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 General Information Clinical Sales Demonstration Terminology

Sales

Typical System Configurations

It is important to understand that all of our General Imaging systems can support MSK imaging.
The systems below are the typical systems purchased.

ACUSON Freestyle ACUSON P300 ACUSON X300 PE ACUSON X700 ACUSON S Family,
system system system system HELX Evolution
Primary customer is Best value for Best value for Best value for Best value for
buying for procedure customers who need customers who need customers who need customers who need
guidance a fully-featured, a cart-based system a cart-based system a high performance
portable system with the next level with a higher level imaging system
with advanced of performance in of performance in and may also need
technologies at a image quality image quality and elastography or
value price technology sheer wave imaging
Mobile, small Mobile, small Lightweight, Ergonomic system Innovative system
footprint system, footprint system, compact system design with 20” LED design with 21.5“ HD
easy to transport easy to transport design with 18” LED display monitor with LCD Display monitor
between clinical between clinical display monitor and articulating arm with articulating arm
sites with a 15” LED sites with a 15” articulating arm
LCD display monitor XVGA display
monitor
Wireless high High frequency High frequency High frequency High frequency
frequency trans­ transducer LA435 transducer VF13-5 transducer VF12-4 transducer 18L6 HD
ducer L13-5 (up to 18 MHz) (up to 13 MHz) with wide footprint transducer and
(up to 13 MHz) (9L4 transducer for
Virtual Touch™
Imaging)

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ACUSON Freestyle ACUSON P300 ACUSON X300 PE ACUSON X700 ACUSON S Family,
system system system system HELX Evolution
Typical Typical Typical Typical Typical
Configuration Configuration Configuration Configuration Configuration
Spatial Tissue Enhancement Tissue Harmonic Tissue Harmonic General Imaging
Compounding* Imaging (TEI)* Imaging (THI)* Imaging (THI)* Technologies
(includes Advanced
Speckle Filter* Speckle reduction Dynamic TCE™ Dynamic TCE
SieClear compound-
(M-View)* tissue contrast technology*
Pixelformer™ image ing, Dynamic TCE
enhancement
processing Spatial compounding Advanced technology,
technology (DTCE)
architecture* (XView)* SieClear™ spatial TEQ™ ultrasound
Footswitch compounding* technology,
Battery* (2 with Auto Optimization
Clarify™ vascular
system) for 2D and Doppler* VF13-5 transducer TGO™ tissue gray­
enhancement (VE)
(superficial) scale optimization
Roll Stand Customized technology,
technology*
measurement and and/or SieScape and
Keyboard
reporting* DICOM* Color SieScape™
VF10-5 transducer
L8-3 transducer panoramic imaging)
VPAN Panoramic (general) Footswitch
(general)
Imaging* DICOM*
(includes a battery) VF12-4 transducer
Footswitch Native Tissue
and/or
Harmonic Imaging
Battery
L13-5 transducer (THI)*
(superficial) Integrated Cart
Footswitch
(includes a battery)
LA435 transducer
18L6 HD transducer
(6–18 MHz)
(superficial)
(superficial)
and/or
and/or
14L5 transducer
LA523 transducer
(general)
(5–12 MHz)
(general)

* Standard on system

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 General Information Clinical Sales Demonstration Terminology

Sales

Typical System Configurations

ACUSON Freestyle ACUSON P300 ACUSON X300 PE ACUSON X700 ACUSON S Family,
system system system system HELX Evolution
Other options Other options Other options Other options Other options
C5-2 transducer LA522E transducer VF8-3 transducer 6C2 transducer 9L4 transducer for
(Hips, Spine) (3–12 MHz) (may (3–10 MHz) (hips/spine) VTIQ
(includes a battery) substitute for LA523 (large shoulders)
VF10-5 transducer 6C1 HD transducer
if they do a lot of
B/W printer CH5-2 transducer or 6C2 transducer
large extremities SieScape™
(hips, spine) (hips/spine)
panoramic imaging
IOE323 intra-
VF13-5sp 14L5sp transducer
operative transducer B/W printer
(5–12 MHz) DICOM Multi-modality
review (standard on
DICOM SieScape™
ACUSON S3000™
panoramic imaging
B/W printer ultrasound system)
TGO™ tissue gray­
Virtual Touch™ IQ
scale optimization
(not available on
technology
the ACUSON S1000
SieClear™ multi-view system)
spatial compounding
Virtual Touch™
B/W printer imaging
“General Imaging
Basics” package can
be substituted for
“General Imaging
Technologies”
package depending
on customer need
B/W printer

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 General Information Clinical
Demonstration
Preparing for Clinical
Demonstration
Terminology
Review the Musculoskeletal Market Terminology to be
prepared to address customers’ questions and understand
what they are asking.
Exams
◾◾ Ask the customer to have a few different exams to scan
to ensure that various types of patients and pathology
can be visualized.
◾◾ When setting up the system, set up specific preset for
the different exams.
-- Set up a “penetration” and “general” preset and for
nerves a “detail” setting.
-- For procedures, make sure the depth, focus, and
color Doppler is set so the user does not have to
manipulate the controls.
-- The ACUSON Freestyle system has automated focus
and frequency – therefore depth, gain and color
Doppler are the primary aspects to emphasize.
-- Turn off all other presets in the set-up menu.
-- Be sure to customize the text for their protocol or
create a basic text (medial, lateral, Rt. Lt., anterior,
posterior, tendon, cyst, nerve), as well as different
segments of the specific target (example: different
tendons of the shoulder).
They may not take the time to label, but preparing
the labels shows you understand their market and
what they need.
Sales Demonstration Terminology
Measurements & Reporting
◾◾ Most of the measurements will be standard distance
measurements.
◾◾ For ACUSON S Family systems, setting up specific
protocols can assist with workflow as they move from
one tendon to the next.
◾◾ Using the ACUSON P300 system, generic measurements
can be set-up for easy identification.
-- Customize recommendations and/or comments if
reporting is key.
-- Input site logo for Physician Summary Report using
a USB thumb drive.
-- Prepare a printed example of the report or have a
PDF available to show the physician.
System
◾◾ Remove old patient studies from the patient browser
and load MSK marketing images into the patient
browser.
◾◾ Input the site name.
◾◾ Since many of these physicians use both hands to
perform injection procedures or scan while
manipulating the extremity, having the footswitch
available can aid in the demo.
-- Set one side for clip capture to capture the injection
procedure or real-time movement.
-- Increasing the clip length to 4–5 seconds will provide
more information for review
-- With a longer clip, additional images can be stored
to showcase after the patient has left.
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Demonstration

Performing the Demonstration

When demonstrating value priced systems, many times Siemens develops advanced technologies and typically
the systems are comparable in features and image quality, releases them on premium performance systems
so it is important to make sure what you say addresses (ACUSON S Family systems).
their needs and how Siemens solves them. Physicians
Our philosophy of technology migration allows migration
are very busy and may give you little time to demonstrate
of these technologies across to our other platforms,
the overall system.
providing additional value to our customer.
During the sales process, it is important to differentiate
Remember to stress the three key customer benefits in
yourself from your competitors.
Clinical, Operational and Financial.
Emphasize the value Siemens brings as an innovative
company and why we are the Ultrasound Pioneers.

Key Benefits

Clinical Benefits Operational Benefits Financial Benefits

◾◾ Excellent image quality to
differentiate subtle tissue
textures in the tendon,
nerves and ligaments
◾◾ Advanced technology
available
◾◾ Doppler sensitivity
to demonstrate
microvasculature and
inflammatory arthropathies
◾◾ Clear needle visualization
for procedures
◾◾ Siemens Remote Service
provides continuous access
to Siemens‘s product
experts during warranty
term and with service plans
◾◾ Easy to use from exam start
to reporting
◾◾ Automation and customized
presets reduce image
optimization
◾◾ Lightweight transducers
to reduce stress and
strain (including ACUSON
Freestyle system cable-free
transducers)
◾◾ Minimal workflow
interruptions with Siemens
Remote Service
◾◾ Meets clinical needs with
scalable products for
different customer needs
◾◾ Reliability and local
serviceability to maintain
workflow
◾◾ Siemens Remote Service
(SRS) included in product
warranty and service plans
(not available on the
ACUSON Freestyle or
ACUSON P300 systems)

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 General Information Clinical
Demonstration
Demonstrate Key Features
It is important for the physician to believe the system
was designed just for their practice. Be familiar with terms
for MSK ultrasound, and focus on their clinical needs.
Pick three specific things to focus on and continue to
point these out throughout the demo.
Siemens transducers are lightweight, ergonomic
designed with SuppleFlex™ transducer cables:
This provides for less stress and strain while doing the
exams. This is a great selling feature when they are
doing a large workload of different exam types.
Workflow is simplified:
User interface ease of use provides reduced button
presses needed to complete an exam:
◾◾ One touch image auto optimization
◾◾ Excellent color Doppler sensitivity for low flow volume
◾◾ Trapezoid imaging for extended field of view in the
near field
◾◾ 2D beam steer for improved needle visualization
◾◾ Panoramic imaging for extended field of view
Sales Demonstration Terminology
With simplified workflow, the physician or sonographer
can focus on the patient and not the controls. When
demonstrating the control panel, focus on just the major
controls – Start exam, Freeze, Store, Depth, Color and
Measure. Additional controls can be reviewed as needed.
Throughout the exam, take images/clips using the
footswitch to showcase with the physician. This is
especially useful in shoulders where the physician may
stand behind the patient and scan to evaluate motion
with the monitor in front of the patient. Many of these
physicians are not used to taking a lot of images as
they are focused on the anatomy and diagnosis.
The Dual feature can allow the user to scan one side and
then compare to the other side easily.
If cart-based, focus on the large monitor, image size and
an articulating arm that allows for excellent viewing angle
for ease in real-time assessment and injection procedures.
If demonstrating the ACUSON P300 system, make sure
the physician is in front of the system and you can
see all the gray bars on the display monitor for best
representation of the image.
When demonstrating the ACUSON Freestyle system, tilt
the monitor for best viewing angle. The top of the screen
should be at or just below eye level.
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 General Information Clinical Sales Demonstration Terminology

Demonstration

Demonstrate Key Features

Excellent image quality with advanced imaging Customizable imaging presets to address the easy to
technology for consistent, reproducible results: the most technically difficult exam:
◾◾ Spatial compounding and speckle reduction technology Customizable imaging presets to address imaging from
is standard or part of the typical configuration for the superficial detailed anatomy to the most technically
the primary products (listed on the Typical System difficult exam like a large shoulder.
Configurations chart) sold into this environment.
Point out all the imaging parameters this sets from depth,
◾◾ This provides the contrast and detail resolution needed focus, image aesthetics and frequency. Show the value
to distinguish the subtle changes and fine tissue texture of presets.
in tendons, nerves and ligaments.
Excellent needle visualization:
◾◾ Excellent sensitivity to demonstrate low flow volume
with Color and Power Doppler. ◾◾ This can be easily be demonstrated with a phantom on
a previously stored clip.
◾◾ MultiHertz™ multiple frequency imaging, migrated from
the ACUSON S Family systems, demonstrates how easy ◾◾ 2D beam steer can aid in needle visualization, but in
it is to improve the penetration on larger shoulders and some cases does not work with advanced imaging
legs with just a touch of a button on the ACUSON X700 (compounding), so use discretion.
and ACUSON X300 PE systems.
-- The ACUSON P300 system has multi-frequency
imaging
-- The ACUSON Freestyle system has standard
Pixelformer™ image processing architecture
technology and automates frequency with depth
adjustments
◾◾ It can be challenging to point out specific anatomy even
for the clinical specialist as many may not have the
clinical expertise in this specialty.
◾◾ Physicians can be great teachers and will typically point
out what they are looking at but a basic understanding
of the anatomy is important.
◾◾ There are many references available to provide basic
MSK ultrasound understanding.
◾◾ The presentation on procedural MSK for Ultrasound
using ACUSON Freestyle system (available on the
Intranet/Healthcare Partner Portal) is an excellent
resource for Sales and Clinical Specialists, especially
to demonstrate basic anatomy and scanning views.

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 General Information Clinical Sales Demonstration Terminology

Terminology

MSK Ultrasound Common Terminology

Sources http://www.aium.org/resources/guidelines/musculoskeletal.pdf
http://www.amssm.org/Content/pdf%20files/MSKUltrasoundTool.pdf
http://www.musclejointmed.com/pinzon10_PPM_June09.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302037/
http://medical-dictionary.thefreedictionary.com/tenosynovitis
http://www.essr.org/html/img/pool/knee.pdf
http://www.ultrasoundpaedia.com/normal-ankle/
http://my.clevelandclinic.org/neurological_institute/neuromuscular-center/diagnostics
Anatomy
Articular cartilage Flexible connective tissue found in joints between bones; not as hard and rigid as bone
but stiffer and less flexible than muscle; does not contain blood vessels.
Bursae Bursae are small fluid-filled sacs that act as a cushion between a bone and other moving
parts such as muscles, tendons or skin.
Dorsal The back of the hand and upper surface of the foot are both described as the dorsal
surface.
Ligaments A band of fibrous connective tissue that connects bones to other bones to form a joint;
ligaments stabilize joints.
Palmar or Volar Referring to the palm of the hand.
Peripheral nerves Any nerve outside the central nervous system. The median nerve is a common peripheral
nerve visualized in the wrist that, when viewed in a transverse plane, has a classic
“honeycomb” appearance on ultrasound.
Plantar The plantar surface of the foot is commonly referred to as the sole of the foot.
Retinaculum It is not part of any muscle; rather it is a band around tendons that holds them in place.
Its function is mostly to stabilize a tendon.
Sesamoid bones A bone embedded within a tendon typically located in the hands and feet. The patella
(knee cap) is a large sesamoid bone within the quadriceps tendon. They modify pressure,
diminish friction and can change the direction of a muscle pull.
Tendons A tough band of fibrous connective tissue that usually connects muscle to bone – an
extension of the muscle that surrounds a joint and provides structural stability and
assistance in movement.

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 General Information Clinical Sales Demonstration Terminology

Terminology

MSK Ultrasound Common Terminology

Pathology
Baker’s cyst Baker's cyst, also known as a popliteal cyst, is a benign swelling of the semi-membranous
bursa (or more rarely some other synovial bursa) found behind the knee joint.
Bursitis Inflammation of the bursae commonly caused by repetitive movement and excessive
pressure of the joint, trauma or injury.
Carpal tunnel Carpal tunnel syndrome is a disorder caused by compression at the wrist of the median
syndrome nerve supplying the hand, causing numbness and tingling.
Cyst Anechoic, fluid-filled structures; showing posterior enhancement. May be simple or
complex.
Plantar fascitis Inflammation of the fascia. Associated with plantar fasciitis.
Shoulder impingement Occurs when tendons of the rotator cuff muscles become irritated and inflamed as they
syndrome pass through the subacromial space. Causes pain, weakness, loss of movement. Also
referred to as swimmer’s shoulder and thrower’s shoulder.
Synovitis Fluid secreted by the synovial membrane and found in joint cavities that are inflamed.
Tendinitis Inflammation of the tendon.
Tendinosis Also called chronic tendinitis, tendinosis, chronic tendinopathy, or chronic tendon injury,
is damage to a tendon at a cellular level (the suffix “osis” implies a pathology of chronic
degeneration without inflammation). It is thought to be caused by micro-tears in the
connective tissue in and around the tendon.
Tenosynovitis Inflammation of the fluid filled sheath (synovium) that surrounds a tendon. Symptoms
include pain, swelling and difficulty moving a joint.
MSK Movement
Abduction Movement that brings a structure away from the body.
Adduction Movement that brings a structure towards the body.
Contralateral Contralateral means a structure on the other side of the body.
Distal Distal is further from the center of the body or near the end of a structure (think
“distant”). Example: the knee joint is formed where the proximal tibia meets the distal
femur.
Dorsiflexion Dorsiflexion is the bending of the foot upward, decreasing the angle of the dorsal aspect
of the foot to the leg.

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 General Information Clinical Sales Demonstration Terminology

Ipsilateral Ipsilateral refers to locations on the same side as a reference location.

Plantar flexion Extending the foot downward toward the sole using the calf muscles.
Pronation Medial rotation of a joint turns the limb inward towards the central axis of the body.
Proximal Proximal is a direction or location closer to the center of the body, or the beginning of a
structure (think “proximity”).
Subluxation Incomplete or partial dislocation of a joint or organ.
Supination Lateral rotation of a joint turns the limb outward away from the central axis of the body.
Ultrasound-specific
Anisotropy Anisotropy (pronounced an-ice-o-tropy) is an ultrasound artifact which occurs when the
ultrasound beam is not perpendicular to the structure being scanned. Therefore, the
structure being insonated is not able to produce direct reflection. The result is a
hypoechoic area, or appearance of “drop-out”. This artifact can often be confused with
pathology especially in tendons.
EHR/EMR Physicians may ask if your system can connect to the EHR/EMR. These are systems that
(Electronic Health store patient medical information electronically.
Records / Electronic
Medical Records)
Elastography Elastography is a technology that identifies tissue stiffness. It can be used in conjunction
with 2D imaging to evaluate masses.
Hyperechoic/Echogenic Highly reflective and echo rich when compared with neighboring structures, appears as
varying shades of lighter gray, the term echogenic is often used interchangeably.
Hypoechoic Low level gray echoes, darker than surrounding tissue or comparative structures.
Fine Needle Aspiration A diagnostic procedure used to investigate superficial (just under the skin) lumps or
(FNA) masses. In this technique, a thin, hollow needle is inserted into the mass for sampling of
cells that will be examined under a microscope.
In-plane needle In-plane needle placement occurs when the needle can be seen on the US monitor in the
placement long-axis view (long axis of the needle is situated within the US scanning plane).
Out-of-plane needle Out-of-plane needle placement occurs when the long axis of the needle is directed
placement across the scanning plane so the needle can be seen in the short-axis view.

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The products/features mentioned in
this document may not be commercially
available in all countries. Due to
regulatory reasons their future
availability cannot be guaranteed.
Please contact your local Siemens
organization for further details.
Standalone clinical images may have
been cropped to better visualize
pathology.
ACUSON Freestyle, ACUSON P300,
ACUSON S Family, ACUSON S1000,
ACUSON S2000, ACUSON S3000,
ACUSON X Family, ACUSON X300,
ACUSON X700, Advanced SieClear,
Clarify, Dynamic TCE, HELX, Native,
SieScape, TEQ, TGO, and Virtual Touch
are trademarks of Siemens Medical
Solutions USA, Inc.

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