Manual de Administrador Aspen

ACUSON Aspen™ Ultrasound System
Administrator Manual
Siemens Medical Solutions USA, Inc.

1230 Shorebird Way
P.O. Box 7393
Mountain View, CA 94043 -7393
USA
800 498 7948
650 969 9112
CE Declaration
This product is provided with a CE marking in accordance with the
regulations stated in Council Directive 93/42/EEC of June 14, 1993
0123 concerning Medical Devices. Siemens is certified by notified body 0123 to
Annex 11.3. Full Quality System.
Authorized EC Representative:
Siemens Aktiengesellschaft
Medical Solutions
Henkestraße 127 Document No. 07702850
D-91052 Erlangen Rev. 1
Germany Language: English
ii ACUSON Aspen Ultrasound System 0503
COPYRIGHT Copyright © 2003 by Siemens. All rights reserved.
No part of this publication may be reproduced, transmitted, transcribed, stored in
retrieval systems, or translated into any language or computer language, in any
form or by any means, electronic, mechanical, magnetic, optical, chemical,
manual, or otherwise, without the prior written permission of Siemens.
Siemens reserves the right to change its products and services at any time. In
addition, this manual is subject to change without notice. Siemens welcomes
customer input on corrections and suggestions for improvements to this manual.
Although Siemens has attempted to ensure accuracy throughout this manual,
Siemens assumes no liability for any errors or omissions, nor for any damages
resulting from the application or use of this information.
TRADEMARKS ACUSON, MultiHertz, Native, RES, Sequoia, SpaceTime, The Value of Vision,
Vector, ACUSON XP, ACUSON 128XP, ACUSON 128XP/4, ACUSON 128XP/10,
and AEGIS are registered trademarks of Siemens. 128XP/10c, ACUSON AcuNav,
ACUSON Aspen, ACUSON Aspen Advanced, Cadence, CCD, Convergent,
CWS3000, ACUSON Cypress, DBPro, DELTA, DIMAQ, DS3000, DTI, EF,
eUltrasound, FreeStyle, Imagegate, microCase, MICROSON, Multizone,
NewView, Perspective, PerformancePlus, ProtoCALL, OBPro, QuantX, Quik-Clip,
Solo, Signature, SST, SwiftLink, TEQ, ≅TEQ, WorkPro, WebPro, WS3000, ViewPro,
ViewPro-Net, and Xpress are trademarks of Siemens. Remote First is a service
mark of Siemens QuantX, Quik-Clip, Solo, SST and WebPro are trademarks of
Siemens.
Cidex, Cidex Plus, and Cidex 7 are registered trademarks of Surgikos, Inc. K-Y
Lubricating Gel is a trademark of Johnson & Johnson Products, Inc. IBM is a
registered trademark of International Business Machines Corporation. Metricide
is a trademark of Metrex Research Corporation. Omnicide is a trademark of
Cottrell, Ltd. Panasonic is a trademark of Matsushita Electric Industrial Co. Ltd.
Polaroid is a registered trademark of Polaroid Corporation. 3M is a registered
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Apple Computer, Inc. DOT is a registered trademark of Digital Optical
Technologies. Pinnacle Micro Inc., Kodak, and Ektascan are registered trademarks
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Systems, Incorporated. Ricoh is a trademark of Ricoh Company, Ltd. Sony is a
registered trademark of Sony Corporation of America. Verbatim is a registered
trademark of Verbatim Corporation. Tosoh is a trademark of Tosoh Corporation.
Multi-Imager is a trademark of International Imaging Electronics.
All other product names are trademarks of their respective companies.
CAUTION! In the United States of America, federal law restricts this device to sale or use by, or
on the order of, a physician.
0503 Administrator Manual iii

LICENSE AGREEMENT All computer programs copyright 1990-2003 by Siemens or its suppliers. Such
programs are licensed under the following software license agreement:
Siemens or its suppliers retain(s) ownership of and title to any computer program
supplied with the equipment and to the trade secrets embodied in such computer
programs. Subject to the Buyer’s acceptance and fulfillment of the obligations in
this paragraph, Siemens grants the Buyer a personal, non-transferable, perpetual,
non-exclusive license to use any computer program supplied with the Equipment
that is necessary to operate the Equipment solely on the medium in which such
program is delivered for the purpose of operating the equipment in accordance
with the instructions set forth in the operator’s manuals supplied with the
Equipment and for no other purpose whatsoever. Buyer may not reverse-
assemble, reverse-compile or otherwise reverse-engineer such computer
programs nor may Buyer make a copy of such program or apply any techniques
to derive the trade secrets embodied therein. In the event of a failure by Buyer to
comply with the terms of this license, the license granted by this paragraph shall
terminate. Further, because unauthorized use of such computer programs will
leave Siemens without an adequate remedy at law, Buyer agrees that injunctive or
other equitable relief will be appropriate to restrain such use, threatened or actual.
Buyer further agrees that (i) any of Siemens suppliers of software is a direct and
intended beneficiary of this end-user sublicense and may enforce it directly
against Buyer with respect to software supplied by such supplier, and (ii) no
supplier of Siemens shall be liable to buyer for any general, special, direct,
indirect, consequential, incidental or other damages arising out of the sublicense
of the computer programs supplied with the equipment.
iv ACUSON Aspen Ultrasound System 0503

TABLE OF CONTENTS
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
About Your Siemens System Manuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Administrator Manual Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Chapter 1 Customizing System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Using the Setup Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Customizing 2-D Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Customizing the AEGIS System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Customizing Auto Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Customizing Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Customizing Color Doppler Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Customizing the Foot Switch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Customizing Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Changing Video Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Customizing Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Customizing the Cursor Line Style . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Customizing Data Field and DGC Curve Appearance . . . . . . . . . . . . . . . . . . 18
Correcting the Date and Time Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Setting up the Output Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Changing the Scale Appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Customizing the Display Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Customizing Strip Mode Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Customizing Study Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Customizing System Lighting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Chapter 2 Customizing On-Board AEGIS Software . . . . . . . . . . . . . . . . . . . 27

Customizing AEGIS System-Wide Functions . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Customizing AEGIS Program-Specific Functions . . . . . . . . . . . . . . . . . . . . . . . 33
Chapter 3 Presets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Siemens Exam Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Using Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Customizing Presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Chapter 4 Customizing OB Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Using the OB Calc Select Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Changing the Report Heading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Selecting a Calculation Program for Composite Menstrual Age Reporting . 44
0503 Administrator Manual v

Customizing USER Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Selecting OB Measurements and Calculations . . . . . . . . . . . . . . . . . . . . . . . . . 53
Customizing the Comment Page Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Selecting Printing Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Chapter 5 Customizing Vascular Calculations . . . . . . . . . . . . . . . . . . . . . . . 55

Customizing the Vascular Calculation Report . . . . . . . . . . . . . . . . . . . . . . . . . 56
Selecting Studies to Include in the Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Customizing Study Names and Site Names . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Vascular Calculation Formulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Chapter 6 Customizing Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . 59

Using the Cardiac Calc Select Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Customizing Cardiac Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Selecting Measurements and Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Cardiac Calculation Formulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Cardiac Calculation References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 7 VCR and Printer Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Setting Up Video Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Setting Up a Video Cassette Recorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Setting up Printers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Appendix A OB Calculation Formulas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Using The Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Siemens Standard Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
OB Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Appendix B AIUM Medical Ultrasound Safety . . . . . . . . . . . . . . . . . . . . . . . . 145
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
vi ACUSON Aspen Ultrasound System 0503

PREFACE
The ACUSON Aspen Ultrasound system is designed to help you perform

radiology, obstetrics, gynecology, cardiac, and/or vascular exams. It
offers a wide range of standard and optional operating modes and
transducer formats.
Siemens systems have an exceptional record of dependability and our
customer service network is ready to respond to your individual needs.
Additional advances in technology are currently under development. For
information, please consult your Siemens sales representative.
About Your Siemens There are four manuals in the ACUSON Aspen system manual set:
System Manuals • This Administrator Manual contains information you use to customize
your system. In addition, it also provides reference information such
as standard Preset charts, obstetrical calculation charts, vascular and
cardiac calculation formulas and references, and an ALARA
supplement.
• Your User Manual contains information that you use regularly as you
perform ultrasound exams. It introduces you to the basic functions of
the system and identifies each operating mode and exam function.
• Your Transducer Manual contains information on available
transducers, what products to use to clean and disinfect your
transducers, and power safety considerations.
• Your Safety Manual contains important safety information for all
ACUSON systems. Read the Safety Manual before you use any
ACUSON system.
The manuals address readers who are familiar with ultrasound
techniques and, therefore, do not include sonography training or clinical
procedures.
0503 Administrator Manual vii

Administrator This Administrator Manual is organized in two parts.
Manual Organization The main body of the manual includes detailed setup and customization
instructions for your ACUSON Aspen system. It describes setup and
customization for various system functions as well as the system’s
calculation packages. It includes the following chapters:
• Chapter 1, “Customizing System Setup,” explains how to customize
different system functions, including the output display, the AEGIS
digital image and data management system, annotation keys,
Auto-Doppler configuration, and imaging modes.
• Chapter 2, “Customizing On-Board AEGIS Software,” explains how
to customize the protocols for the AEGIS digital image and data
management system.
• Chapter 3, “Customizing Presets,” explains how to customize Image
and Exam Presets to optimize system parameters for a particular type
of image or exam.
• Chapter 4, “Customizing OB Calculations,” explains how to
customize the OB calculation package for your needs.
• Chapter 5, “Customizing Vascular Calculations,” explains how to
customize the vascular calculation package for your needs. It also
contains vascular calculation formulas.
• Chapter 6, “Customizing Cardiac Calculations,” explains how to
customize the cardiac calculations and measurements for your needs.
It also contains cardiac calculation formulas and references.
• Chapter 7, “VCR and Printer Setup,” has detailed information on
VCR installation and controls and printer setup, including printer
installation diagrams.
The appendixes cover the following reference information:
• Appendix A, “OB Calculation Formulas,” contains fetal parameter
charts and regression equations for the system’s obstetrical
calculation package.
• Appendix B, “AIUM Medical Ultrasound Safety,” describes how to
conduct exams according to the ALARA principle.
viii ACUSON Aspen Ultrasound System 0503

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

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

labeling images in different languages. This manual uses English labels
for all keys and annotation terms. To convert your system to another
language, contact your Siemens Customer Service Engineer.
0503 Administrator Manual ix

x ACUSON Aspen Ultrasound System 0503
CHAPTER 1
CUSTOMIZING SYSTEM SETUP
Using the Setup Menu 2

Working with Setup Dialog Boxes 3
Customizing 2-D Controls 4
Customizing the AEGIS System 6
Customizing Auto Doppler 6
Turning Configurations On and Off 6
Customizing a Configuration 6
Preset Configurations 8
Customizing Calculations 9
Customizing Color Doppler Options 10
Customizing the Foot Switch 11
Selecting the External Video Source 11
Customizing Printing 12
Adjusting the Print Control Setting 13
Installing and Removing Printing Devices 13
Printing Screen Information 14
Adjusting VCR Signal Output 14
Changing Video Settings 15
Changing the VCR Configuration 15
Changing the External Video Configuration 16
Changing the Printer Configuration 17
Customizing Presets 17
Customizing the Cursor Line Style 18
Customizing Data Field and DGC Curve Appearance 18
Correcting the Date and Time Settings 19
Setting up the Output Display 19
Changing the Scale Appearance 19
Customizing the Display Elements 21
Customizing Strip Mode Controls 23
Customizing Study Types 24
Customizing System Lighting 25
0503 Administrator Manual 1

Using the Setup The Setup menu contains a list of functions that you can customize by
Menu setting the function’s parameters. When you select a function you want to
customize, two menus appear: a full-screen menu listing the function’s
parameters and a soft key menu. These menus are used to set each
parameter or to change its current setting. The following sections explain
how to customize each function. For more information about using these
functions after you have customized them, see your User Manual.
◆ To display the Setup menu, press SETUP.
Figure 1-1 Setup Menu

As you customize functions, you can use the following controls.
CONTROL USE
TRACKBALL Use to highlight and select a system function.
[HIDE MENU] Temporarily remove a dialog box that is
obscuring the image, and change the soft key
label to [SHOW MENU].
[SHOW MENU] Redisplay the dialog box.
[IMAGE] Return to imaging mode.
[()SELECT] Select the highlighted item.
[MODIFY] Displays a menu where you can change the
configuration for the selected setting.
[DELETE] Deletes the selected item.
[ON/OFF] Turns the selected setting on or off (toggle).
[PRIOR] or [RETURN] Return to the prior menu, either a dialog box or
the SETUP menu.
[EXIT] or SETUP Leave the SETUP function.
2 ACUSON Aspen Ultrasound System 0503

Working with Setup The Setup dialog boxes contain pop-up menus, option buttons, text fields,
Dialog Boxes and command buttons that you use to customize a function. Figure 1-2
shows a sample dialog box.
Command Buttons
Click to display
additional options.
Option Buttons
Click to turn on or off.
Red buttons are on.
Pop-up Menu Click to apply
Click to display the menu, changes and leave
select an option, and click the function.
again to choose the option.
Figure 1-2 Dialog Box Components

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

Customizing 2-D To customize 2-D mode options, choose 2-D from the Setup menu and
Controls then set options as described in this section. When you finish making
changes, press [EXIT] or SETUP to leave this function.
Figure 1-3 2-D Options

• Turn on AUTOMATIC IMAGE WIDTH WITH D-FLOW ACTIVATION to
turn on the image width function automatically when you enter
Color Doppler mode.
• Turn on IMAGE WIDTH SIZE TIED TO COLOR PAN BOX to size the
image width box (which is automatically displayed) so that it
matches the size of the Color Doppler box.
• Turn on REMOVE BCOLOR FROM 2D IN COMBINED MODES to
automatically remove B-color from the 2-D image when you enter a
combined 2-D/strip mode.
• Turn on HIGH RES FREEZE to turn on the high-resolution freeze
option for linear transducers. When this option is on, the system
automatically changes to sequential focus and sets persistence to
zero.
• Select a DEPTH KNOB DIRECTION to customize the behavior of the
DEPTH knob, either INCREASE CLOCKWISE or DECREASE
CLOCKWISE.
• Select a FOCUS KNOB DIRECTION to customize the behavior of the

FOCUS knob, either INCREASE CLOCKWISE or DECREASE
CLOCKWISE.
• Select the method of controlling the DGC curve, either using all eight
sliders (8 POT) or using three sliders (3 POT).
• Turn on INVERT DGC to invert the DGC controls when the 2-D image
and DGC curve are inverted.
• Select the method for changing the size of the RES box. When you
select FIXED CENTER, the center of the RES box grows or shrinks
proportionately from the center. When you select FIXED CORNER, the
upper-left corner of the RES box remains stationary as the box grows
or shrinks.

• When in the 2-D mode, you may change trackball sensitivity to a
faster trackball response or leave the it at the default setting of
NORMAL. The settings are SET-AND-FORGET VALUES stored in
BBM. The following list shows the options with this new faster
trackball response. For more information see your User Manual.

Customizing the Images are stored, reviewed, and printed according to your on-board
AEGIS System AEGIS digital image and data management system configuration. For
information about customizing the AEGIS system, see Chapter 2.
Customizing Auto Auto Doppler configurations specify several sites at which to record
Doppler measurements. For each site, a configuration determines which
measurements are recorded from the spectral Doppler display. Table 1-1
lists the preset Auto Doppler configurations.
You can customize the Auto Doppler function by turning configurations
on or off. You can further customize each configuration by turning
measurements on or off and, in some cases, changing the name, number
of sites, and signal type.
Turning Configurations ◆ To configure Auto Doppler status:
On and Off
1. Select AUTO MEASURE: DOPPLER CONFIGURATION FUNCTION from
the Setup menu.
The Doppler Configuration Function menu lists each of the available
configurations and their current status, either On or Off.
Figure 1-4 Doppler Configuration Function

2. To turn a configuration on or off, select the configuration and press
[()OFF/ON] to select the status you want.
Customizing a You can customize each configuration by specifying which measurements
Configuration to display and record for both live and frozen strips. See Table 1-1 for a
complete list of available Auto Doppler measurements.
You can also customize one of the user-defined configurations by
specifying a different name, number of sites, and signal type. You cannot
change these parameters for ACUSON preset configurations.

◆ To customize a configuration:
1. Select the configuration in the Doppler Configuration Function
menu, and press [MODIFY].
The Auto-Doppler Configuration menu lists measurements for the
selected configuration.
Figure 1-5 Auto-Doppler Configuration Measurements

2. To turn a measurement on or off, select it and press [()OFF/ON] to
select the status you want.
3. To change a user-defined configuration name, move the cursor to the
Configuration Name field and type a new name.
4. To change the number of sites for a user-defined configuration, move
the cursor to the Number of Sites field and type a new number
(from 1 to 8).
You can customize site names in the Auto Doppler report. For
instructions, see your User Manual.
5. To change the signal type for a user-defined configuration, move the
cursor to the Signal Type field to display the Signal Type pop-up
menu and choose a type. The menu displays the following choices:
SIGNAL TYPE SUGGESTED APPLICATION SITE
High Volume Carotid, Aorta
Low Resistance Renal, Ovary
Tri-Phasic Femoral, Brachial Artery
LVOT LVOT
6. Select a signal type which is similar to the waveform you want to

sample and measure.

7. Press [PRIOR MENU] to return to the Auto-Doppler Configuration
Function menu, or press [IMAGE] to return to the image.
Preset Configurations
Table 1-1 Preset Auto Doppler Configurations

Configuration Carotid Ovaries Tri-phasic Renal LVOT Config 1 Config 2 Config 3
Name
Signal Type High Volume Low Tri-Phasic Low LVOT Low Low High Volume
Resistance Resistance Resistance Resistance
Number of Sites 8 2 2 2 1 2 2 2
Site Names RT CCA RT Ovary RT Femoral RT Kidney LVOT

LT CCA LT Ovary LT Femoral LT Kidney
RT ICA
LT ICA
RT ECA
LT ECA
RT Vertebral
LT Vertebral
Measurements Live Frozen Live Frozen Live Frozen Live Frozen Live Frozen Live Frozen Live Frozen Live Frozen
Maximum ON ON ON ON ON ON ON ON OFF OFF ON ON ON ON ON ON

Velocity
Minimum ON ON ON ON ON ON ON ON OFF OFF ON ON ON ON ON ON

Velocity
Angle ON ON ON ON ON ON ON ON OFF OFF ON ON ON ON ON ON
Time Averaged OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF
Max. Vel
Heart Rate ON ON ON ON ON ON OFF OFF OFF OFF ON ON ON ON ON ON
Acceleration OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF
Pulsatility Index OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF ON ON ON ON
Resistivity Index OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF ON ON OFF OFF
Systolic/Diastoli OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF ON ON ON ON
c Ratio
Velocity Time OFF OFF OFF OFF OFF OFF OFF OFF ON ON OFF OFF OFF OFF OFF OFF
Integral
Ejection Time OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF
Acceleration OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF
Time
Mean Gradient OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF
Peak Gradient OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF OFF
Cardiac Output OFF OFF OFF OFF OFF OFF OFF OFF ON ON OFF OFF OFF OFF OFF OFF

Customizing To customize the system’s calculation packages, choose CALC SET-UP
Calculations from the Setup menu.
• Press [OB SEL] to set up OB calculations. For instructions, see
Chapter 4.
• Press [VASCULAR SEL] to set up vascular calculations. For
instructions, see Chapter 5.
• Press [CARDIAC SEL] to set up cardiac calculations. For instructions,
see Chapter 6.
• Press [OTHER SEL] to display a full-screen menu for turning on or off
other miscellaneous calculations. Use the trackball to select a
calculation and then press [ON/OFF] to turn it on or off. Calculations
that are turned on appear as options in the CALC pop-up menu.
To exit the calculation setup menus and apply your changes, press [EXIT]
or SETUP.

Customizing Color To customize Color Doppler options, choose COLOR DOPPLER IMAGING
Doppler Options from the Setup menu and then set options as described in this section.
When you finish making changes, press [EXIT] or SETUP to leave this
function.
Figure 1-6 Color Doppler Options

• Turn on GHOSTBOX FOR CDI BOX MOVEMENT to display only an
outline of the Color Doppler (CD) box (called a ghostbox) as you
position it (instead of full color information). By moving only the
outline, the system can move and resize the CD box much more
quickly.
• Turn on FREQUENCY INDEPENDENCE BETWEEN 2D AND COLOR
FREQUENCIES to allow adjusting the 2-D and CD frequencies
independently. When this option is turned off, changing the
frequency in one mode also affects the other mode.
• Turn on SHRINK CDI BOX IN TRIPLEX FOR BETTER FRAME RATE to
automatically reduce the size of the CD box when you enter triplex
(combined 2D/CD/spectral Doppler) mode. Reducing the size of the
CD box allows the system to display CD information at a higher
frame rate. Turn off this option to maintain the CD box size.
• Select a method for changing the size of the CD box. When you select
FIXED CENTER, the size of the CD box grows or shrinks
proportionately from the center. When you select FIXED CORNER, the
upper-left corner of the CD box remains stationary as the box grows
or shrinks.
NOTE: Two strip mode customization options also affect the behavior of
the CD box when you change the steering for a linear transducer.
AUTO-INVERT ON STEER CHANGE automatically inverts the spectral
Doppler display. LINK PW CURSOR TO CD PAN BOX changes the angle of
the CD box automatically. For more information, see “Customizing Strip
Mode Controls” on page 23.

Customizing the If your system has an optional foot switch, you can customize the two
Foot Switch buttons on the foot switch to perform the functions of frequently used
keyboard keys. You press a foot switch pedal with your foot to perform
the programmed function. Initially the left pedal functions as the PRINT
key and the right pedal functions as the GAIN/FRZ/RUN key. The foot
switch settings available to you depend on the options installed on your
system.
◆ To program the foot switch, select FOOT SWITCH from the Setup
menu.
• Press [LEFT=SETTING] to select the function you want the left foot
switch button to perform.
• Press [RIGHT=SETTING] to select the function you want the right foot
switch button to perform.
The new foot switch settings are effective immediately.
Selecting the You use the EX VIDEO key to activate the external video input source. The
External Video external video input source can be an external VCR or a Sony Color Page
Source Printer. (An external VCR is any VCR other than the integrated
SVO-9500MD.) When the external video input source is a VCR, the
system displays images from a videotape. When the external video input
source is a printer, the system displays printer menus or an image stored
in the printer's memory.
Depending on the external video input source and the current status of
the VCR, pressing EX VIDEO has the following effect:
EXTERNAL VIDEO FIRST PRESS OF SECOND PRESS OF

INPUT SOURCE EX VIDEO EX VIDEO
VCR Starts playback Stops playback
Printer with:
• VCR in playback Stops VCR playback Activates printer

mode
• VCR turned off Activates printer Deactivates printer
The external video source has different default values depending on the
options installed on your system. When you turn on or reset the system,
the external video source is reset to its default value. In most cases, you
do not need to change the external video source from its default value.

◆ To specify the external video source:
1. Select PERIPHS: EXTERNAL VIDEO SOURCE from the Setup menu.
2. Press the soft key corresponding to the source you want. Use the
following settings:
CONTROL USE
[SYSTEM VCR] Selects the system’s VCR.

[COLOR PRINTER] Selects the color printer.
[THIRD SOFT KEY] Toggles between other available video sources.
Customizing The system supports many kinds of printing devices. You use the Print
Printing Control menu to install printing devices, specify how the system
responds when you print, and manually print to a specific device.
Chapter 7 contains information on setting up VCRs, printers, and
external video functions.
When one or more devices are installed and turned on, pressing PRINT
prints the screen information to each device.
◆ To control printing devices, select PERIPHS: PRINT CONTROL from
the Setup menu.
The Print Control soft key menu appears. Use the soft keys as
described in the following procedures.
Figure 1-7 Print Control Soft Key Menu

Adjusting the Print Print control settings control the function of the PRINT key.
Control Setting
◆ To change the print control setting, press [FRZ/PRT/ACTN] in the
Print Control soft key menu to select the option you want.
CONTROL USE
FRZ/PRT/FRZ The image freezes, prints, and remains frozen after

printing is complete.
FRZ/PRT/RUN The image freezes, prints, and then returns to
real-time imaging.
Installing and Removing Installing a printer consists of three steps: physically installing the device,
Printing Devices informing the system that the device is installed, and turning on the
device. Your Siemens Customer Service Engineer will initialize your
system for your particular printers during system installation.
◆ To install or remove a printing device:
1. Press [PRINTER LIST] in the Print Control soft key menu to display a
catalog of supported devices as shown below.
NOTE: [ON/OFF] appears only when the selected device is already
installed.
Supported Devices lists the

optional hard copy devices
currently available on your
system.
For each available device,
Current Status lists the device
as Installed (if it is), and
indicates whether it is on or off.
Figure 1-8 Supported Printing Devices

2. Select the device you want to install or remove.
3. Press [ACTION] to select INSTALL or REMOVE.
4. Press [ON/OFF] to turn the device ON or OFF.
5. Press [RETURN] to return to the Print Control soft key menu.

Printing Screen If you do not want to print to all printers, you can manually print to the
Information device of your choice.
◆ To print screen information to only one installed device:
1. Press [MANUAL] in the Print Control soft key menu to display a
catalog of supported devices.
NOTE: [MANUAL] appears only when multiple printing devices are
installed.
2. Select the device to which you want to print.
3. Press [PRINT].
4. Press [RETURN] to return to the Print Control soft key menu.
Adjusting VCR You can adjust the system’s VCR signal output level.
Signal Output
WARNING! The adjustment of the video output level affects the video signal that
goes to the system monitor AND to all of the video outputs on the back
panel. For example, adjusting the video output level affects the dynamic
range, available gray scale levels, and B-color representation. Consult
your Siemens Customer Service Engineer before adjusting the video
output levels.
◆ To adjust the VCR signal output:

1. Select PERIPHS: VCR SIGNAL OUTPUT CONTROL from the Setup
menu to display the Video Signal Output Control menu.
Figure 1-9 VCR Output Signal Control Menu

VCR signal outputs range from 0 to 100. 0 indicates no intensity and
100 indicates the normal signal output.
2. Move the trackball up to increase or down to decrease the current
output level.

3. Press [SAVE] to save the current signal output level as the default
level. The default signal output level is the level that is used each time
you begin VCR playback.
4. Press [FRAME/FIELD] to select the mode for signal conversion that is
best suited for your use of the system.
If you usually use the ACUSON Aspen ultrasound system to review
videotapes that have been recorded on the ACUSON Aspen system,
select [FRAME]. If you usually use a Review Station to review such
videotapes, select [FIELD].
Changing Video You can change the way the system’s video configuration supports a
Settings VCR, external video source, or video printer.
IMPORTANT: Change video settings only when directed to do so by a Siemens

representative. This manual does not provide detailed information
about the purpose and use of each setting. Your Siemens representative
will tell you which settings are appropriate for your system.
Changing the VCR ◆ To change the VCR configuration:

Configuration
1. Select PERIPHS: VCR/EXT VIDEO/PRINTER CONFIGURATION from the
Setup menu to display the VCR Configuration menu.
The VCR Configuration menu displays three parameters: VCR Type,
VCR Interface, and VCR Video Output. Below each parameter is a list
of settings. Only one setting is in effect at a time. There is a New and
Saved column for each setting. The Saved column shows the current
configuration. The setting with a Yes in this column is the one
currently in effect.
Figure 1-10 VCR Configuration Menu

2. To select a different setting for a parameter, select the setting you
want and press [NEW] to display a Yes in the New column.
3. Repeat step 2 for each setting you want to change.
4. To apply your changes, press [SAVE].

5. When asked, press [SAVE] again to confirm your changes or press any
other key to cancel them.
When you press [SAVE], the Yes moves from the New column to the
Saved column for each setting you changed.
Changing the External ◆ To change the external video configuration:
Video Configuration
1. From the VCR Configuration menu, press [EXT VID CONFIG] to
display the External Video Configuration menu.
The External Video Configuration menu displays two parameters:
Input Type and RGB Output Type. Below each parameter is a list of
possible settings. You change these settings using the same methods
you use to change VCR Configuration settings. You can also assign
labels to the Input Type settings.
Figure 1-11 External Video Configuration Menu

2. To select a different setting for a parameter, select the setting you
want and press [NEW] to display a Yes in the New column.
3. Repeat step 2 for each setting you want to change.
4. To change the label for an Input Type, select the type and type the
new label.
5. Repeat step 4 for all labels you want to change, and then press
[SAVE LABELS] to apply your changes.
6. To apply your changes to the External Video Configuration
parameters and the labels, press [SAVE].

Changing the Printer ◆ To change the printer configuration:
Configuration
1. From the External Video Configuration menu, press
[PRINTER CONFIG] to display the Printer Configuration menu.
The Printer Configuration menu displays one parameter: Printer
Type. Below it is a list of possible settings. You change the Printer
Type setting using the same method you use to change VCR
Configuration settings.
Figure 1-12 Video Printer Configuration Menu

2. Select the setting you want and press [NEW] to display a Yes in the
New column.
3. To apply your changes, press [SAVE].
When you press [SAVE], the Yes moves from the New column to the
Saved column for each setting you changed.
Customizing For information about customizing presets, see Chapter 3.

Presets

Customizing the The cursor line is a line that extends through a 2-D image along one of the
Cursor Line Style ultrasound scan lines. You use it to indicate where you want to obtain
spectral Doppler or M-mode information.
The cursor line consists of dots spaced an equal distance apart. You can
control the appearance of the line by selecting the density of the dots. You
have three options for the cursor line density: low, medium, and high.
The cursor line density is the same in all operating modes.
All three settings correlate the cursor line density to the image depth. The
density decreases when the image depth is 80 mm or more. The following
table describes the cursor line density options:
OPTION DENSITY FOR DEPTH DENSITY FOR DEPTH

LESS THAN 80 MM 80 MM OR MORE
LOW (Default) 1 dot every 5 mm 1 dot every 10 mm

MED 1 dot every 2.5 mm 1 dot every 5 mm
HIGH 1 dot every 1.25 mm 1 dot every 2.5 mm
◆ To change the cursor line style:

1. Select SCREEN DATA: CURSOR DENSITY from the Setup menu.
2. Press the soft key corresponding to the density you want.
3. Move the trackball for the new cursor line density to take effect.
Customizing Data System information is reported by displaying data fields and a Depth
Field and DGC Gain Compensation (DGC) curve. System parameters appear in the
Curve Appearance system data field on the right side of the screen. Displayed directly below
the system data field, each operating mode has its own data field
containing parameters for that mode. The DGC Curve also appears on the
right side of the screen. Figure 1-13 shows the system data field, 2-D data
field, and DGC curve.
Permanent
System Data Field
Removable 2-D
Data Field
DGC Curve runs

from top to bottom,
behind data fields.
Figure 1-13 Data Fields and DGC Curve

You can turn the operating mode data field and the DGC curve on or off.
You cannot turn off the system data field or the AEGIS system status line.
◆ To change the data field and DGC display options:
1. Select SCREEN DATA: DATA from the Setup menu.
2. Press [DGC ON/OFF] to turn the DGC curve ON or OFF.
3. Press [DATA ON/OFF] to turn the data field ON or OFF.
Correcting the Date The system clock operates even when the system is turned off. Your
and Time Settings Siemens Customer Service Engineer sets the clock to the correct date and
time during installation. When you use the system, the current date and
time appear in the permanent system data field. You will need to reset the
time to adjust for daylight saving time.
Do not change the date and time when the image is frozen. Because
changes do not take effect until you unfreeze the image, you will not be
able to see changes as you make them. Furthermore, after you change the
date and time, you should turn the system off and back on so that the
changes will take effect immediately within the AEGIS system. (Refer to
your Safety Manual for instructions on turning the system on and off.)
◆ To change the date or time:
1. Select SCREEN DATA: DATE/TIME from the Setup menu.
2. To change the time, press [HOUR], [MINUTE] and [SECOND] to advance
to the correct hour and minute and to reset seconds to zero.
3. To change the date, press [DATE].
4. Press [DAY], [MONTH], and [YEAR] to advance to the correct day,
month, and year.
5. Press [TIME] to return to the Time soft key menu.
Setting up the The ACUSON Aspen system includes a built-in Output Display system
Output Display that lets you monitor acoustic output levels for the active transducer and
imaging modes during an exam. For information about using and
customizing the Output Display, see your User Manual.
Changing the Scale You can change the location and brightness of the scale markers that
Appearance indicate image depth in both 2-D and strip modes. In 2-D, the exact scale
options depend on the format of the transducer you are using. The
following table lists scale options for each transducer format:
SCALE OPTION LINEAR VECTOR/ CURVED

SECTOR
Horizontal and vertical scales √ √
Vertical scale only √ √ √
Vertical scale and grid pattern √ √ √
Single-dotted-edge scale √ √
Double-dotted-edge scale √ √

The vertical scales and the dotted-edge scales measure the distance from
the face of the transducer. Vertical, horizontal, and center scales report
image depth in 5 mm increments. There are large tick marks every
10 mm, and smaller marks every 5 mm.
In strip modes, the exact scale options depend on the mode you are in.
The following table lists the scale options for strip modes:
SCALE OPTION M-MODE PW CW
White horizontal and vertical scales √ √ √
• Vertical dot scale every second √
• Vertical dash scale every second √
Blue scale dashes √
Blue horizontal scale and baseline √ √
Dotted-edge scale markings depend on the imaging mode you are using.
In 2-D imaging mode, a small dot appears every 10 mm along the edge of
the image and a larger dot appears every 50 mm. In combined mode, in
most cases, the scale consists of a small dot every 10 mm; in the special
cases described in the following table, the scale consists of a
medium-sized dot every 20 mm.
STRIP DISPLAY IMAGE DEPTH GREATER THAN
2/3 120 mm
1/2 160 mm
1/3 200 mm
If you are not sure whether dots are 10 mm or 20 mm apart, use calipers
to measure the distance.
In RES enhanced resolution imaging, the larger dots correspond to the
depth from the face of the transducer, not the top of the displayed image.
◆ To change the scale appearance:
1. Make sure you are in the mode for which you want to change the
scale appearance.
2. Select SCREEN DATA: SCALE from the Setup menu.
3. Press [NEXT SCALE] to cycle through the available scales for the
current transducer until you see the scale presentation you want on
the screen.

Customizing the The system has several controls for adjusting the display. You can adjust:
Display Elements • Gray shades
• Graphics brightness
• Text brightness
• Monitor tint
◆ To control display elements:
1. Select SCREEN DATA: SCREEN CONTROL (GRAY LEVEL) from the
Setup menu.
2. Use the soft keys as described in the following procedures.
Adjusting Gray Shades To adjust the gray shades displayed on the screen, you display a gray
scale test pattern (gray test) and adjust the BRIGHTNESS and CONTRAST
controls.
◆ To adjust gray shades:
1. Press [GRAY TEST] in the Screen Control soft key menu to display a
gray test pattern which consists of 16 vertical bars and a 256-shade
grade.
2. Use the monitor BRIGHTNESS and CONTRAST controls (on the lower
right side of the monitor) to adjust the gray shades in the test pattern.
The BRIGHTNESS and CONTRAST controls affect only the monitor.
They do not affect video signal output to any peripheral recording
devices.
Brightness and contrast controls for playback from peripheral
recording devices are separate and do not alter the monitor.
3. Press [PRIOR MENU] to return to the Screen Control soft key menu.
Adjusting Text and You can control the brightness or intensity of the text and graphics on the
Graphics Brightness display. There are three levels of text and graphics brightness: low,
medium, and high.
◆ To adjust text and graphics brightness:
1. Press [GRAPHICS=LVL] in the Screen Control soft key menu to select
the graphics brightness setting you want.
2. Press [TEXT=LVL] in the Screen Control soft key menu to select the
text brightness setting you want.

Adjusting the Monitor Tint The monitor tint impacts the overall look of the screen. Some users prefer
a neutral gray, while others prefer subtle blue or red shades. You can set
the monitor tint to any of the following options.
• 0 - No correction
• 1- Balance
• 2 - Red
• 3 - Green
• 4 - Blue 1
• 5 - Blue 2
• 6 - Blue 3
• 7 - Blue 4
◆ To set the monitor tint:
1. Press [MONITOR TINT] in the Screen Control soft key menu to display
the monitor tint soft key menu.
2. Press [MONITOR TINT] (the fourth soft key) until it displays the level
you want.
As a shortcut, you can also press the numeric key associated with the
level you want. For example, press 1 to choose 1 - Balance.
3. Press [PRIOR MENU] to return to the Screen Control soft key menu, or
press RETURN to exit the Setup function.

Customizing Strip To customize spectral Doppler and M-mode options, choose STRIP
Mode Controls MODES from the Setup menu and then set options as described in this
section. When you finish making changes, press [EXIT] or SETUP to leave
this function.
Figure 1-14 Strip Mode Options

• Turn on AUTO-INVERT ON STEER CHANGE to automatically invert the
spectral Doppler display each time you change the steering for a
linear transducer.
• Turn on LINK PW CURSOR TO CD PAN BOX to change the angle of the
CD box automatically when you change cursor steering for a linear
transducer.
• In the KEEP CURSOR ACTIVE BY DEFAULT AREA, select the
transducer types for which you want to retain the cursor when you
exit a strip mode. You can turn this option on and off for linear
transducers and for all other transducer types.
• You can set up the system to anchor the strip’s baseline so that when
the strip inverts, the baseline automatically shifts to accommodate the
new direction of flow. The ANCHOR BASELINE ON INVERT feature
applies to linear transducers only. You can turn on or off this feature
for Color Doppler (DCOLOR), PW Doppler (PW), or CW Doppler
(CW).
• Use STRIP DISPLAY SIZING options to select the default size for strip
modes. (You can use the SIZE key to switch between the size you
select here and a full-screen strip.)
• Select PHYSIO WINDOW to display physiological traces in a separate
area on the screen.
• In the SELECT UPDATE area, select an update interval for the 2-D
image while in strip modes. Choose every second (1), every 3 seconds
(3), every 5 seconds (5), or real-time (INFINITE).
• In the DEFAULT CURSOR area, select the default cursor type: M-MODE,
CW, or PW. The default cursor type is the type that appears when you
press the CURSOR key.

Customizing Study Study Types determine what patient information is stored with a study.
Types Siemens provides the following standard Study Types.
Abdomen Intracardiac Peripheral Vascular
Biopsy Neonatal Echo Pharm Stress
Breast Neonatal Head Prostate
Cardiac None Renal
Carotid OB TCI
Contrast Echo Other TEE
Exercise Stress Ped Echo Testicular
Fetal Echo Pelvis Thyroid
Venous LE
If your Hospital Information System (HIS) or Radiology Information

System (RIS) uses different Study Types, you copy one of the standard
Study Types to create a new one. You can also remove any Study Types
that you create. You cannot remove any of the standard ACUSON Study
Types. Changes that you make to Study Types do not take effect until you
restart the system.
To customize Study Types, choose STUDY TYPE from the Setup menu and
then set options as described in this section. When you finish making
changes, press [EXIT] or SETUP to leave this function.
Figure 1-15 Customizing Study Types

• To select a Study Type, select it from the STUDY TYPE list.
• To create a new Study Type, select a Study Type to copy, enter a name
for it in the NEW STUDY TYPE text box, and click CREATE COPY.
• To remove a Study Type, select it and click DELETE.

Customizing System To customize system lighting, choose SYSTEM LIGHTING from the Setup
Lighting menu and then set options as described in this section. When you finish
making changes, press [EXIT] or SETUP to leave this function.
1. Press [LIGHTS] to select the type of lighting that you want to
customize: keyboard lights (KEYB LIGHTS), other system lights
(DOWN LIGHT), Output Display brightness (LCD BRIGHT), or Output
Display contrast (LCD CONTRAST).
2. To adjust the lighting level for the selected lighting type, do one of the
following:
• Press [LEVEL] to choose one of the preset lighting levels: LOW
MEDIUM, or HIGH.
• Press [CUSTOMIZE LIGHTING] to select a specific level. Change the
lighting level by moving the trackball. The current level appears as an
octal number on the display. Press [SAVE XXX] to save your change.
3. Repeat steps 1 and 2 for each type of lighting that you want to
customize.

CHAPTER 2
CUSTOMIZING ON-BOARD AEGIS

SOFTWARE
Customizing AEGIS System-Wide Functions 28

Setting Up Network Printers 29
Setting Up Network File Servers 31
Setting Up a Worklist Server 32
Customizing AEGIS Program-Specific Functions 33
Creating Capture Types and Stages 34
Saving Clips 36

Images are stored, reviewed, and printed according to your AEGIS digital
image and data management system configuration. AEGIS system-wide
configuration controls the storage and printing of studies. AEGIS
program-specific configuration allows you to create protocols and set clip
storage and review parameters.
Customizing AEGIS You need to customize AEGIS system-wide parameters before you begin
System-Wide storing and printing images. You usually customize the settings for these
Functions parameters once. If you change a parameter setting during a study, the
new setting will take effect immediately.
To customize AEGIS system-wide parameters, choose AEGIS:
SYSTEM-WIDE FUNCTIONS from the Setup menu and then set options as
described in this section. When you finish making changes, press [EXIT]
or SETUP to leave this function.
Figure 2-1 Aegis System-Wide Configuration

• Click DEFINE PRINTERS to set up network printers. See “Setting Up
Network Printers” on page 29.
• Click DEFINE SERVERS to configure the system to use network file
servers. See “Setting Up Network File Servers” on page 32.
• Click DEFINE WORKLIST to set up the system to connect to a network
worklist server. See “Setting Up a Worklist Server” on page 33.
• Choose the information items that you want to display at the top of
the image: PATIENT NAME, PATIENT ID, and/or SONOGRAPHER’S
INITIAL.

• If your Siemens Customer Service Engineer has configured your
system to connect to the network from different locations (with
different network addresses), those locations appear in the LOCATION
NAME list. To change the location, select the location you want and
click SELECT. Your change takes effect the next time you restart the
system. To cancel your change, click CANCEL.
• To automatically store images when you print them to a local printer,
select STORE ON LOCAL PRINT.
Setting Up Network To set up network printers, click DEFINE PRINTERS from the AEGIS:
Printers System Wide Functions screen and set options as described in this
section. When you finish making changes, press [PRIOR] to return to the
AEGIS: System Wide Functions screen or press [EXIT] or SETUP to leave
the Setup function.

Figure 2-2 Network Printing Setup
• In the NETWORK B&W PRINTER and NETWORK COLOR PRINTER
areas, use the pop-up menus to select the network black-and-white
and color printers that you want to print to. Your Siemens Customer
Service Engineer configures your system to connect to network
printers.
• In the SEND B-COLOR TO area, choose a type of printer, COLOR
PRINTER or B&W PRINTER, for B-Color images.
• In the SEND 2-D CD W/STRIP TO area, Choose a type of printer,

COLOR PRINTER or B&W PRINTER, for combined 2-D/strip images.
• In the PRINT DEFAULT area, choose the default print status assigned
to stored images, print or skip.
• In the AUTO PRINTING area, turn on one of the automatic printing
options. (Automatic printing is often called batch or bulk printing.) IN
PROGRESS prints images to the network printer as you press the
STORE key during an exam. ON STUDY CLOSE prints all of the
images selected for printing at once when you end the exam (this
feature is often called bulk printing). OFF turns off the automatic
printing feature. If automatic printing is turned off, you can use the
Study Utilities function to print a study. See your User Manual for
instructions.

• Turn on AUTO RE-TRY to continue attempting to print in situations
where images cannot be printed immediately. For example, if the
printer is out of paper and this option is turned on, images will print
as soon as paper is added to the printer. Also, if the system is
disconnected from the network (for example, for portable exams),
studies will print automatically once the system is reconnected. If this
option was turned off and you turn it on, you must turn the system
off and on again for the new setting to take effect. Siemens
recommends that you always leave this option on.
NOTE: The AUTO RE-TRY option identifies the studies that have not been
printed. It does not prevent a study from being removed (either manually
or automatically when the hard disk becomes full) before it has been
printed.
• In the JOBS KEPT text field, enter the number of days to store
incomplete print jobs before removing them.

Setting Up Network File Network file servers store saved images, clips, patient information, and
Servers calculation information in studies. To set up network file servers, click
DEFINE SERVERS from the AEGIS: System Wide Functions screen and set
options as described in this section. When you finish making changes,
press [PRIOR] to return to the AEGIS: System Wide Functions screen or
press [EXIT] or SETUP to leave the Setup function.
Figure 2-3 Network Server Setup

• Use the pop-up menus to select a primary (DICOM STORAGE SERVER
1) and secondary (DICOM STORAGE SERVER 2) storage server and to
assign a priority to each server. Your Siemens Customer Service
Engineer configures your system to connect to file servers.
• Turn on one of the automatic copying options. IN PROGRESS stores
studies to the network server during an exam (as they are stored to
the local hard disk). ON STUDY CLOSE copies all of the exam data at
once when you end the exam (this feature is often called bulk copy).
OFF turns off the automatic copy feature. When automatic copy is off,
you can use the Study Utilities function to copy studies to a server.
See your User Manual for instructions.
• Turn on AUTO RE-TRY to continue attempting to copy in situations
where studies cannot be copied immediately. If the system is
disconnected from the network (for example, for portable exams),
studies will be stored automatically once the system is reconnected.
• In the JOBS KEPT text field, enter the number of days to store
incomplete copy jobs before removing them.

Setting Up a Worklist The ACUSON Aspen system can retrieve patient information from a
Server Hospital Information System (HIS) or Radiology Information System
(RIS) worklist server. To specify a worklist server, click DEFINE WORKLIST
SERVER from the AEGIS: System Wide Functions screen and set options
as described in this section. When you finish making changes, press
[PRIOR] to return to the AEGIS: System Wide Functions screen or press
[EXIT] or SETUP to leave the Setup function.
Figure 2-4 DICOM Worklist Server Setup

• Choose a worklist server from the DICOM WORKLIST SERVER pop-up
menu.
• Choose a maximum number of scheduled exams to return when you
query the worklist server from the MAXIMUM QUERY ENTRIES
pop-up menu.
• Turn QUERY on or off to enable or disable retrieving patient
information from the worklist server.
• Turn on PRE-FETCH FOR TODAY to automatically connect to the
worklist server and retrieve the day’s exams each time you press
[START NEW PATIENT].
• In the FILTER WORKLIST area, turn on the types of studies you want
to retrieve to the ACUSON Aspen system: only studies schedule for
this system or all studies.
• Turn on SEND U/S STUDIES ONLY to retrieve only ultrasound studies
(instead of all imaging department studies).

Customizing AEGIS Clips can be stored under a Free Form protocol or a Staged protocol. A
Program-Specific Free Form protocol allows straightforward review of images. A Staged
Functions protocol allows shuffling images by stage names and view names.
You need to customize the AEGIS system protocol parameters before you
begin storing clips.
◆ To customize AEGIS system protocol parameters:
1. Select AEGIS PROGRAM SPECIFIC FUNCTIONS from the Setup menu.
Figure 2-5 Aegis Program Customization

2. Select a parameter in the AEGIS Program Customization menu and
press [SHOW MENU] or press a select button to display a pop-up
menu of available settings or toggle between settings.
Table 2-1 describes your options.
3. Press a select key to choose a setting from the pop-up menu.
4. Repeat steps 2 and 3 for each parameter.
5. Press [IMAGE] to return to the image.

Table 2-1 AEGIS System Protocol Parameters
PARAMETER AVAILABLE SETTINGS
Exam Type Exam types listed in the Study field of the patient
demographic page.
Playback Mode Loop Align - Playback synchronized; all clips begin
(during review) and end together.
Free Running - Clips run at own times and speeds.
Same Start - Clips begin together but run at different
speeds.
Save Clips on ON - Clips permanently saved when they are included
Select in a Select Set.
OFF - Clips not permanently saved by being included
in a Select Set.
Protocol Free Form - Allows a straightforward review of
images.
Staged - Allows shuffling of images by stage names
and view names.
Protocol Enter and define a capture type name or stage name
Capture Types for each capture type or stage in the protocol. For more
or Protocol information, see “Creating Capture Types and
Stagesa Stages,” next.
View Names Type in a view name and press [ADD] for each view in
the capture type or stage.
a. Depending on the protocol indicated in the Protocol field.
Creating Capture Types You can customize the clip store settings for each capture type or stage
and Stages that you create. In order to use a Free Form protocol, you must create at
least one capture type. In order to use a Staged protocol, you must create
at least one stage.
◆ To create a capture type or stage:
1. In the AEGIS Program Customization page, select PROTOCOL and
choose either FREE FORM or STAGED.
2. Select Protocol Capture Types and type in a new name or press
[SHOW MENU] to select a name from a pop-up menu of existing
capture types.
3. Press [ADD] to add the new name or [MODIFY] to change the settings
for an existing name.
The Clip Store Settings menu appears.

Figure 2-6 AEGIS Clip Store Settings
4. The Capture Type or Stage name appears in the heading of the screen.
If you want to rename it, type a new name in the field.
5. Select a parameter in the Clip Store Settings menu and type in a value
or press [SHOW MENU] or a select button to choose a setting as
described in Table 2-2.
Press [CANCEL] to cancel the change.
6. Repeat step 5 for each parameter.
7. Press [PRIOR] to return to the AEGIS Program Customization menu.
8. In the View Names field, type in a name and press [ADD] for each
view you want to include in the Capture Type or Stage.
9. Press [IMAGE] to return to the image.
Table 2-2 Protocol Capture Type/Stage Parameters

PARAMETER DESCRIPTION
Clips per Store Selects number of clips to store.
Enter a number from 0 to 99 to specify a fixed number of clips.
Enter I for an indefinite number of clips (until CLIP STORE is
pressed again).
Clip Duration Defines length of each clip.
Enter a number from 0 to 999999 to specify a fixed length. Enter
I for an indefinite length (until CLIP STORE is pressed again).
Select units from the pop-up menu: Frames, MS (milliseconds)
or Beats (when acquisition is triggered by ECG).
Triggered Indicates frame at which to start clip, relative to R-wave
Delay trigger. Appears only when Clip Duration is Beats or MS.
Enter a number between -999999 and 999999.
Duration per Defines length of each trigger. Limits stores to systole only.
Beat
Enter a number from 0 to 999999 to specify a fixed duration.
Enter I for an indefinite duration (until CLIP STORE is pressed
again).

Table 2-2 Protocol Capture Type/Stage Parameters
PARAMETER DESCRIPTION
Capture Size Specifies default size of a clip: Minified (entire screen is
captured), ROI (selected region of interest is captured), or Full
(entire screen is captured, full size, with minimal compression)
Capture Frame Selects temporal resolution.
Rate (Max)
On NTSC systems, choices are 7.5 HZ, 15 HZ, 20 HZ, and 30
HZ.
On PAL systems, choices are 6.25 HZ, 12.5 HZ, 25 HZ.
Selecting a lower Capture Frame Rate value saves memory
and disk space, but reduces temporal resolution.
Compression Specifies JPEG clip compression. Options range from High
(JPEG) (lowest image quality and least disk usage) to Minimal (highest
image quality and most disk usage).
Auto Review When turned on, the system automatically enters AEGIS
review after completing a clip store
Save Clips on When turned on, the system automatically marks clips to be
Capture saved as they are stored. Clips need not be included in a Select
Set in order to be saved.
In order to save clips permanently, Save Clips on Capture
must be turned on, or Save Clips on Select must be turned on
in the AEGIS Program Specific Functions menu.
Display Timers When turned on, the system displays a timer during clip
capture.
Saving Clips Unlike static images, clips must be saved during a study in order to be
stored permanently.
WARNING! If clips are not saved, they will be deleted when you end the study.
There are two ways to save clips during a study:

• You can turn on Save Clips on Select in the AEGIS Program
Customization menu, and clips will be permanently stored when you
include them in a Select Set.
• You can turn on Save Clips on Capture in the Clip Store Settings
menu, and all clips stored for that protocol will be automatically
saved as they are stored.
IMPORTANT: If Save Clips on Capture is turned on, you will not have to include clips
in a Select Set in order to store them permanently. However, if Save
Clips on Capture is turned off and you do not include any clips in a
Select Set, all clips will be deleted when you end the study.
For more information on using the AEGIS system, see your User Manual.

CHAPTER 3
PRESETS
Overview 38
ACUSON Exam Presets 38
Using Presets 39
Customizing Presets 39

Overview Exam Presets and Image Presets make selecting scanning parameters
simple and fast. An Image Preset is a collection of system parameters, for
each imaging mode, that affect the look of the image. Image Presets
represents the imaging goal, the clinical application, or anatomy. An
Exam Preset is a collection of Image Presets. An Exam Preset also includes
information regarding the format of the screen and other system setup
information. Each Exam Preset contains Image Presets for 2-D, Color
Doppler, M-mode, and spectral Doppler modes.
ACUSON Exam The ACUSON Aspen system includes the following Exam Presets. An
Presets next to the Preset name identifies the ACUSON-provided Presets. You
cannot delete or modify the ACUSON Presets; however, you can create
your own additional Presets.
EXAM PRESET NAME TYPES OF EXAM PRESET NAME TYPES OF

EXAMS EXAMS
ABDOMEN Abdomen NEONATAL ECHO Cardiac
BREAST Breast OB OB
CAI - A Cardiac contrast PEDIATRIC ECHO Cardiac
CAI - A FLOW LVO Cardiac contrast PELVIS Pelvis
CAI- A INV LMI Cardiac contrast PHARM STRESS 4 Cardiac
CAI-A PH STRESS Cardiac contrast PHARM STRESS 7 Cardiac
CAI-B Cardiac contrast PROSTATE Prostate
CAI - B FLOW LVO Cardiac contrast PV ARTERIAL Arterial
CAI- B INV LMI Cardiac contrast PV VENOUS Venous
CAI-B PH STRESS Cardiac contrast SMALL PARTS Small parts
CARDIAC DIFFICULT Cardiac TCI 219 Transcranial,
CARDIAC EASY Cardiac TCI ORB 219 Transcranial
CAROTID Carotid artery TCI 4V2 Transcranial
ENDOVAGINAL Endovaginal TCI ORB 4V2 Transcranial
EXERCISE STRESS Cardiac TEE Cardiac
INTRACARDIAC Cardiac TESTICLE Testicle
MUSCULO Musculoskeletal THYROID Thyroid

Using Presets Exam Presets and Image Presets make selecting scanning parameters
simple and fast. An Image Preset is a collection of system parameters you
can use with each imaging mode to affect the look of the image. Image
Presets represent the imaging goal rather than the clinical application or
anatomy. An Exam Preset is a collection of Image Presets. An Exam Preset
also includes information regarding the format of the screen and other
system setup information. An Exam Preset typically contains several
Image Presets for each imaging mode.
Your User Manual describes how to recall Presets, change existing Presets,
and add new Presets. It also lists the ACUSON Presets.
Customizing You cannot modify or remove any of the ACUSON-provided Exam

Presets Presets. However, you can use the Presets Library function to control
which of the ACUSON-provided Exam Presets are available on your
system. Exam Presets that are turned on appear in the Exam Presets menu
(when you press EXAM PRESETS). Exam Presets that are turned off do not
appear in the menu. You can change the order of user-defined Exam and
Image Presets to fit your needs. Presets must be turned on to change their
display order.
◆ To set up the ACUSON-provided Exam Presets for your system:
1. Press SETUP and select PRESETS from the Setup menu.
2. Press [SHOW LIBRARY] to display the Library of ACUSON Defaults
menu.
The Library of ACUSON Defaults lists all of the ACUSON-provided
Exam Presets and their current status, either on or off.
Figure 3-1 Preset Library

3. To turn an Exam Preset on or off, select it and press [ON/OFF] until the
Exam Preset has the status you want.
The Image Presets list shows the Image Presets associated with the
Exam Preset. This information might be useful in determining what
status you want the Exam Preset to have. To view Image Presets for a
particular mode, choose that mode from the Mode pop-up menu.
4. Press [PRIOR MENU] to return to the Store Presets Setup page, or press
[EXIT] to return to imaging.
◆ To sort the display order of user-defined Exam and Image

Presets.
1. Press the SETUP hardkey to enter the Setup menu.
2. Use the trackball to highlight the user-defined Preset to sort.
3. Select the UP or DOWN key to move the Preset up or down in the list
of Presets. The UP button moves the highlighted Preset up the list,
and the DOWN button moves the Preset down the list one line at a
time.
• When changing the order of Exam Presets use the Up and Down keys
located under the Exam Preset menu.
• Like wise, when changing the order of Image Presets use the Up and
Down keys located under the Image Preset menu.

CHAPTER 4
CUSTOMIZING OB CALCULATIONS
Using the OB Calc Select Menu 42

Changing the Report Heading 43
Selecting a Calculation Program for Composite Menstrual Age
Reporting 44
Customizing USER Programs 45
Customizing MA Coefficients for Biometric Measurement Equations 46
Customizing Biometric Measurement with Table Entry 47
Adding Optional Biometric Measurements 48
Adding Optional Biometric Ratio 50
Customizing the EFW Equation 51
Customizing the LMP Percentile Calculation 52
Selecting OB Measurements and Calculations 53
Customizing the Comment Page Template 53
Selecting Printing Options 54

While the standard OB calculation package is adequate for most uses,
there are several ways to customize the calculation package for your
specific needs. This chapter explains how to:
• Change the heading and program names that appear on each page of
the OB report
• Select a program for calculating the menstrual age (MA).
• Add optional, user-defined biometric measurements, user-defined
ratio, and customize EFW equations.
• Turn individual measurement and calculation displays on or off
• Change the template for the first comment page.
• Choose the method for performing Doppler measurements.
• Set up the package to print to a multiformat camera and/or a printer.
Appendix A of this manual lists the fetal parameter charts (used for the
standard ACUSON Aspen ultrasound system programs) and additional
regression equations.
Using the OB Calc ◆ To customize the obstetrical calculation package:

Select Menu 1. Press SETUP and then choose CALC SET-UP.
2. Press [OB SEL] to select the OB calculation package.
NOTE: You cannot customize the OB calculation package if you are

working in the package. Press CALC to exit the calculation
package first.
Figure 4-1 OB Calc Select Menu

Use the following keys in the OB Calc Select Menu:
CONTROL USE
[PAGE] Displays the next page of the OB Calc Select

menu.
[MODIFY] Displays menus, screens, and/or soft key

menus used for customizing the selected item.
[ON/OFF] Turns the selected item on or off.
[EXIT] Exits the OB Calc Select menu.
Changing the The heading at the top of each OB report page initially reads ACUSON
Report Heading Standard Calculation Report. You can replace it with your own text.
◆ To change the report heading or program name:
1. Select REPORT HEADER in the OB Calc Select menu and press
[MODIFY].
2. Type the new report header or program name.
Press [UNDO] to restore the original entry.
3. Press [ENTER] to save your changes and return to the OB Calc Select
menu.

Selecting a There are three programs for calculating the composite menstrual age
Calculation Program (MA): ACUSON/M, ACUSON/H, and USER. All programs initially
for Composite default to Dr. Hadlock’s regression analysis for the individual BPD, HC,
Menstrual Age AC, FL, and CRL parameters.
Reporting
PROGRAM DESCRIPTION
ACUSON/M The ACUSON/M program uses Dr. Hadlock’s

regression analysis for the individual default
parameters (BPD, HC, AC, FL, and CRL). It derives
the composite menstrual age from the arithmetic
mean of the measurement parameters. If you record
optional parameters, they are included in the
calculation.
ACUSON/Ha The ACUSON/H program uses Dr. Hadlock’s

regression analysis for only four of the individual
default parameters (BPD, HC, AC, and FL). It derives
the composite menstrual age from a weighted
regression model using a combination of these
parameters. For a detailed explanation of the
calculations contained in ACUSON/H, see the
article:
Hadlock, F.P., et al. 1984. Estimating Fetal Age:
Computer-Assisted Analysis of Multiple Fetal
Growth Parameters. Radiology 152:497-501.
USER A custom program that lets you modify Biometric
measurements through equation or table entry. You
can modify all default equations and tables (BPD,
HC, AC, FL, and CRL), and add optional parameters.
The composite menstrual age derives from an
arithmetic mean of all measurement parameters.
(The ability to enter and modify tables is available
upon purchase and installation of Service Update 1.
Otherwise, modification through equation is the
option installed on your system.)
a.
Optional parameters and CRL measurements are not included in Dr.
Hadlock’s weighted regression model. If you record optional parameters or
CRL measurements in addition to the basic measurement parameters (BPD,
HC, AC, and FL), the composite menstrual age is calculated as an
arithmetic mean.
◆ To select a calculation program:

1. Select PROGRAM SELECT in the OB Calc Select menu and press
[MODIFY].
2. Press the soft key of the program you want.

3. Press [PRIOR MENU] to return to the OB Calc Select menu.

Customizing USER When selecting a custom USER program for MA calculation, you can
Programs specify:
• MA coefficients and table entry for the BPD, HC, AC, FL, and CRL
measurements.
• Up to three optional biometric measurements
• An optional biometric ratio.
• The EFW equation.
• The LMP PERCENTILE equation.
For standard biometric tables and coefficients, see “Siemens Standard
Charts” on page 85. If you do not modify standard measurement
parameters, the system uses the Hadlock charts. For additional charts, see
“OB Charts” on page 86.
You customize a measurement by entering values and text in an entry
screen. Each type of item (biometric measurements, optional biometric
measurements, optional ratio, EFW, and LMP Percentile equations) has
its own entry screen. The initial steps to customize an item, as described
in this section, are the same for all items. The sections that follow describe
the additional steps required to customize each item.
◆ To customize a measurement:
1. Select one of the following items in the OB Calc Select menu:
• BPD, HC, AC, FL, or CRL
• OPTION 1, OPTION 2, and/or OPTION 3

• OPTIONAL RATIO
• EFW
• LMP PERCENTILE
2. Press [MODIFY] to display the entry screen and soft key menu for the
selection.
CONTROL USE
[PRINTER] Prints the measurement or calculation definition

for your records.
[PRIOR MENU] Saves your changes and returns to the OB Calc
Select menu.
[EXIT] Exits the OB CALC Setup.
3. Refer to the sections that follow for descriptions of each of the entry
screens that you use to customize the equation, measurement, or
ratio.
NOTE: The EQUATION ENTRY or the TABLE ENTRY screen will

display. If the TABLE ENTRY screen displays press the [USE EQN]
softkey to access the EQUATION ENTRY screen. Likewise, if the
EQUATION ENTRY screen displays press the [USE TABLE]
softkey to access the TABLE ENTRY screen.

Customizing MA ◆ To customize the biometric measurement equation:
Coefficients for
Biometric Measurement 1. Enter the author’s name in the AUTHOR field and press the RETURN
Equations hardkey.
The label can be the author of the equation or any other name you
want to use to identify the equation on growth curves.
2. Enter the MA coefficients for the measurement by typing the value
for each coefficient in the corresponding column.
3. To include a standard deviation, enter range coefficients by typing
the value for each coefficient in the corresponding column.
NOTE: If you do not enter range coefficients, the standard deviation will
not appear on the worksheet, report, or growth curve.
4. Enter values for the MIN and MAX limits of validity for the
measurement.
5. Enter range labels for growth curves. For information on displaying
growth curves, see your User Manual.
The measurement name appears at the top of the Measurement Equation
Entry screen, shown in Figure 4-2.
Figure 4-2 Measurement Equation Entry

You must enter values for an MA coefficient and maximum limit, or the
error message EQUATION NOT VALID will appear on the screen and the
equation will not be entered.
The regression equation for biometric measurements is:
MA = Q0 + Q1(X) + Q2(X)2 + Q3(X)3 + Q4(X)4 + Q5(X)5
The coefficients in this equation are Q0, Q1, Q2, Q3, Q4, and Q5; X
represents the measurement being customized.
The range equation for biometric measurements is:
RANGE = Q0 + Q1(X) + Q2(X)2 + Q3(X)3 + Q4(X)4 + Q5(X)5

Customizing Biometric ◆ To customize the biometric measurement table:
Measurement with Table
Entry 1. Enter the author’s name in the AUTHOR field and press the RETURN
hardkey.
The label can be the author of the table or any other name you want
to use to identify the table on growth curves.
2. Select the measurement type L (linear), C (circumference), or A (area).
3. Enter the data into the table.
NOTE:
• If you do not enter the data in the range column, the standard
deviation will not appear on the worksheet, report, or growth curve.
• Unit of measurements for linear and range are in mm. Some
published charts are in cm.
• Unit of age is in weeks. Some published charts are in days, or weeks
and days.
• The Options Table Entry allows the user to enter a blank table with a
table name only. This is permitted in order to allow linear
measurements such as APTD and TTD.
Figure 4-3 BPD Measurement Table
CONTROL USE
PREVIOUS Scrolls through the table toward the beginning of the

PAGE table until reaching the first page.
NEXT PAGE Scrolls through the table toward the end of the table
until reaching the last page.
CLEAR TABLE Clears the table data, not the table header
information, author or measurement name.
INSERT ROW Inserts a new row into the table above the selected
row.
DELETE ROW Deletes the selected row from the table.

Adding Optional ◆ To customize the Optional Biometric Measurement via
Biometric Measurements equations:
1. Enter a label for the equation in the AUTHOR field.
The label can be the author of the equation or any other name you
want to use to identify the equation on growth curves.
2. Type the measurement name (up to four alphanumeric characters).
3. Specify Method of Measurement: type L if the measurement is linear,
A if the measurement is an area, and C if the measurement is a
circumference.
4. Enter the MA coefficients for the measurement by typing the value
for each coefficient in the regression equation:
MA = Q0 + Q1(OP1) + Q2(OP1)2 + Q3(OP1)3 + Q4(OP1)4 + Q5(OP1)5
The coefficients in this equation are Q0, Q1, Q2, Q3, Q4, and Q5.
5. If you want to include a standard deviation, enter range coefficients
for the standard deviation equation:
RANGE = Q0 + Q1(MA) + Q2(MA)2 + Q3(MA)3 + Q4(MA)4 + Q5(MA)5
NOTE: If you do not enter range coefficients for the standard deviation,
the standard deviation will not appear in the worksheet or the
report.
6. Enter values for the MIN and MAX limits of validity for the
measurement.
The Equation Entry Option screen is shown in Figure 4-4.
Figure 4-4 Equation Entry Option Screen
NOTE: You must enter values for an MA coefficient, maximum limit,

name, and measurement type, or the error message EQUATION
NOT VALID will appear on the screen and the equation will not be
entered

◆ To customize the Options Biometric Measurement table:
1. Enter the author’s name in the AUTHOR field and press the RETURN
hardkey.
The label can be the author of the table or any other name you want
to use to identify the table on growth curves.
2. Type the table name.
3. Specify Method of Measurement: type L if the measurement is linear,
A if the measurement is an area, and C if the measurement is a
circumference.
4. Enter the data into the table.
NOTE:
• If you do not enter the data in the range column, the standard
deviation will not appear on the worksheet, report, or growth curve.
• Unit of measurements for area is mm2. Some published charts are in
cm2.
• Unit of measurements for linear and range are in mm. Some
published charts are in cm.
• Unit of age is in weeks. Some published charts are in days, or weeks
and days.
The options name appears at the top of the measurement table entry
screen shown in Figure 4-5
Figure 4-5 The Options Measurement Table screen

.
CONTROL USE
PREVIOUS PAGE Scrolls through the table toward the beginning of the
table until reaching the first page.
NEXT PAGE Scrolls through the table toward the end of the table
until reaching the last page.
CLEAR TABLE Clears the table data, not the table header information,
author or measurement name.
INSERT ROW Inserts a new row into the table above the selected row.
DELETE ROW Deletes the selected row from the table.
Adding Optional The Optional Ratio Entry screen is shown in Figure 4-6.
Biometric Ratio
Figure 4-6 Optional Ratio Entry

Component measurements must exist and be turned on in the OB Calc
Select menu before you can use them in a ratio. Refer to “Selecting OB
Measurements and Calculations” on page 53.
Set Up the User-defined ◆ To set up the user-defined ratio:
Ratio
1. To specify the numerator of the ratio, select a measurement from the
list, press [NUM/DEN] so that NUM is highlighted, and then press
[ENTER].
2. To specify the denominator of the ratio, select a measurement from
the list, press [NUM/DEN] so that DEN is highlighted, and then press
[ENTER].
3. Press [PRIOR MENU] to save the ratio and return to the OB Calc Select
menu.

Customizing the EFW The EFW Equation Entry screen is shown in Figure 4-7. It contains a row
Equation of fields for each component of the EFW Equation.
Figure 4-7 EFW Equation Entry

To customize an EFW equation, select the USER program. EFW is
determined from measurements you take. The regression equation for the
EFW equation has the following format:
LOG EFW = T0 + T1 + T2 + T3 + T4 + T5
◆ To set the values for the EFW Equation, move to each of the
fields and enter the following:
hardkey.
IN THIS COLUMN: DO THIS:
Column 1 Type a numeric value.
Column 2 • Press the second softkey to select a biometric

measurement or select NONE.
Column 3
Column 4 • Press the third softkey to select the power or
log for the measurement (x/ x2 / x3 / logx /
1
/x).
Examples of EFW equations:

• OSAKA University EFW equation
EFW = 1.25647 * BPD3 + 3.50665 * FTA * FL + 6.3
• TOKYO University EFW equation:
EFW = 1.07 * BPD3 + 3.42 * APTD * TTD * FL

Customizing the LMP The LMP Percentile Entry screen is shown in Figure 4-8.
Percentile Calculation
The OB calculation package computes a low limit LMP percentile (10th
percentile) and a high limit LMP percentile (90th percentile). For each, it
uses the following equation:
EFW = Q0 + Q1(MA) + Q2(MA)2 + Q3(MA)3 + Q4(MA)4 + Q5(MA)5
The coefficients in this equation are Q0, Q1, Q2, Q3, Q4, and Q5.
Specify one set of coefficients for the low limit equation and another set
for the high limit equation.
◆ To set the values for the LMP Percentile Calculation:
hardkey.
2. Enter values for each of the coefficients for each equation.
3. Enter values for the MIN and MAX limits of validity.
Figure 4-8 LMP Percentile Entry

Selecting OB You can make individual OB measurements and calculations available by
Measurements and turning them on, or unavailable by turning them off. When a
Calculations measurement or calculation is turned on, it can appear in the worksheet
and report.
To turn on a ratio for MA calculations, the applicable component
measurements must be on. For example, FL and AC must be on in order
to turn on the FL/AC ratio. For more information, see “Adding Optional
Biometric Ratio” on page 50.
◆ To turn a measurement or calculation on or off:
1. Select the measurement or calculation in the OB Calc Select menu.
2. Press [ON/OFF] to select ON or OFF.
Customizing the The OB calculation worksheet contains two comment pages on which
Comment Page you can add additional information about the OB exam. The first
Template comment page contains several headings for fetal anatomy and
biophysical profile. During an exam, you enter comments after these
headings. The second comment page is designed for free form comments.
You can customize the first comment page to change or delete any of the
headings.
◆ To customize the comment page template:
1. Select COMMENT PAGE TEMPLATE in the OB Calc Select menu and
press [MODIFY] to display the template shown in Figure 4-9.
Figure 4-9 Comment Page Template

2. Use the trackball to position the cursor where you want to add or
change existing text and type the new text.
Press [UNDO ALL] if you want to restore the original template.
3. Press [ENTER] to save the new comment page template and return to
the OB Calc Select menu.

Selecting Printing The OB Calc Select menu contains four options for printing the OB
Options calculation worksheet and the growth curves to a multiformat camera or
an off-line printer:
• PRINT WORKSHEET TO PRINTER
• PRINT WORKSHEET TO CAMERA
• PRINT GROWTH CURVE TO PRINTER
• PRINT GROWTH CURVE TO CAMERA
◆ To set up worksheet and growth curve printing, select each

printing option and press [ON/OFF] to turn it ON or oFF.

CHAPTER 5
CUSTOMIZING VASCULAR CALCULATIONS
Customizing the Vascular Calculation Report 56

Selecting Studies to Include in the Report 56
Customizing Study Names and Site Names 57
Vascular Calculation Formulas 58

Customizing the You can customize the vascular calculation report by:
Vascular Calculation • Selecting the studies you want to include in it
Report
• Changing the site names
• Changing the study names for the two user-defined studies
• Adding your own custom title
For a full description of the vascular calculation package, see your User
Manual.
Selecting Studies to You select the studies that you want to include in the vascular calculation
Include in the report by turning them on. Turning off a study removes it from the
Report calculation package and the report.
◆ To customize the vascular calculation report:
1. Press SETUP and then choose CALC SET-UP.
2. Press [VASCULAR SEL] to display the Vascular Calc Select menu.
NOTE: You cannot customize the vascular calculation package if you are
working in the package. Press CALC to exit the calculation package first.
Figure 5-1 Vascular Calc Select Menu

3. Select a study from the list and press [ON/OFF] to turn it on or off.
4. Press [EXIT] to return to the image.

Customizing Study ◆ To customize study names and site names:
Names and Site 1. Press REPORT.
Names
2. Press [VASCULAR RPT] to display the vascular calculation report.
The report displays only the studies that you turned on. If you have
not taken any measurements, it does not display the site columns.
3. Press [PAGE] until the page you want to customize is displayed.
4. Press [RPT/WRKSHT] to select WRKSHT and display the worksheet.
All fields that you can edit are highlighted.
Figure 5-2 Vascular Report

5. Move the cursor to the item you want to change. You can change the
names of the VELOCITY and RATIO studies and all site names.
6. Type the new study name or site name.
NOTE: For studies that are related, such as the CAROTID and IC/CC, and
the PI, RI, and S/D RATIO, any changes you make to the site names in one
study will automatically change the same site names in the related study
or studies.
7. Type a new title in the title field, such as your site or department.
The title is saved permanently and is usually entered just once. If you
want to change it later, return to the vascular report, select the title,
and type a new title.
8. Press [RPT/WRKSHT] to apply your changes and return to the report.

Vascular Calculation
Formulas
STUDY VASCULAR CALCULATION FORMULAS
CAROTID None
IC/CC ICA pk /CCA pk
ICA pk= Internal carotid peak systolic velocity
CCA pk= Common carotid peak systolic velocity
PI | (MAX–MIN) | / |TAMX |
MAX= Maximum velocity
MIN= Minimum velocity
TAMX= Time averaged maximum velocity
RI | (MAX –MIN) | / | MAX |
S/D RATIO |MAX/MIN |
VELOCITY None
RATIO |NUM / DEN |
NUM= Any velocity
DEN= Any velocity
% STEN A (A–a) / A x 100
A= Greater of AREA 1 and AREA 2
a= Lesser of AREA 1 and AREA 2
% STEN D (D–d) / D x 100
D= Greater of DIAM 1 and DIAM 2
d= Lesser of DIAM 1 and DIAM 2

CHAPTER 6
CUSTOMIZING CARDIAC CALCULATIONS
Using the Cardiac Calc Select Menu 60

Customizing Cardiac Setup 62
Enter Vmax from VTI 62
Automatic Cycling 62
Averaging 62
Printing 62
Selecting Measurements and Calculations 63
Cardiac Calculation Formulas 67
Cardiac Calculation References 71
2D Volumes / Mass 71
M-mode 71
Doppler 71

You can customize the cardiac calculation package for your particular
needs. For example, you can select the measurements and calculations
you want to include in the report and worksheet. Any changes you make
remain in effect until you change them again.
To customize the package, you can:
• Specify the display of the measurement soft key and measurement
tool to easily allow multiple measurements at the same site
• Specify the printer type for printing the report
• Choose whether the calculation report shows average values for
measurements that you record multiple times
• Turn on the individual measurements and calculations that you want
to include in the report
For a full description of the cardiac calculation package, see your User
Manual.
Using the Cardiac You use the Cardiac Calc Select menu to customize the cardiac calculation
Calc Select Menu package.
◆ To customize the cardiac calculation package:
1. Press SETUP and then choose CALC SETUP.
2. Press [CARDIAC SEL] to display the first page of the Cardiac Calc
Select menu. The menu is comprised of several pages: Set-up,
2-D (three pages), M-mode, and Doppler.
NOTE: You cannot customize the cardiac calculation package if you are
working in the package. Press CALC to exit the calculation package first.
Figure 6-1 shows all six pages of the menu. For more information about
general setup, see “Customizing Cardiac Setup” on page 62. For
information about customizing calculations, see “Selecting
Measurements and Calculations” on page 63.
3. Press [PAGE] until you see the page where you want to make changes.
4. Select each item you want to change and press [ON/OFF] to turn it on
or off.
5. To leave this function, press [EXIT].

Page 1 Page 2
Page 3 Page 4
Page 5 Page 6
Figure 6-1 Cardiac Calculations Setup

Customizing
Cardiac Setup
Enter Vmax from VTI In spectral Doppler mode you can obtain a Velocity Time Integral (VTI)
calculation for all valve studies. In the LVOT, PV, and AoV studies you
can choose to have the Vmax automatically entered when you trace the
VTI, or you can choose to take a separate Vmax measurement. If you turn
on Enter Vmax From VTI, the Vmax will automatically be displayed on
the screen and entered when you enter the VTI. If necessary, you can
reposition the Vmax before you enter the VTI and Vmax measurements. If
you turn off Enter Vmax From VTI, you must perform the Vmax and VTI
measurements separately.
Automatic Cycling If you routinely take each measurement only once, you can customize the
system such that after you enter a measurement, the system
automatically sets up for the next measurement. This option is called
automatic cycling.
If you routinely take measurements multiple times at each site, it is
convenient to customize the system such that after you enter a
measurement, the system resets to take the measurement again.
You can independently turn Automatic Cycling on or off in 2-D imaging
mode, M-mode, and spectral Doppler mode.
Averaging You can record up to ten values for each cardiac measurement. When the
system uses these measurements to perform calculations and report
them, it uses either the average value for each measurement or the last
value you entered for each measurement. You specify which method the
system uses by turning Averaging on or off.
You can independently turn Averaging on or off in 2-D imaging mode,
M-mode, and spectral Doppler mode. The report shows measurement
values differently depending on which option you select.
Printing You can print the report or worksheet using any recording device linked
to the PRINT hard key. Turn on Print Worksheet to Printer to link PRINT
to the dot matrix printer. Turn on Print Worksheet to Camera to link
PRINT to a camera or page printer. Each camera or printer must be
installed and turned on.
A dot matrix printer prints all pages of the displayed worksheet or report.
Any other printer or camera prints only the current page. If both options
are turned on, the report or worksheet will be printed to both devices.

Selecting To tailor the cardiac calculation report and worksheet to your needs, you
Measurements and can turn measurements and calculations on and off.
Calculations
IMPORTANT: When you turn off a measurement, any calculations that use that
measurement automatically turn off. Furthermore, when you turn the
measurement back on, the calculations that use it DO NOT
automatically turn back on; to use the calculations again, you must turn
them back on. When you turn on a calculation, the measurements it
uses automatically turn on because they are required for the calculation.
Table 6-1, Table 6-2, and Table 6-3 list, by mode, the measurements and
calculations that affect each other when one or the other is turned on or
off.
◆ To turn off measurements and calculations:

1. Display the 2-D, M-mode, or Doppler page of the Cardiac Calc
Select menu.
2. Select a measurement or calculation that you want to turn on or off.
3. Press [ON/OFF] to select ON or OFF.
4. Repeat these steps for each measurement and calculation and for
each page.
Table 6-1 Related 2-D Measurements and Calculations

Measurement Or Turning Label ON Automatically Turning Label OFF Automatically
Calculation Label Turns ON The Following: Turns OFF The Following:
Simpson Volume (A4C) LVd area (A4C) Simpson Volume (Biplane)
Simpson Volume (A2C) LVd area (A2C) Simpson Volume (Biplane)
Simpson Volume (Biplane) Simpson Volume (A4C)
Simpson Volume (A2C)
LVd area (A4C)a
LVd area (A2C)
Area-Length (A4C) LVd area (A4C)
Area-Length (Biplane) LVd area (A4C)
LVd area (A2C)
Bullet Formula LVd area (A4C)
LV area (PSAX MV)
LV Mass (Area-Length)b LV area (PSAX MV) LVepi areac

LVepi area
LV Mass (Trunc Ellip) LVepi area LVepi area
LV area (PSAX MV)

Table 6-1 Related 2-D Measurements and Calculations (Continued)
Measurement Or Turning Label ON Automatically Turning Label OFF Automatically
Calculation Label Turns ON The Following: Turns OFF The Following:
LV Area(A4C) LVd area LVd area
LVs area (A4C) LVs area (A4C)
Simpson Volume (Biplane)
Area-Length (A4C))
Area-Length (Biplane)
Bullet Formula
LV Area (A2C) LVd area LVd area
LVs area (A2C) LVs area (A2C)
Simpson Volume (Biplane)
Area-Length (Single Plane)
LV Area (PSAX MV) LVd area LVd area
LVs area (PSAX MV) LVs area (PSAX MV)
Bullet Formula
LV Mass (Area-Length)
LV Mass (Trunc Ellip)
PLAX Study All measurements in this study, All measurements in this study,
except for: except for:
LVOT DIAM LVOT DIAM
PSAX MV Study All measurements in this study All measurements in this study
LVd area LVd area
LVepi area LVepi area
LVs area LVs area
PSAX AO Study All measurements in this study All measurements in this study
A4C Study All measurements in this study All measurements in this study
LVd area LVd area
LVs area LVs area
Wall Score Study All measurements in this study All measurements in this study
a. LVd area is not shown in Calc Select as a selectable item.

b. You can only turn on either LV Mass (Area Length) or LV Mass (Trunc Ellip). They cannot both
be on at the same time.
c. LV epi area is not shown in Calc Select as a selectable item.

Table 6-2 Related M-Mode Measurements And Calculations
Measurement or Turning label ON automatically Turning label OFF automatically
Calculation Label turns ON the following: turns OFF the following:
Stroke Volume LV Diameter ~
(Teichholz)
IVS Thickness ~ LV Mass
IVS/LVPW Ratio
LV Diameter ~ Stroke Volume
LV Mass
EPSS/LVed Ratio
LV Mass IVS Thickness ~
LV Diameter
LV Post Wall
LV Post Wall ~ LV Mass
IVS/LVPW Ratio
IVS/LVPW Ratio IVS Thickness ~
LV Post Wall
E Septal Separation ~ EPSS/LVed Ratio
EPSS/LVed Ratio E Septal Separation ~
LV Diameter
AO Diameter - Diastole ~ LA/AO Ratio
LA Diameter - Systole ~ LA/AO Ratio
LA/AO Ratio AO Diameter - Diastole ~
LA Diameter - Systole
VCF Study All measurements in this study All measurements in this study

Table 6-3 Related Doppler Measurements And Calculations
Measurement or Turning label ON automatically Turning label OFF automatically
Calculation Label turns ON the following: turns OFF the following:
Qp/Qs ~ ~
Continuity Equation, Vmax LVOT Vmax/Pressure Grad ~
LVOT Diam
AoV Vmax/Pressure Grad
Continuity Equation, VTI AoV VTI ~
LVOT VTI
LVOT Diam
LVOT VTI ~ Continuity Equation, VTI
LVOT CO
LVOT Vmax/Pressure Grad ~ Continuity Equation, Vmax
LVOT Diam ~ Continuity Equation, Vmax
Continuity Equation, VTI
LVOT Cardiac Output
AoV Vmax/Pressure Grad ~ Continuity Equation, Vmax
AoV VTI ~ Continuity Equation, VTI
LVOT Cardiac Output LVOT VTI ~
(LVOT CO) LVOT Diam
MV Pressure Half Time ~ MV Area
MV Area MV Pressure Half Time ~
TR Vmax/Pressure Grad ~ RV Systolic Pressure
RV Systolic Pressure TR Vmax/Pressure Grad ~
Diastolic Function ~ E/A Ratio, A/E Ratio
E/A Ratio Diastolic Function ~
A/E Ratio Diastolic Function ~

Cardiac Calculation
Formulas
Table 6-4 2-D Calculation Formulas

Study Calculation Units Formula
Method of Volume ml [(π/4) x L x Sum (Ai x Bi) /20]
Disks
where L is the longest length, Sum is the sum of the
(Biplane)
20 slices, and Ai and Bi are the 2ch and 4ch slices.
Area-Length End Diastolic ml 8(LVAd 4 ch)2/(3π x LVLd 4 ch)
(Single Plane) Volume
End Systolic ml 8(LVAs 4 ch)2/(3π x LVLs 4 ch)
Volume
Stroke Volume ml End Diastolic Volume - End Systolic Volume
Stroke Index ml/m2 Stroke Volume/Body Surface Area
Ejection Fraction % [(End Diastolic Volume - End Systolic Volume)/End

Diastolic Volume] x 100
Cardiac Output L/min (Stroke Volume x Heart Rate)/1000
Cardiac Index L/min/m2 Cardiac Output / Body Surface Area
Area-Length End Diastolic ml (8 x LVAd 4 ch x LVAd 2 ch)/(3π x LVLd)
(Biplane) Volume
where LVLd is the longer of LVLd 4 ch and LVLd 2
ch
End Systolic ml (8 x LVAs 4 ch x LVAs 2 ch)/(3π x LVLs)
Volume
where LVLs is the longer of LVLs 4 ch and LVLs 2 ch
Stroke Index L/min/m2 Stroke Volume/Body Surface Area
Bullet End Diastolic ml 5/6 x LVAd SAX x LVLd 4 ch
Formula Volume
End Systolic ml 5/6 x LVAs SAX x LVLs 4 ch
Volume
Stroke Index L/min/m2 Stroke Volume/Body Surface Area

Table 6-4 2-D Calculation Formulas (Continued)
LV Mass LV Mass gm 1.05 x {[5/6 x LVd Area SAX epi x (LVd 4ch Length +
(Area-Length) t)] - [5/6 x LVd Area SAX endo x LVd Length 4ch]}
t LVdAreaSAXepi ⁄ π – LVdAreaSAXendo ⁄ π
LV Mass (TE) LV Mass gm 1.05 x π {(b +t)2 * [2/3(a +t) + d - (d3/3(a+t)2)] - b2

x [2/3(a) + d - (d3/3a2)]}
b (minor radius) LVdAreaSAX ⁄ π
t (mean wall LvdAreaSAXepi ⁄ π – b

thickness)
a (semimajor axis) left ventricle long or semimajor axis from widest
minor axis radius to apex from LVd length 4ch or
LVd length 2ch
(When both LVd length 4ch and LVd length 2ch
measurements are available, the longer of the two
is used.) LV Mass indexed by body surface area =
LV mass / body surface area
d (truncated left ventricle long axis from widest short-axis
semimajor axis) diameter to mitral anulus plane from LVd length
4ch or LVd length 2ch
Parasternal Fractional % [ ( LVDd – LVDs ) ⁄ ( LVDd ) ] × 100
Long Axis Shortening
(PLAX)
Parasternal Fractional % [ ( LVDd SAX – LVDs SAX ) ⁄ LVDd SAX ] × 100
Short Axis at Shortening
Mitral Valve
(PSAX MV)
Fractional Area % ( ( LVd area SAX – LVs Area SAX ) ⁄ LVdArea SAX ) × 100
Change

Table 6-5 M-Mode Calculation Formulas
Left End Diastolic Volume ml 7.0/(2.4 + LVDd) x LVDd3
Ventricular (DIA VOL)
(LV)
End Systolic Volume ml 7.0/(2.4 + LVDs) x LVDs3
(SYS VOL)
Stroke Volume (SV) ml End Diastolic Volume - End Systolic Volume
Ejection Fraction (EF) % [(End Diastolic Volume - End Systolic Volume)/End
Cardiac Output L/min (Stroke Volume x Heart Rate) / 1000
Left Ventricular % [(LVDd - LVDs)/LVDd] x 100
% Fractional Shortening
(FRAC SHTNG)
Interventricular Septal % [(IVSs - IVSd)/IVSd] x 100
% Fractional Thickening
(FRAC THCKNG)
Left Ventricular % [(LVPWs - LVPWd)/LVPWd] x 100
Posterior Wall%
Fractional Thickening
(FRAC THCKNG)
Interventricular IVSd/LVPWd
Septal/Left Ventricular
Posterior Wall Ratio
(IVS/LVPW)
Left Ventricular Mass gm 1.04 [(LVDd +LVPWd + IVSd)3 - LVDd3]
(LV MASS) (ASE)
Left Ventricular Mass gm .80 LV MASS (ASE) + 0.6
(LV MASS) (corr)
EPSS/LVed Ratio MV E -Septal Separation / Left Ventricular
Diameter (end diastole)
Aortic/Left Left Atrium/Aortic Ratio LA DIAs/Ao DIAd
Atrial
(AO/LA)
VCF Study LVETc msec
LVETms ⁄  --------------------
R – Rms-
(VCF) 1000 
VCFc circs/sec LVDd – LVDs
--------------------------------------- × 1000
LVDd × LVETc

Table 6-6 Spectral Doppler Calculation Formulas
Study Formula Units Calculation
Aortic valve (AoV) AoV Pressure Gradient mmHg 4 x Vmax2
(PGRAD)
LVOT Cross Sectional Area cm2 π × ( LVOT DIAM ⁄ 2 ) 2
(LVOT AREA)
Continuity Equations:
Aortic Valve Areaa (AVA)

AVA (Vmax)) cm2 πd 2 ⁄ 4 × Vmax ( LVOT ) ⁄ Vmax ( AV )
(d measured in systole)
AVA (VTI)) cm2 πd 2 ⁄ 4 × VTI ( LVOT ) ⁄ VTI ( AV )
(d measured in systole)
AT/ET AoV AT/ AoV ET
Cardiac Output L/min SV x Heart Rate/ 1000
Mitral valve (MV) E/A Peak E / Peak A
A/E Peak A / Peak E
MV AREA cm2 220/ MV PHT
Pulmonic valve Pressure Gradient (PGRAD) mmHg 4 x Vmax2

(PV)
Tricuspid valveb Pressure Gradient Tricuspid mmHg 4 x Vmax2

(TV) Regurgitation (TR PGRAD)
Right Ventricular Systolic mmHg RA(Keyed in) + 4(TR Vmax2)

Pressure (RVSP)
Qp/Qs study Systemic Cross Sectional Area cm2 π × ( SYST DIAM ⁄ 2 ) 2
(SYST CSA)
Systemic Stroke Volume (SV) ml SYST VTI x SYST CSA x 100
Pulmonary Cross Sectional cm2 π × ( PULM DIAM ⁄ 2 ) 2
Area (PULM CSA)
Pulmonary Stroke Volume (SV) ml PULM VTI x PULM CSA x 100
Qp/Qs PULM CO / SYST CO
Qp - Qs L/min PULM CO - SYST CO if PULM CO >
SYST CO
Cardiac Output L/min SV x (HR/1000)
(Pulm and Syst)
a. The system can use either or both the LVOT VTI with the AoV VTI or the LVOT Vmax with the AoV Vmax.
The report indicates which values were used to calculate the AV AREA.
b. If you enter a TR Vmax, the right ventricular systolic pressure is 10 mm Hg + 4Vmax2 and is calculated
automatically. If the TR Vmax is not entered, the RA pressure heading is not displayed. You can display the
heading and manually enter it in the worksheet using [EDIT].

Cardiac Calculation
References
2D Volumes / Mass Weyman, A.: Clinical Applications of Cross-Sectional Echocardiography.
Circulation 1982; pp 284, 291-296, 398, 399, 405, 406.
Silverman, N. H., T. A. Ports, A. R. Snider, et al.: Determination of Left
Ventricular Volume in Children: Echocardiographic and Angiographic
Comparisons. Circulation 1980; 62:548-557.
Mercier, J. C., T. G. DiSessa, J. M. Jarmakani, et al.: Two-Dimensional
Echocardiographic Assessment of Left Ventricular Volumes and Ejection
Fraction in Children. Circulation 1982; 65:962-969.
Schiller, N. B., H. Acquatella, T. A. Ports, et al.: Left Ventricular Volume
from Paired Biplane Two-Dimensional Echocardiography. Circulation
1979; 60:547-555.
Wahr, D. W., Y. S. Wang, N. B. Schiller: Left Ventricular Volumes
Determined by Two-Dimensional Echocardiography in a Normal Adult
Population. J Am Coll Cardiol 1983; 1:863-868.
Schiller, N. B., et al.: Recommendations for Quantification of the Left
Ventricle by Two-Dimensional Echocardiography. J Am Soc Echo 1989;
2:358-267.
M-mode Sahn, D. J., A. DeMaria, J. Kisslo, A. Weyman: Recommendations
Regarding Quantitation in M-mode Echocardiography: Results of a
Survey of Echocardiographic Measurements. Circulation 1978; 6:58.
Snider, A. Rebecca, M.D. and Serwer, Gerald A., M.D. 1990.
Echocardiography in Pediatric Disease 1990; Yearbook Medical Publishers;
p. 81.
Doppler Appleton, C. P., L. K. Hatle, and R. L. Popp: Relation of Transmitral Flow
Velocity Patterns to Left Ventricular Diastolic Function: New Insights
from a Combined Hemodynamic and Doppler Echocardiographic Study.
J Am Coll Cardiol; 12:426-440.
Berger, M. A., A. Haimowitz, A. Van Tosh, et al: Quantitative Assessment
of Pulmonary Hypertension in Patients with Tricuspid Regurgitation
Using CW Doppler. J Am Coll Cardiol 1985; 6:359-365.
Grayburn, P.A., R. Handshoe, M. D. Smith, M. R. Harrison, A. J. DeMaria.
Quantitative Assessment of the Hemodynamic Consequences of Aortic
Regurgitation by Means of Continuous Wave Doppler Recordings.
J Am Coll Cardiol 1987; 10 (1):135-141.
Hatle, Liv, M.D., and Bjorn Angelson. Doppler Ultrasound in Cardiology
1985; pp 8-9, 114-116, 118, 306-319.
Hatle, Liv, M.D. Noninvasive Assessment of Atrioventricular Pressure
Half-Time by Doppler Ultrasound. Circulation 1979; 60 (5):1096-1104.
Hatle, Liv, M.D. Noninvasive Assessment of Pressure Drop in Mitral
Stenosis by Doppler Ultrasound. British Heart Journal 1978; 40:131-149.
Labovitz, A. J., M.D., FACC; R.P. Ferrara, M.D.; M.J. Kern, M.D., FACC;
R.J Bryg, M.D.; D.G. Mrosek; G.A. Williams, M.D., FACC. Quantitative
Evaluation of Aortic Insufficiency by Continuous Wave Doppler
Echocardiography. J Am Coll Cardiol 1986; 8 (6):1341-1347.

Masuyama T., K. Kodama, A. Kitabatake, S. Nanto, et al. Noninvasive
Evaluation of Aortic Regurgitation by Continuous-Wave Doppler
Echocardiography. Circulation 1986; 73 (3): 460-466.
Otto, C. M., A. S. Pearlman, et. al. Simplification of the Doppler
Continuity Equation for Calculating Stenotic Aortic Valve Area. J Am Soc
Echo 1988; 1:155-157.
Reichek, N., J. Helak, T. Plappert, M. St. John Sutton, K. T. Weber:
Anatomic Validation of Left Ventricular Mass Estimates from Clinical
Two-dimensional Echocardiography: Initial Results. Circulation 1983;
Vol. 67, No. 2:348-352.
Skjaerpe, Terje, M.D., L. Hegrenaes, L. Hatle. Noninvasive Estimation of
Valve Area in Patients with Aortic Stenosis by Doppler Ultrasound and
Two-Dimensional Echocardiography. Circulation 1985; 72 (4):810-818.
Snider, A. Rebecca, M.D. and Gerald A. Serwer, M.D. Echocardiography in
Pediatric Heart Disease 1990; Yearbook Medical Publishers. p. 78-133.
Snider, A. Rebecca, M.D. Prediction of Intracardiac Pressures and
Assessment of Ventricular Function with Doppler Echocardiography.
Echocardiography 1987; 4 (4):305-319.
Tajik, A. J.: Recommendations for Quantitation of the Left Ventricle by
Two-Dimensional Echocardiography. J Am Soc Echo (Sept/Oct) 1989;
Vol. 2, No. 5:358-367.
Teague, S. M., J. A. Heinsimer, J. L. Anderson, K. Sublett, E. G. Olson,
Thadani Voyles. Quantification of Aortic Regurgitation Utilizing
Continuous Wave Doppler Ultrasound. J Am Coll Cardiol 1986; 8
(3):592-599.
Zoghbi, William A., M. D., K. L. Farmer, J. G. Soto, J. G. Nelson, M. A.
Quinones. Accurate Noninvasive Quantification of Stenotic Aortic Valve
Area by Doppler Echocardiography. Circulation 1986; 73 (3):452-459.

CHAPTER 7
VCR AND PRINTER SETUP
Setting Up Video Controls 74

Setting Up the VCR Counter 74
Adjusting Brightness, Color Levels, and Contrast 74
Setting Up a Video Cassette Recorder 75
Connecting a Sony SVO-9500MD VCR 75
Adjusting the Sony 9500 VCR Settings 76
Installing and Using an External VCR 77
Setting up Printers 78
Quick Disconnect Installation 79
Installing and Servicing the Multi-Imager 81
Connecting a Computer Printer 82

Setting Up Video The video setup function lets you set the VCR counter and select the
Controls external video input source for viewing on the monitor.
Setting Up the VCR The ACUSON Aspen system displays a VCR counter in the data field to
Counter identify VCR recorded time. This feature helps you keep track of where
you are in a tape. You can set the VCR counter to zero to record on a new
tape, or set it to match the number displayed on the VCR’s tape counter
when you are recording on a tape that already contains images. The tape
counter is highlighted when you are recording. The three tape counter
fields are hours, minutes, and seconds. For example:
0:45:32
◆ To display the VCR counter, press VCR CTRL.

1. To reset the VCR counter to zero, press [COUNTER CLEAR].
2. To input a time other than zero, use the numeric keys. Use the Tab
key to change fields.
3. To enter the new counter values, press [COUNTER SET].
The setting is entered into the ACUSON Aspen system.
4. To leave the VCR counter feature, press VCR CTRL, or press RETURN
on the ACUSON Aspen system.
The soft key menu and the VCR counter display disappear from the
screen.
Adjusting Brightness, You can adjust the brightness, color levels, and contrast during video
Color Levels, and playback.
Contrast
◆ To adjust brightness, color level, and contrast during video
playback, press VCR CTRL.
1. Press [BRIGHTEN=XX], [CONTRAST=XX], or [COLOR=XX] to select the
adjustment you want to make. Move the trackball up to increase or
down to decrease the corresponding level.
2. To save the new level as a default level, press [SAVE].
3. Repeat steps 1 and 2 for each level you want to adjust.
4. To leave this function, press RETURN or VCR CTRL.
NOTE: You cannot adjust these levels during video playback if
GAIN/FRZ/RUN is activated. The soft key menu does not appear.

Setting Up a Video The ACUSON Aspen user interface was designed for use with the Sony
Cassette Recorder SVO-9500MD VCR and requires a special cable from Siemens to integrate
the VCR controls. You can connect a different VCR using the ACUSON
Aspen system’s external video connection. However, such an external
VCR is not integrated with the VCR control keys on the ACUSON Aspen
system keyboard.
NOTE: The system only supports playback of Super VHS video formats.
If you purchased a VCR from Siemens, your Siemens Customer Service
Engineer will connect it to the ACUSON Aspen system for you.
Regardless of where you purchased your VCR, you must purchase from
Siemens the cables for connecting it to the ACUSON Aspen system.
WARNING! A VCR must be plugged into one of the isolated accessory outlets on the
back of the ACUSON Aspen system. Using another power source
compromises electrical patient isolation and may exceed safe leakage
current levels.
Connecting a Sony Your Siemens Customer Service Engineer installs the integrated Sony
SVO-9500MD VCR SVO-9500MD VCR for you. If you need to reinstall the VCR, refer to
Figure 7-1 for an installation diagram.
ACUSON Aspen System

I/O Panel
Connect to VCR 8
VCR Cable
P/N 34810
VCR Remote Siemens Adapter

Required P/N
VCR Audio
VCR Audio
35013
Video-Out
SVHS in
Video-In
Out Left
In Left
VCR
VCR
AUDIO MONITOR VIDEO

AUDIO IN VIDEO IN OUT OUT OUT on
CH-1/L CH-1/L
S Video RS-232C
75¾ 75¾ S-Video
off on off on
CH-2/R CH-2/R
INDICATE
AC POWER
VCR Audio
VCR Audio
SVHS Out
Out Right
Set swtich 4 off to operate

In Right
VCR from ACUSON Aspen

keyboard. Set to on to operate
VCR from VCR front panel
controls.
Figure 7-1 Connecting a Sony SVO-9500MD VCR

Adjusting the Sony 9500 The Sony 9500 VCR has settings that specify how it records and plays
VCR Settings back video information. Your Siemens Customer Service Engineer will
configure the VCR to ACUSON Aspen recommended settings upon
installation.
Front Panel Controls Set the controls on the front panel of the VCR as described in the
following table.
Table 7-1 Front Panel Settings

Switch Recommended Setting
Monitor Mix
Audio Hi-Fi
Hi-Fi On
Tracking Detent (adjust detent, if required, to produce a
stable, uniform image)
Program Off
Index CTL
Back Panel Controls Set the controls on the back panel of the VCR as described in the
following table.
Table 7-2 Back Panel Settings

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

1. Press STOP on the ACUSON Aspen keyboard.
2. Turn the VCR’s INDEX switch from CTL to MENU.
3. Press and hold the VCR PLAY button.
4. Press the VCR ITEM button to scroll through the menu of available
settings.
5. To change the setting for a menu item, press the VCR DATA button
while continuing to hold PLAY.
Siemens recommends the settings shown in Table 7-3.

6. To exit the setup function and return to normal operation, turn the
VCR’s INDEX switch from MENU to CTL.
Table 7-3 Recommended VCR Settings

Parameter Recommended Setting (NTSC and PAL)
nOn On
FrA On
HS On
uS On
u1A On
FOt LE
tPE Et
SuH At
Cnr OF
Ynr OF
YEn OF
FrE Fr
SOP OF
34P PA
FrS PA
LPH 45
L1n OF
Installing and Using an An external VCR is any VCR other than the integrated Sony
External VCR SVO-9500MD. For instructions on connecting an external VCR to your
system, consult your Siemens Customer Service Engineer.
Configuring an External To set up your system to use an external VCR:
VCR
1. Change the ACUSON Aspen system external video settings to their
appropriate values for your VCR. For instructions, see “Changing the
External Video Configuration” on page 16.
2. Set the external video input source to the external VCR. For
instructions, see “Selecting the External Video Source” on page 11.
Using an External VCR You use the controls on the VCR to record and to playback videotapes.
You cannot use the VCR keys on the ACUSON Aspen system keyboard.
◆ To use an external VCR for recording or playback:
1. Press EX VIDEO to start playback on the external VCR.
2. Press EX VIDEO again to stop playback.
3. Use the controls on the VCR for all other VCR functions.

Setting up Printers See the Printer Quick Reference Guide (part number 63313) or the
manufacturer’s printer manual for more details.
There are two ways to install a printer:
• You can connect the printer directly to the ACUSON Aspen system’s
I/O panel. You normally use this method when the printer is placed
directly on the ACUSON Aspen system’s accessory shelf.
• You can connect the printer using the special Siemens Quick
Disconnect cable. You normally use the Quick Disconnect cable when
a printer is placed on an accessory cart and you need to be able to
quickly disconnect it to move the cart or the system.
WARNING! DO NOT plug printers, or other connected peripheral devices,

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

temperatures, excessive dust, mechanical vibration, or direct sunlight.
Clean the cabinet, panel, and controls with a dry soft cloth or a soft cloth
lightly moistened with a mild detergent solution. Do not use any type of
solvent, such as alcohol or benzene, that may damage the finish.

Quick Disconnect To connect a printer using the Quick Disconnect cable, connect it between
Installation the printer and the system as shown in the following illustration.
NOTE: The Quick Disconnect cable is sold separately. Please contact
your Siemens Customer Service Engineer for more information.
QD SYSTEM CONNECTION
ACUSON
SYSTEM
Connect to
"Quick
Disconnect"
Rear View
}
COLOR PAGE PRINTER
CONNECTIONS
CABLE EXAMPLE: SONY 5650
LABELS PRINTER
SYSTEM QUICK
DISCONNECT
CABLE P/N 39933
IMAGER IN- RED INPUT- R
IMAGER IN- GREEN INPUT- G
IMAGER IN- BLUE INPUT- B
IMAGER IN- SYNC INPUT- SYNC
IMAGER OUT- RED N/C
IMAGER OUT- GREEN N/C
IMAGER OUT- BLUE N/C
IMAGER OUT- SYNC N/C
IMAGER - VIDEO OUT OUTPUT-VIDEO

IMAGER - EXPOSE/ REMOTE
NOTE: SIEMENS ADAPTER
REQUIRED P/N 26096
1
IMAGER - REMOTE N/C
6
B/W MULTI IMAGE CAMERA
}
CABLE CONNECTIONS
LABELS EXAMPLE IIE:4000 CAMERA
MIC - VIDEO VIDEO IN
MIC - EXPOSE/ REMOTE EXPOSE
Figure 7-2 Quick Disconnect Installation

Observe the following safety precautions when using the printer:
• Unplug the printer from the ACUSON Aspen system if you do not
expect to use it for a long period of time.
• Do not turn the power off while the printer is printing; otherwise the
thermal head may be damaged.
• Do not touch the printer cutting blade.
• Do not carry and move the printer when the paper roll is placed in
the printer.
• Unplug the printer immediately if any liquid falls into the cabinet.
Have the printer serviced immediately.

Installing and Servicing Your Siemens Customer Service Engineer will initially install the printer
the Multi-Imager for you. If you need to remove and reinstall the printer, do so as shown in
the following diagram.
ACUSON Aspen System

I/O Panel
Connect to Connect to
"Exp/Cntrl" "Cam Video"
Exp/Control CamVideo
Cable P/N Cable P/N
39934 39935
Video In
Remote
Expose
AC Power
Figure 7-3 Multi-Imager Installation

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

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

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

APPENDIX A
OB CALCULATION FORMULAS
Using The Charts 85

Siemens Standard Charts 85
References 86
OB Charts 86
AC Chart, Campbell 87
AC Chart, Hadlock 88
AC Chart, Jeanty 91
Binocular Distance Chart, Jeanty 92
BPD Chart, Campbell 93
BPD Chart, Hadlock 94
BPD Chart, Hansmann 95
BPD Chart, Jeanty 96
BPD Chart, Kurtz 97
BPD Chart, Sabbagha 98
BPD Chart, Tokyo University 99
BPD Chart, Yale 100
Cerebellum Chart, Goldstein 101
Cerebellum Chart, McLeary 102
CRL Chart, Hadlock 103
CRL Chart, Hansmann 104
CRL Chart, Jeanty 105
CRL Chart, Nelson 106
CRL Chart, Robinson, 1975 107
CRL Chart, Robinson, 1988 108
CRL Chart, Tokyo University 109
EFW Chart, Shepard 110
Fibula Chart, Jeanty 118
FL Chart, Campbell 119
FL Chart, Hadlock 120
FL Chart, Hansmann 121
FL Chart, Hohler 122
FL Chart, Jeanty 123
FL Chart, O’Brien 124
FL Chart, Queenan 125
FL Chart, Tokyo University 126
Foot Chart, Mercer 127
Gestational Sac, Hansmann 128
Gestational Sac, Hellman 129
HC Chart, Campbell 130
HC Chart, Hadlock 131
HC Chart, Hansmann 134

HC Chart, Hoffbauer 135
HC Chart, Jeanty 136
Humerus Chart, Jeanty 137
Outer Orbits Chart, Mayden 138
Thoracic Circumference, Romero 139
Thoracic Diameter, Hansmann 140
Tibia Chart, Jeanty 141
Tibia Chart, Merz 142
Ulna Chart, Jeanty 143

Using The Charts This appendix provides the OB calculation formulas used to estimate
menstrual age (MA) and estimated fetal weight (EFW). All charts,
including Siemens standard equations and additional equations that you
can enter into the system, are listed in alphabetical order.
Siemens assumes no responsibility or liability for customers choosing
nonstandard regression coefficients in the ACUSON Aspen OB
Calculation Option. The resulting equations are calculated by a standard
regression analysis technique contained in the Visi-Trend/Plot program,
manufactured by Paladin Software of San Jose, California.
The accuracy of the regression equation in actual use depends on the
accuracy of the data entered in the ACUSON Aspen system, among other
factors. Siemens assumes no responsibility for the accuracy of the
regression program or the equation derived from the program.
IMPORTANT: The equations are valid only within the limits provided.
The terms gestational age and menstrual age are often used
interchangeably in ultrasound literature despite the fact that they have
different meanings. Siemens assumes that the age data in the
user-supplied table was expressed as menstrual age, regardless of how
the table is labeled.
ACUSON Aspen The standard ACUSON Aspen system programs use the following fetal
Standard Charts parameter charts:
• AC Chart, Hadlock
• BPD Chart, Hadlock
• CRL Chart, Hadlock
• FL Chart, Hadlock
• HC Chart, Hadlock

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

AC Chart, Campbell
14-40 weeks
AC Menstrual Age
(mm) (weeks)
86 14
103 16
130 18
151 20
174 22
198 24
220 26
242 28
254 29
264 30
276 31
286 32
298 33
308 34
320 35
326 36
338 37
346 38
354 39
360 40
Regression Equation:
MA Coeff 2SD Coeff
Q0 = 4.4901880 Q0 = 0.0000000
Q1 = 1.2778320 Q1 = 0.0000000
Q2 = – 0.0221740 Q2 = 0.0000000
Q3 = 0.0003847 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
4.4901880+1.2778320*AC+–0.0221740*AC^2+0.0003847*AC^3
Limits
MIN = 14.0 wks 8.6 cm
MAX = 40.0 wks 36.0 cm
Reference: Campbell, S., Wilkin, D. 1975. Ultrasonic Measurement of Fetal Abdominal Circumference
in the Evaluation of Fetal Weight. British Journal of Obstetrics and Gynecology 82. 689-697.

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

(mm) (weeks) Dev (mm) (weeks) Dev (mm) (weeks) Dev
51 12.1 1.7 90 15.2 1.7 130 18.5 2.1

52 12.2 1.7 91 15.3 1.7 131 18.6 2.1
53 12.2 1.7 92 15.4 1.7 132 18.7 2.1
54 12.3 1.7 93 15.5 1.7 133 18.8 2.1
55 12.4 1.7 94 15.5 1.7 134 18.9 2.1
56 12.5 1.7 95 15.6 1.7 135 19.0 2.1
57 12.5 1.7 96 15.7 1.7 136 19.0 2.1
58 12.6 1.7 97 15.8 1.7 137 19.1 2.1
59 12.7 1.7 98 15.9 1.7 138 19.2 2.1
99 15.9 1.7 139 19.3 2.1
60 12.8 1.7 100 16.0 1.7 140 19.4 2.1

61 12.9 1.7 101 16.1 1.7 141 19.5 2.1
62 12.9 1.7 102 16.2 1.7 142 19.6 2.1
63 13.0 1.7 103 16.3 1.7 143 19.6 2.1
64 13.1 1.7 104 16.4 1.7 144 19.7 2.1
65 13.2 1.7 105 16.4 1.7 145 19.8 2.1
66 13.3 1.7 106 16.5 1.7 146 19.9 2.1
67 13.3 1.7 107 16.6 1.7 147 20.0 2.1
68 13.4 1.7 108 16.7 1.7 148 20.1 2.1
69 13.5 1.7 109 16.8 1.7 149 20.2 2.1
70 13.6 1.7 110 16.9 1.7 150 20.2 2.1

71 13.7 1.7 111 16.9 1.7 151 20.3 2.1
72 13.7 1.7 112 17.0 1.7 152 20.4 2.1
73 13.8 1.7 113 17.1 1.7 153 20.5 2.1
74 13.9 1.7 114 17.2 1.7 154 20.6 2.1
75 14.0 1.7 115 17.3 1.7 155 20.7 2.1
76 14.1 1.7 116 17.4 1.7 156 20.8 2.1
77 14.2 1.7 117 17.4 1.7 157 20.8 2.1
78 14.2 1.7 118 17.5 1.7 158 20.9 2.1
79 14.3 1.7 119 17.6 1.7 159 21.0 2.1
80 14.4 1.7 120 17.7 1.7 160 21.1 2.1

81 14.5 1.7 121 17.8 1.7 161 21.2 2.1
82 14.6 1.7 122 17.9 1.7 162 21.3 2.1
83 14.6 1.7 123 17.9 1.7 163 21.4 2.1
84 14.7 1.7 124 18.0 2.1 164 21.5 2.1
85 14.8 1.7 125 18.1 2.1 165 21.5 2.1
86 14.9 1.7 126 18.2 2.1 166 21.6 2.1
87 15.0 1.7 127 18.3 2.1 167 21.7 2.1
88 15.0 1.7 128 18.4 2.1 168 21.8 2.1
89 15.1 1.7 129 18.5 2.1 169 21.9 2.1

AC Chart, Hadlock
(continued)

170 22.0 2.1 210 25.5 2.2 250 29.2 2.2

171 22.1 2.1 211 25.6 2.2 251 29.3 2.2
172 22.2 2.1 212 25.8 2.2 252 29.4 2.2
173 22.2 2.1 213 25.8 2.2 253 29.5 2.2
174 22.3 2.1 214 25.9 2.2 254 29.6 2.2
175 22.4 2.1 215 26.0 2.2 255 29.7 2.2
176 22.5 2.1 216 26.1 2.2 256 29.8 2.2
177 22.6 2.1 217 26.2 2.2 257 29.9 2.2
178 22.7 2.1 218 26.3 2.2 258 30.0 2.2
179 22.8 2.1 219 26.4 2.2 259 30.1 3.0
180 22.9 2.1 220 26.4 2.2 260 30.2 3.0

181 22.9 2.1 221 26.5 2.2 261 30.2 3.0
182 23.0 2.1 222 26.6 2.2 262 30.3 3.0
183 23.1 2.1 223 26.7 2.2 263 30.4 3.0
184 23.2 2.1 224 26.8 2.2 264 30.5 3.0
185 23.3 2.1 225 26.9 2.2 265 30.6 3.0
186 23.4 2.1 226 27.0 2.2 266 30.7 3.0
187 23.5 2.1 227 27.1 2.2 267 30.8 3.0
188 23.6 2.1 228 27.2 2.2 268 30.9 3.0
189 23.7 2.1 229 27.3 2.2 269 31.0 3.0
190 23.7 2.1 230 27.4 2.2 270 31.1 3.0

191 23.8 2.1 231 27.5 2.2 271 31.2 3.0
192 23.9 2.1 232 27.5 2.2 272 31.3 3.0
193 24.0 2.2 233 27.6 2.2 273 31.4 3.0
194 24.1 2.2 234 27.7 2.2 274 31.5 3.0
195 24.2 2.2 235 27.8 2.2 275 31.6 3.0
196 24.3 2.2 236 27.9 2.2 276 31.7 3.0
197 24.4 2.2 237 28.0 2.2 277 31.8 3.0
198 24.5 2.2 238 28.1 2.2 278 31.9 3.0
199 24.6 2.2 239 28.2 2.2 279 32.0 3.0
200 24.6 2.2 240 28.3 2.2 280 32.0 3.0

201 24.7 2.2 241 28.4 2.2 281 32.1 3.0
202 24.8 2.2 242 28.5 2.2 282 32.2 3.0
203 24.9 2.2 243 28.6 2.2 283 32.3 3.0
204 25.0 2.2 244 28.7 2.2 284 32.4 3.0
205 25.1 2.2 245 28.7 2.2 285 32.5 3.0
206 25.2 2.2 246 28.8 2.2 286 32.6 3.0
207 25.3 2.2 247 28.9 2.2 287 32.7 3.0
208 25.4 2.2 248 29.0 2.2 288 32.8 3.0
209 25.5 2.2 249 29.1 2.2 289 32.9 3.0

AC Chart, Hadlock
(continued)

290 33.0 3.0 320 35.9 3.0 350 38.9 3.0

291 33.1 3.0 321 36.0 3.0 351 39.0 3.0
292 33.2 3.0 322 36.1 3.0 352 39.1 3.0
293 33.3 3.0 323 36.2 3.0 353 39.2 3.0
294 33.4 3.0 324 36.3 3.0 354 39.3 3.0
295 33.5 3.0 325 36.4 3.0 355 39.4 3.0
296 33.6 3.0 326 36.5 3.0 356 39.5 3.0
297 33.7 3.0 327 36.6 3.0 357 39.6 3.0
298 33.8 3.0 328 36.7 3.0 358 39.7 3.0
299 33.9 3.0 329 36.8 3.0 359 39.8 3.0
300 34.0 3.0 330 36.9 3.0 360 39.9 3.0

301 34.1 3.0 331 37.0 3.0 361 40.0 3.0
302 34.2 3.0 332 37.1 3.0 362 40.1 3.0
303 34.3 3.0 333 37.2 3.0 363 40.2 3.0
304 34.4 3.0 334 37.3 3.0 364 40.3 3.0
305 34.5 3.0 335 37.4 3.0 365 40.4 3.0
306 34.6 3.0 336 37.5 3.0 366 40.5 3.0
307 34.7 3.0 337 37.6 3.0 367 40.6 3.0
308 34.7 3.0 338 37.7 3.0 368 40.7 3.0
309 34.8 3.0 339 37.8 3.0 369 40.8 3.0
310 34.9 3.0 340 37.9 3.0 370 40.9 3.0

311 35.0 3.0 341 38.0 3.0 371 41.0 3.0
312 35.1 3.0 342 38.1 3.0 372 41.1 3.0
313 35.2 3.0 343 38.2 3.0 373 41.2 3.0
314 35.3 3.0 344 38.3 3.0 374 41.3 3.0
315 35.4 3.0 345 38.4 3.0 375 41.4 3.0
316 35.5 3.0 346 38.5 3.0 376 41.5 3.0
317 35.6 3.0 347 38.6 3.0 377 41.6 3.0
318 35.7 3.0 348 38.7 3.0 378 41.7 3.0
319 35.8 3.0 349 38.8 3.0 379 41.8 3.0
380 42.0 3.0
MA Coeff 2SD Coeff
Q0 = 8.1400000 Q0 = 0.0000000
Q1 = 0.7530000 Q1 = 0.0000000
Q2 = 0.0036000 Q2 = 0.0000000
Q3 = 0.0000000 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.1 wks
MAX = 42.0 wks
Reference: Hadlock, F. P. et al. 1984. Estimating Fetal Age: Computer-Assisted Analysis of Multiple
Fetal Growth Parameters. Radiology 152 (no.2) 499.

AC Chart, Jeanty
12-40 weeks
AC Menstrual Age
(mm) (weeks)
57 12
67 13
77 14
88 15
98 16
109 17
119 18
130 19
141 20
152 21
163 22
173 23
184 24
195 25
205 26
215 27
225 28
235 29
244 30
254 31
262 32
271 33
279 34
286 35
293 36
300 37
306 38
311 39
316 40
MA Coeff 2SD Coeff
Q0 = 4.4675610 Q0 = 0.0000000
Q1 = 1.4946060 Q1 = 0.0000000
Q2 = – 0.0402130 Q2 = 0.0000000
Q3 = 0.0008904 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.0 wks
MAX = 40.0 wks
Reference: Jeanty, P., Romero, R. 1984. A Longitudinal Study of Fetal Abdominal Growth.
Obstetrical Ultrasound.

Binocular Distance Chart, Jeanty

10.4 - 40.1 weeks
Binocular Menstrual Binocular Menstrual
Distance Age Distance Age
(mm) (weeks + days) (mm) (weeks + days)
15 10 + 3 40 25 + 2
16 11 + 0 41 25 + 6
17 11 + 4
18 12 + 1 42 26 + 4
19 12 + 6 43 27 + 1
44 27 + 5
20 13 + 3 45 28 + 2
21 14 + 0 46 28 + 6
22 14 + 4 47 29 + 4
23 15 + 1 48 30 + 1
24 15 + 6 49 30 + 5
25 16 + 3
26 17 + 0 50 31+ 2
27 17 + 4 51 31 + 6
28 18 + 1 52 32 + 4
29 18 + 6 53 33 + 0
54 33 + 4
30 19 + 3 55 34 + 1
31 20 + 0 56 34 + 6
32 20 + 4 57 35 + 3
33 21 + 1 58 36 + 0
34 21 + 5 59 36 + 4
35 22 + 2
36 22 + 6 60 37 + 1
37 23 + 4 61 37 + 6
38 24 + 1 62 38 + 3
39 24 + 5 63 39 + 0
64 39 + 4
65 40 + 1
MA Coeff 2SD Coeff
Q0 = 0.3659456 Q0 = 3.3574960
Q1 = 7.5928040 Q1 = –0.0005119
Q2 = –0.9036491 Q2 = 0.0000000
Q3 = 0.2393220 Q3 = 0.0000000
Q4 = –0.0304329 Q4 = 0.0000000
Q5 = 0.0014845 Q5 = 0.0000000
Limits
MIN = 10.4 wks
MAX = 40.1 wks
Reference: Jeanty, P. and R. Romero. 1984. Obstetrical Ultrasound. McGraw Hill. Fibula Chart, Jeanty.

BPD Chart, Campbell
13 - 40 weeks
BPD Menstrual Age
(mm) (weeks)
21.6 13
27.3 14
31.9 15
35.5 16
38.5 17
42.2 18
45.0 19
48.3 20
51.8 21
54.5 22
58.7 23
61.8 24
64.6 25
66.8 26
70.1 27
72.9 28
75.5 29
78.2 30
80.1 31
82.5 32
85.2 33
86.6 34
88.5 35
89.7 36
91.4 37
92.6 38
93.7 39
94.4 40
MA Coeff 2SD Coeff
Q0 = 9.3634460 Q0 = 0.0000000
Q1 = 2.4510590 Q1 = 0.0000000
Q2 = –0.9873671 Q2 = 0.0000000
Q3 = 0.3878420 Q3 = 0.0000000
Q4 = –0.0522160 Q4 = 0.0000000
Q5 = 0.0024480 Q5 = 0.0000000
9.3634460+2.4510590*BPD+–0.9873671*BPD^2+0.3878420*BPD^3+–
0.0522160*BPD^4+0.0024480*BPD^5
Limits
MIN = 13.0 wks 2.16 cm
MAX = 40.0 wks 9.44 cm
Reference: Campbell, S., Wilkin, D. 1975. Ultrasonic Measurement of Fetal Abdominal Circumference
in the Evaluation of Fetal Weight. British Journal of Obstetrics and Gynecology 82. 689-697.

BPD Chart, Hadlock

12.1 - 41.6 weeks
BPD MA 2 Std BPD MA 2 Std BPD MA 2 Std

15 12.1 1.2 44 19.3 1.7 73 29.3 2.2

16 12.3 1.2 45 19.6 1.7 74 29.7 2.2
17 12.5 1.2 46 19.9 1.7 75 30.1 3.1
18 12.8 1.2 47 20.2 1.7 76 30.5 3.1
19 13.0 1.2 48 20.5 1.7 77 30.9 3.1
49 20.8 1.7 78 31.3 3.1
20 13.2 1.2 79 31.7 3.1
21 13.4 1.2 50 21.1 1.7
22 13.6 1.2 51 21.5 1.7 80 32.1 3.1
23 13.8 1.2 52 21.8 1.7 81 32.5 3.1
24 14.1 1.2 53 22.1 1.7 82 33.0 3.1
25 14.3 1.2 54 22.4 1.7 83 33.4 3.1
26 14.5 1.2 55 22.8 1.7 84 33.8 3.1
27 14.8 1.2 56 23.1 1.7 85 34.2 3.1
28 15.0 1.2 57 23.4 1.7 86 34.7 3.1
29 15.2 1.2 58 23.8 1.7 87 35.1 3.1
59 24.1 2.2 88 35.6 3.1
30 15.5 1.2 89 36.0 3.2
31 15.7 1.2 60 24.5 2.2
32 16.0 1.2 61 24.8 2.2 90 36.5 3.2
33 16.3 1.2 62 25.2 2.2 91 36.9 3.2
34 16.5 1.2 63 25.5 2.2 92 37.4 3.2
35 16.8 1.2 64 25.9 2.2 93 37.8 3.2
36 17.0 1.2 65 26.3 2.2 94 38.3 3.2
37 17.3 1.2 66 26.6 2.2 95 38.7 3.2
38 17.6 1.2 67 27.0 2.2 96 39.2 3.2
39 17.9 1.2 68 27.4 2.2 97 39.7 3.2
69 27.7 2.2 98 40.2 3.2
40 18.1 1.7 99 40.6 3.2
41 18.4 1.7 70 28.1 2.2
42 18.7 1.7 71 28.5 2.2 100 41.1 3.2
43 19.0 1.7 72 28.9 2.2 101 41.6 3.2
MA Coeff 2SD Coeff
Q0 = 9.5400000 Q0 = 0.0000000
Q1 = 1.4820000 Q1 = 0.0000000
Q2 = 0.1676000 Q2 = 0.0000000
Q3 = 0.0000000 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.1 wks
MAX = 41.6 wks
Reference: Hadlock, F.P. et al. 1984. Estimating Fetal Age: Computer-Assisted Analysis of Multiple

BPD Chart, Hansmann
12.6 - 41.6 weeks
BPD Menstrual Age BPD Menstrual Age
(mm) (wks + days) (mm) (wks + days)
20 12 + 4 60 23 + 7
21 12 + 6 61 24 + 2
22 13 + 1 62 24 + 4
23 13 + 2 63 24 + 6
24 13 + 4 64 25 + 1
25 13 + 6 65 25 + 4
26 14 + 2 66 25 + 6
27 14 + 3 67 26 + 1
28 14 + 5 68 26 + 3
29 14 + 7 69 26 + 5
30 15 + 2 70 27 + 1
31 15 + 4 71 27 + 3
32 15 + 6 72 24 + 6
33 16 + 1 73 28 + 1
34 16 + 3 74 28 + 4
35 16 + 5 75 28 + 6
36 16 + 7 76 29 + 2
37 17 + 2 77 29 + 4
38 17 + 4 78 29 + 7
39 17 + 5 79 30 + 3
40 18 + 1 80 30 + 5
41 18 + 3 81 31 + 1
42 18 + 4 82 31 + 4
43 18 + 6 83 31 + 7
44 19 + 1 84 32 + 3
45 19 + 3 85 32 + 5
46 19 + 5 86 33 + 1
47 20 + 1 87 33 + 4
48 20 + 3 88 34 + 1
49 20 + 5 89 34 + 4
50 20 + 7 90 34 + 7
51 21 + 2 91 35 + 3
52 21 + 4 92 35 + 7
53 21 + 6 93 36 + 4
54 22 + 1 94 37 + 1
55 22 + 3 95 37 + 5
56 22 + 5 96 38 + 3
57 23 + 1 97 39 + 1
58 23 + 3 98 39 + 6
59 23 + 5 99 40 + 4
100 41 + 4
MA Coeff 2SD Coeff
Q0 = 3.5656910 Q0 = 0.0000000
Q1 = 6.9421940 Q1 = 0.0000000
Q2 = – 1.8968540 Q2 = 0.0000000
Q3 = 0.4028942 Q3 = 0.0000000
Q4 = –0.0403642 Q4 = 0.0000000
Q5 = 0.0015878 Q5 = 0.0000000
Limits
MIN = 12.6 wks
MAX = 41.6. wks
Reference: Hansmann, M., et al. 1985. Ultrasound Diagnosis in Obstetrics and Gynecology.
Springer-Verlag.

BPD Chart, Jeanty

14 - 38.3 weeks
BPD Menstrual Age BPD Menstrual Age
28 14 62 24 + 1
29 14 + 1 63 24 + 4
30 14 + 4 64 24 + 6
31 14 + 6 65 25 + 2
32 15 + 1 66 25 + 4
33 15 + 2 67 26
34 15 + 4 68 26 + 3
35 15 + 6 69 26 + 5
36 16 + 1 70 27 + 1
37 16 + 3 71 27 + 4
38 16 + 5 72 27 + 6
39 17 73 28 + 2
40 17 + 2 74 28 + 5
41 17 + 4 75 29 + 1
42 17 + 6 76 29 + 4
43 18 + 1 77 29 + 6
44 18 + 3 78 30 + 2
45 18 + 5 79 30 + 5
46 19 80 31 + 1
47 19 + 2 81 31 + 4
48 19 + 4 82 32
49 19 + 6 83 32 + 4
50 20 + 2 84 32 + 6
51 20 + 4 85 33 + 3
52 20 + 6 86 33 + 6
53 21 + 1 87 34 + 2
54 21 + 4 88 34 + 6
55 21 + 6 89 35 + 2
56 22 + 1 90 35 + 5
57 22 + 4 91 36 + 1
58 22 + 6 92 36 + 5
59 23 + 1 93 37 + 1
60 23 + 4 94 37 + 5
61 23 + 6 95 38 + 2
MA Coeff 2SD Coeff
Q0 = 5.7525730 Q0 = 0.0000000
Q1 = 3.6829320 Q1 = 0.0000000
Q2 = –0.4774910 Q2 = 0.0000000
Q3 = 0.0946081 Q3 = 0.0000000
Q4 = –0.0073637 Q4 = 0.0000000
Q5 = 0.0002514 Q5 = 0.0000000
Limits
MIN = 14.0 wks
MAX = 38.3 wks
Reference: Jeanty, P. and R. Romero. 1984. Obstetrical Ultrasound. McGraw Hill.

BPD Chart, Kurtz
14 - 40 weeks
BPD Menstrual Age
(mm) (weeks)
27 14
31 15
34 16
38 17
41 18
45 19
48 20
51 21
54 22
57 23
60 24
63 25
66 26
69 27
71 28
74 29
76 30
79 31
81 32
83 33
85 34
87 35
89 36
91 37
92 38
94 39
95 40
MA Coeff 2SD Coeff
Q0 = 5.6546870 Q0 = –7.0429760
Q1 = 4.3971500 Q1 = 0.9529071
Q2 = –0.9223110 Q2 = – 0.0337610
Q3 = 0.2162220 Q3 = 0.0003800
Q4 = –0.0222450 Q4 = 0.0000000
Q5 = 0.0009221 Q5 = 0.0000000
Limits
MIN = 14.0 wks
MAX = 40.0 wks
Reference: Kurtz, A.B., et al. 1980. Analysis of Biparietal Diameter as an Accurate Indicator of Gestation
Age. J. Clin. Ultrasound 8:319.

BPD Chart, Sabbagha

14 - 40 weeks
BPD Menstrual Age
(mm) (weeks)
28 14
32 15
36 16
39 17
42 18
45 19
48 20
51 21
54 22
58 23
61 24
64 25
67 26
70 27
72 28
75 29
78 30
80 31
82 32
85 33
87 34
88 35
90 36
92 37
93 38
94 39
95 40
MA Coeff 2SD Coeff
Q0 = 4.9921070 Q0 = 0.0000000
Q1 = 5.4484330 Q1 = 0.0000000
Q2 = –1.7498230 Q2 = 0.0000000
Q3 = 0.4740796 Q3 = 0.0000000
Q4 = – 0.0556882 Q4 = 0.0000000
Q5 = 0.0024200 Q5 = 0.0000000
Limits
MIN = 14.0 wks
MAX = 40.0 wks
Reference: Sabbagha, R.E. and M. Hughey. 1978. Standardization of Sonar Cephalometry and
Gestational Age. Obstet Gynecol. 52:402.

BPD Chart, Tokyo University
BPD Gestation week ±day

(cm) (weeks)
2.00 12 7
2.40 13 7
2.76 14 7
3.10 15 7
3.38 16 8
3.72 17 8
4.05 18 9
4.39 19 10
4.71 20 10
5.04 21 10
5.35 22 10
5.67 23 11
5.97 24 11
6.27 25 12
6.56 26 13
6.84 27 13
7.12 28 13
7.38 29 14
7.64 30 15
7.88 31 16
8.12 32 16
8.34 33 18
8.55 34 20
8.74 35 25
8.92 36 25
9.08 37 25
9.23 38 25
9.36 39 25
9.47 40 25

BPD Chart, Yale

11.6 - 39.8 weeks
BPD Menstrual Age BPD Menstrual Age BPD Menstrual Age BPD Menstrual Age
(mm) (weeks) (mm) (weeks) (mm) (weeks) (mm) (weeks)
19 11.6 40 18.4 60 24.7 80 33.0
20 11.6 42 18.9 61 25.2 82 33.5
21 12.1 43 19.4 62 25.2 83 34.0
22 12.6 44 19.4 63 25.7 84 34.4
23 12.6 45 19.9 64 26.2 85 35.0
24 13.1 46 20.4 65 26.2 86 35.4
25 13.6 47 20.4 66 26.7 88 35.9
26 13.6 48 20.9 67 27.2 89 36.4
27 14.1 49 21.3 68 27.6
28 14.6 69 28.1 90a 36.9
29 14.6 50 21.3 91a 37.3
51 21.8 70 28.6 92a 37.8
30 15.0 52 22.3 71 29.1 93a 38.3
31 15.5 53 22.3 73 29.6 94a 38.8
32 15.5 54 22.8 74 30.0 96a 39.3
33 16.0 55 23.3 75 30.6 97a 39.8
34 16.5 56 23.3 76 31.0
35 16.5 57 23.8 77 31.5
36 17.0 58 24.3 78 32.0
37 17.5 59 24.3 79 32.5
38 17.9
a Indicates a fetus of 36 or more weeks in a nondiabetic.
MA Coeff 2SD Coeff
Q0 = 5.386194 Q0 = 0.0000000
Q1 = 3.383561 Q1 = 0.0000000
Q2 = –0.091307 Q2 = 0.0000000
Q3 = 0.011580 Q3 = 0.0000000
Q4 = 0.000000 Q4 = 0.0000000
Q5 = 0.000000 Q5 = 0.0000000
Limits
MIN = 11.6 wks
MAX = 39.8 wks
Reference: Hobbins, John C., M.D., et al. 1983. Ultrasonography in Obstetrics and Gynecology.
Second Edition. Williams & Wilkins, Baltimore, M.D.
Yale Nomogram for BPD using leading edge to leading edge based on B-mode dots (graticule).

Cerebellum Chart, Goldstein
15 - 36.5 weeks
Cerebellum Diameter Calculated
(mm) Menstrual Agea (weeks)
14.0 15.2
16.0 16.0
17.0 17.4
18.0 18.2
19.0 19.1
20.0 19.6
22.0 21.4
23.0 22.1
24.0 23.0
25.0 23.6
28.0 26.0
29.0 26.5
30.0 27.3
31.0 28.1
34.0 30.1
35.0 30.5
38.0 32.3
38.0 32.3
40.0 33.4
40.0 33.4
40.5 —
43.0 34.6
45.0 35.4
48.5 —
52.0 36.5
a
Calculated Menstrual Age is based on Goldstein’s
Regression Equation.
MA Coeff 2SD Coeff
Q0 = 6.3290000 Q0 = 0.0000000
Q1 = 4.8070000 Q1 = 0.0000000
Q2 = 1.4840000 Q2 = 0.0000000
Q3 = -0.2474000 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 15.0 wks
MAX = 36.5 wks
Reference: Goldstein, I. 1987. Cerebellum Measurements with Ultrasonography in the Evaluation of
Fetal Growth and Development. American Journal of Obstetrics and Gynecology. 1987.156:1065-1069

Cerebellum Chart, McLeary

16 - 37 weeks
Cerebellum Diameter Menstrual Age
(mm) (weeks)
15.0 16
16.0 17
17.0 18
18.5 19
20.0 20
21.0 21
23.0 22
24.0 23
25.0 24
27.0 25
28.0 26
29.5 27
31.5 28
33.0 29
35.0 30
36.5 31
38.5 32
40.0 33
42.5 34
46.0 35
49.0 36
53.0 37
MA Coeff 2SD Coeff
Q0 = – 8.0795850 Q0 = 0.0000000
Q1 = 29.3032400 Q1 = 0.0000000
Q2 = –14.0328700 Q2 = 0.0000000
Q3 = 4.4554060 Q3 = 0.0000000
Q4 = –0.7016286 Q4 = 0.0000000
Q5 = 0.04166980 Q5 = 0.0000000
Limits
MIN = 16.0 wks
MAX = 37.0 wks
Reference: McLeary, R. D. 1984. Ultrasonography of the Fetal Cerebellum. Radiology. 1984:151: 439-442.

Ob Charts
CRL Chart, Hadlock

5.7 - 18 weeks
CRL Menstrual CRL Menstrual CRL Menstrual CRL Menstrual
(mm) Age (mm) Age (mm) Age (mm) Age
2 5.7 32 10.1 63 12.7 94 15.3

3 5.9 33 10.2 64 12.8
4 6.1 34 10.3 65 12.8 95 15.3
5 6.2 35 10.4 66 12.9 96 15.4
36 10.5 67 13.0 97 15.5
6 6.4 37 10.6 68 13.1 98 15.6
7 6.6 38 10.7 69 13.1 99 15.7
8 6.7 39 10.8 70 13.2 100 15.9
9 6.9 40 10.9 71 13.3 101 16.0
10 7.1 41 11.0 102 16.1
11 7.2 72 13.4 103 16.2
12 7.4 42 11.1 73 13.4 104 16.3
13 7.5 43 11.2 74 13.5
14 7.7 44 11.2 75 13.6 105 16.4
15 7.9 45 11.3 76 13.7 106 16.5
46 11.4 77 13.8 107 16.6
16 8.0 47 11.5 78 13.8 108 16.7
17 8.1 48 11.6 79 13.9 109 16.8
18 8.3 49 11.7 80 14.0 110 16.9
19 8.4 50 11.7 81 14.1 111 17.0
20 8.6 51 11.8 112 17.1
21 8.7 82 14.2 113 17.2
22 8.9 52 11.9 83 14.2 114 17.3
23 9.0 53 12.0 84 14.3
24 9.1 54 12.0 85 14.4 115 17.4
25 9.2 55 12.1 86 14.5 116 17.5
56 12.2 87 14.6 117 17.6
26 9.4 57 12.3 88 14.7 118 17.7
27 9.5 58 12.3 89 14.8 119 17.8
28 9.6 59 12.4 90 14.9 120 17.9
29 9.7 60 12.5 91 15.0 121 18.0
30 9.9 61 12.6 92 15.1
31 10.0 62 12.6 93 15.2
MA Coeff 2SD Coeff
Q0 = 5.340164 Q0 = .0000000
Q1 = 1.921032 Q1 = .0800000
Q2 = –.1690442 Q2 = .0000000
Q3 = .0081207 Q3 = .0000000
Q4 = .0000000 Q4 = .0000000
Q5 = .0000000 Q5 = .0000000
Limits
MIN = 5.7 wks
MAX = 18.0 wks
Reference: Hadlock, F., et al. 1992. Fetal Crown-Rump Length: Reevaluation of Relation to Menstrual
Age (5-18 weeks) with High-Resolution Real-Time US. Radiology 1992; 182:501-505.

CRL Chart, Hansmann

7.1 - 22.4 weeks
CRL Menstrual Age CRL Menstrual Age CRL Menstrual Age CRL Menstrual Age
(mm) (wks + days) (mm) (wks + days) (mm) (wks + days) (mm) (wks + days)
6 7+1 42 12 + 3 79 15 + 1 116 18 + 2
7 7+2 43 12 + 4 80 15 + 1 117 18 + 2
8 7+4 44 12 + 5 81 15 + 1 118 18 + 3
9 7+6 45 12 + 6 82 15 + 2 119 18 + 3
46 12 + 6 83 15 + 2
10 7+7 47 12 + 7 84 15 + 3 120 18 + 4
11 8+2 48 12 + 7 85 15 + 3 121 18 + 5
12 8+3 49 13 + 1 86 15 + 4 122 18 + 6
13 8+4 87 15 + 4 123 18 + 7
14 8+6 50 13 + 1 88 15 + 5 124 18 + 8
15 8+7 51 13 + 2 89 15 + 5 125 19 + 1
16 9+2 52 13 + 2 126 19 + 2
17 9+3 53 13 + 3 90 15 + 6 127 19 + 3
18 9+4 54 13 + 3 91 15 + 6 128 19 + 4
19 9+5 55 13 + 4 92 15 + 7 129 19 + 5
56 13 + 4 93 15 + 7
20 9+6 57 13 + 5 94 16 + 1 130 19 + 6
21 9+7 58 13 + 5 95 16 + 2 131 19 + 6
22 10 + 1 59 13 + 6 96 16 + 3 132 19 + 7
23 10 + 2 97 16 + 3 133 20 + 1
24 10 + 3 60 13 + 6 98 16 + 4 134 20 + 2
25 10 + 4 61 13 + 6 99 16 + 4 135 20 + 3
26 10 + 5 62 13 + 7 136 20 + 4
27 10 + 6 63 13 + 7 100 16 + 5 137 20 + 5
28 10 + 7 64 13 + 7 101 16 + 5 138 20 + 6
29 11 + 1 65 14 + 1 102 16 + 6 139 20 + 6
66 14 + 1 103 16 + 7
30 11 + 2 67 14 + 2 104 17 + 1 140 20 + 7
31 11 + 2 68 14 + 2 105 17 + 1 141 21 + 1
32 11 + 3 69 14 + 3 106 17 + 2 142 21 + 2
33 11 + 4 107 17 + 2 143 21 + 3
34 11 + 5 70 14 + 3 108 17 + 3 144 21 + 4
35 11 + 6 71 14 + 4 109 17 + 3 145 21 + 5
36 11 + 6 72 14 + 4 146 21 + 6
37 11 + 7 73 14 + 5 110 17 + 4 147 21 + 7
38 12 + 1 74 14 + 5 111 17 + 5 148 22 + 1
39 12 + 2 75 14 + 6 112 17 + 6 149 22 + 2
76 14 + 6 113 17 + 7 150 22 + 3
40 12 + 2 77 14 + 7 114 18 + 1
41 12 + 3 78 14 + 7 115 18 + 1
MA Coeff 2SD Coeff
Q0 = 6.3033400 Q0 = 3.7844860
Q1 = 2.0630870 Q1 = –0.7265692
Q2 = –0.1780907 Q2 = 0.0568590
Q3 = 0.0075699 Q3 = –0.0012292
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 7.1 wks
MAX = 22.4 wks
Reference: Hansmann, M., et. al. 1985. Ultrasound Diagnosis in Obstetrics and Gynecology.
Springer-Verlag.

Ob Charts
CRL Chart, Jeanty

6.3 - 12.1 weeks
CRL Menstrual Age CRL Menstrual Age
5 6+2 30 9+6
6 6+4 31 10 + 0
7 6+5 32 10 + 1
8 6+6 33 10 + 1
9 7+1 34 10 + 2
10 7+2 35 10 + 3
11 7+3 36 10 + 4
12 7+4 37 10 + 4
13 7+6 38 10 + 5
14 7+6 39 10 + 6
15 8+1 40 10 + 6
16 8+1 41 11 + 0
17 8+3 42 11 + 1
18 8+4 43 11 + 1
19 8+4 44 11 + 1
20 8+6 45 11 + 2
21 8+6 46 11 + 3
22 9+0 47 11 + 4
23 9+1 48 11 + 4
24 9+1 49 11 + 5
25 9+3 50 11 + 6
26 9+4 51 11 + 6
27 9+4 52 11 + 6
28 9+5 53 12 + 0
29 9+6 54 12 + 1
MA Coeff 2SD Coeff
Q0 = 5.2797150 Q0 = 0.0000000
Q1 = 2.2739030 Q1 = 0.0000000
Q2 = – 0.3109710 Q2 = 0.0000000
Q3 = 0.0231365 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 6.3 wks
MAX = 12.1 wks

CRL Chart, Nelson

8.1 - 14.1 weeks
CRL Menstrual Age
(mm) (weeks)
10 8.1
12 8.3
14 8.5
16 8.6
18 8.8
20 9.0
22 9.2
24 9.3
26 9.5
28 9.7
30 9.9
32 10.0
34 10.2
36 10.4
38 10.5
40 10.7
42 10.9
44 11.1
46 11.2
48 11.4
50 11.6
52 11.7
54 11.9
56 12.1
58 12.3
60 12.4
62 12.6
64 12.8
66 12.9
68 13.1
70 13.3
72 13.5
74 13.6
76 13.8
78 14.0
80 14.1
MA Coeff 2SD Coeff
Q0 = 7.2341430 Q0 = 0.0000000
Q1 = 0.8856020 Q1 = 0.0000000
Q2 = –0.0046905 Q2 = 0.0000000
Q3 = 0.0002347 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 8.1 wks
MAX = 14.1 wks
Reference: Nelson, L. H. 1981. Comparison of methods for determining crown-rump measurement by
real-time ultrasound. J. Clin. Ultrasound. 9:67-70.

Ob Charts
CRL Chart, Robinson, 1975

6.4 weeks - 14.0 weeks
CRL MA 2 Std Dev 2 Std Dev CRL MA 2 Std Dev 2 Std Dev
(mm) (weeks) (1-2) (>3) (mm) (weeks) (1-2) (>3)
6 6.4 0.7 0.4 42 11.1 0.7 0.4

7 6.6 0.7 0.4 43 11.2 0.7 0.4
8 6.8 0.7 0.4 44 11.3 0.7 0.4
9 7.0 0.7 0.4 45 11.4 0.7 0.4
46 11.5 0.7 0.4
10 7.2 0.7 0.4 47 11.6 0.7 0.4
11 7.4 0.7 0.4 48 11.7 0.7 0.4
12 7.6 0.7 0.4 49 11.8 0.7 0.4
13 7.7 0.7 0.4
14 7.9 0.7 0.4 50 11.9 0.7 0.4
15 8.0 0.7 0.4 51 11.9 0.7 0.4
16 8.2 0.7 0.4 52 12.0 0.7 0.4
17 8.3 0.7 0.4 53 12.1 0.7 0.4
18 8.5 0.7 0.4 54 12.2 0.7 0.4
19 8.6 0.7 0.4 55 12.3 0.7 0.4
56 12.4 0.7 0.4
20 8.8 0.7 0.4 57 12.4 0.7 0.4
21 8.9 0.7 0.4 58 12.5 0.7 0.4
22 9.0 0.7 0.4 59 12.6 0.7 0.4
23 9.1 0.7 0.4
24 9.3 0.7 0.4 60 12.7 0.7 0.4
25 9.4 0.7 0.4 61 12.7 0.7 0.4
26 9.5 0.7 0.4 62 12.8 0.7 0.4
27 9.6 0.7 0.4 63 12.9 0.7 0.4
28 9.7 0.7 0.4 64 13.0 0.7 0.4
29 9.8 0.7 0.4 65 13.0 0.7 0.4
66 13.1 0.7 0.4
30 9.9 0.7 0.4 67 13.2 0.7 0.4
31 10.1 0.7 0.4 68 13.3 0.7 0.4
32 10.2 0.7 0.4 69 13.3 0.7 0.4
33 10.3 0.7 0.4
34 10.4 0.7 0.4 70 13.4 0.7 0.4
35 10.5 0.7 0.4 71 13.5 0.7 0.4
36 10.6 0.7 0.4 72 13.5 0.7 0.4
37 10.7 0.7 0.4 73 13.6 0.7 0.4
38 10.8 0.7 0.4 74 13.7 0.7 0.4
39 10.9 0.7 0.4 75 13.8 0.7 0.4
76 13.8 0.7 0.4
40 11.0 0.7 0.4 77 13.9 0.7 0.4
41 11.1 0.7 0.4 78 14.0 0.7 0.4
MA Coeff 2SD Coeff
Q0 = 4.9339120 Q0 = 0.0000000
Q1 = 2.8007000 Q1 = 0.0000000
Q2 = – 0.6356975 Q2 = 0.0000000
Q3 = 0.1170670 Q3 = 0.0000000
Q4 = – 0.0116220 Q4 = 0.0000000
Q5 = 0.0004623 Q5 = 0.0000000
Limits
MIN = 6.4 wks
MAX = 14.0 wks
Reference: Robinson, H.P. et. al. 1975. A Critical Evaluation of Sonar “Crown-Rump Length”
Measurements. British Journal of Obstetrics and Gynecology, 82. (Sept.) 707.

CRL Chart, Robinson, 1988

5.6 - 14.2 weeks
CRL Menstrual Age CRL Menstrual Age
1.93 5+3 30.5 10 + 0
2.38 5+4 31.8 10 + 1
2.83 5+5 33.2 10 + 2
3.28 5+6 34.6 10 + 3
36.0 10 + 4
3.73 6+0 37.4 10 + 5
4.18 6+1 38.9 10 + 6
4.63 6+2
5.08 6+3 40.4 11 + 0
5.53 6+4 41.9 11 + 1
5.98 6+5 43.5 11 + 2
6.58 6+6 45.1 11 + 3
46.7 11 + 4
7.43 7+0 48.3 11 + 5
8.5 7+1 50.0 11 + 6
9.6 7+2
10.7 7+3 51.7 12 + 0
12.0 7+4 53.4 12 + 1
12.9 7+5 55.2 12 + 2
13.8 7+6 57.0 12 + 3
58.8 12 + 4
14.7 8+0 60.6 12 + 5
15.7 8+1 62.5 12 + 6
16.6 8+2
17.6 8+3 64.3 13 + 0
18.7 8+4 66.3 13 + 1
19.7 8+5 68.2 13 + 2
20.8 8+6 70.2 13 + 3
21.9 9+0 72.2 13 + 4
74.2 13 + 5
23.1 9+1 76.3 13 + 6
24.2 9+2 78.3 14 + 0
25.4 9+3
26.7 9+4
27.9 9+5
29.2 9+6
MA Coeff 2SD Coeff
Q0 = 4.9991370 Q0 = 0.0000000
Q1 = 3.0815570 Q1 = 0.0000000
Q2 = – 0.9486124 Q2 = 0.0000000
Q3 = 0.2253123 Q3 = 0.0000000
Q4 = – 0.0268326 Q4 = 0.0000000
Q5 = 0.0012157 Q5 = 0.0000000
Limits
MIN = 5.6 wks
MAX = 14.2 wks
Reference: Robinson, H.P. and J. E. E. Fleming. 1975. A Critical Evaluation of Sonar
“Crown-Rump Length” Measurements. British Journal of Obstetrics and Gynecology. 82: 702-710.
(modified)
Yeh Hsui Chung MD. 1988. Amniotic Sac Development, Ultrasound Feature of Early
Pregnancy. Radiology. 166:97-103.

Ob Charts
CRL Chart, Tokyo University
CRL Fetus Age ±day

(cm) (weeks)
1.40 8 7
2.10 9 7
2.90 10 7
3.70 11 7
4.60 12 7
5.70 13 7
7.10 14 8
8.80 15 14

EFW Chart, Shepard

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

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

EFW Chart, Shepard (continued)

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

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


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

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


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

Ob Charts
Biparietal
Diameter
35.0 35.5 36.0 36.5 37.0 37.5 38.0 38.5 39.0 39.5 40.0
8.8 3211 3296 3383 3473 3565 3659 3756 3856 3958 4063 4171
8.9 3266 3351 3439 3529 3621 3716 3813 3913 4016 4121 4229
9.0 3321 3407 3495 3586 3679 3774 3871 3972 4074 4180 4288
9.1 3378 3464 3553 3644 3737 3832 3930 4031 4134 4239 4348
9.2 3435 3522 3611 3702 3796 3892 3990 4091 4194 4300 4408
9.3 3494 3581 3670 3762 3856 3952 4050 4151 4255 4361 4470
9.4 3554 3641 3731 3823 3917 4013 4112 4213 4317 4423 4532
9.5 3614 3702 3792 3884 3979 4075 4174 4276 4380 4486 4595
9.6 3676 3764 3854 3947 4041 4138 4238 4339 4444 4550 4659
9.7 3738 3827 3918 4010 4105 4203 4302 4404 4508 4615 4724
9.8 3802 3891 3982 4075 4170 4268 4367 4470 4574 4681 4790
9.9 3867 3956 4047 4141 4236 4334 4434 4536 4641 4748 4857
10.0 3933 4022 4114 4207 4303 4401 4501 4604 4708 4815 4925
T0 = 1.2508000 X NONE X NONE
T1 = 0.1660000 X (BPD) X NONE
T2 = 0.0460000 X (AC) X NONE
T3 = –0.0026460 X (BPD) X (AC)
T4 = 0.0000000 X NONE X NONE
T5 = 0.0000000 X NONE X NONE
Reference: Shepard, M.J., et. al. 1982. An Evaluation of Two Equations for Predicting Fetal Weight by
Ultrasound. American Journal of Obstetrics and Gynecology. 147: 47-54.

Fibula Chart, Jeanty

12 - 40 weeks
Fibula Menstrual
(50th Percentile) Age
(mm) (weeks)
6 12
9 13
12 14
15 15
18 16
21 17
23 18
26 19
28 20
31 21
33 22
35 23
37 24
40 25
42 26
44 27
45 28
47 29
49 30
51 31
52 32
54 33
55 34
57 35
58 36
59 37
61 38
62 39
63 40
MA Coeff 2SD Coeff
Q0 = 10.31506 Q0 = 0.0000000
Q1 = 2.651455 Q1 = 0.0000000
Q2 = 0.3790657 Q2 = 0.0000000
Q3 = –0.0615157 Q3 = 0.0000000
Q4 = 0.0083915 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.0 wks
MAX = 40.0 wks

Ob Charts
FL Chart, Campbell
12 - 40 weeks
FL Menstrual Age
(mm) (weeks)
10.0 12
14.0 13
16.6 14
19.9 15
22.0 16
25.2 17
29.6 18
32.4 19
34.8 20
37.5 21
40.9 22
43.5 23
46.4 24
48.0 25
51.1 26
53.0 27
54.4 28
57.3 29
58.7 30
61.5 31
62.8 32
64.9 33
65.7 34
67.7 35
69.5 36
70.8 37
71.8 38
74.2 39
75.4 40
MA Coeff 2SD Coeff
Q0 = 7.920067 Q0 = 0.0000000
Q1 = 4.397133 Q1 = 0.0000000
Q2 = – 0.560659 Q2 = 0.0000000
Q3 = 0.090984 Q3 = 0.0000000
Q4 = – 0.002513 Q4 = 0.0000000
Q5 = 0.000000 Q5 = 0.0000000
7.920067+4.397133*FL+–0.560659*FL^2+0.090984*FL^3+–0.002513*FL^4
Limits
MIN = 12.0 wks 1.0 cm
MAX = 40.0 wks 7.54 cm

FL Chart, Hadlock
12.2 - 42 weeks
FL MA 2 Std FL MA 2 Std FL MA 2 Std
7 12.2 1.4 32 20.0 1.8 58 30.3 3.0

8 12.4 1.4 33 20.3 1.8 59 30.8 3.0
9 12.7 1.4 34 20.7 1.8
35 21.0 1.8 60 31.2 3.0
10 13.0 1.4 36 21.4 1.8 61 31.7 3.0
11 13.3 1.4 37 21.8 1.8 62 32.1 3.0
12 13.5 1.4 38 22.2 1.8 63 32.6 3.0
13 13.8 1.4 39 22.5 1.8 64 33.1 3.0
14 14.1 1.4 65 33.5 3.0
15 14.4 1.4 40 22.9 1.8 66 34.0 3.0
16 14.7 1.4 41 23.3 1.8 67 34.5 3.0
17 15.0 1.4 42 23.7 1.8 68 34.9 3.0
18 15.3 1.4 43 24.1 2.1 69 35.4 3.0
44 24.5 2.1
19 15.6 1.4 45 24.9 2.1 70 35.9 3.0
20 16.0 1.4 46 25.3 2.1 71 36.4 3.1
21 16.3 1.4 47 25.7 2.1 72 36.9 3.1
22 16.6 1.4 48 26.1 2.1 73 37.4 3.1
23 16.9 1.4 49 26.5 2.1 74 37.9 3.1
24 17.2 1.4 75 38.4 3.1
25 17.6 1.4 50 26.9 2.1 76 38.9 3.1
26 17.9 1.4 51 27.3 2.1 77 39.4 3.1
27 18.2 1.8 52 27.7 2.1 78 39.9 3.1
28 18.6 1.8 53 28.2 2.1 79 40.4 3.1
29 18.9 1.8 54 28.6 2.1
55 29.0 2.1 80 40.9 3.1
30 19.3 1.8 56 29.5 2.1 81 41.4 3.1
31 19.6 1.8 57 29.9 2.1 82 42.0 3.1
MA Coeff 2SD Coeff
Q0 = 10.3500000 Q0 = 0.0000000
Q1 = 2.4600000 Q1 = 0.0000000
Q2 = 0.1700000 Q2 = 0.0000000
Q3 = 0.0000000 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.2 wks
MAX = 42.0 wks
Reference: Hadlock, F.P. et al. 1984. Estimating Fetal age: Computer-Assisted Analysis of Multiple

Ob Charts
FL Chart, Hansmann
17.1 - 40.1 weeks
FL Menstrual Age FL Menstrual Age
20 17 + 1 48 27 + 1
21 17 + 3 49 27 + 4
22 17 + 5 50 27 + 6
23 17 + 7 51 28 + 3
24 18 + 2 52 28 + 5
25 18 + 4 53 29 + 2
26 18 + 7 54 29 + 5
27 19 + 2 55 30 + 1
28 19 + 5 56 30 + 4
29 19 + 7 57 30 + 6
58 31 + 3
30 20 + 3 59 31 + 6
31 20 + 5
32 21 + 1 60 32 + 2
33 21 + 3 61 32 + 5
34 21 + 5 62 33 + 2
35 22 + 1 63 33 + 4
36 22 + 4 64 34 + 1
37 22 + 6 65 34 + 4
38 23 + 2 66 35 + 1
39 23 + 4 67 35 + 4
68 36 + 1
40 23 + 7 69 36 + 5
41 24 + 3
42 24 + 5 70 37 + 2
43 25 + 1 71 37 + 5
44 25 + 4 72 38 + 2
45 25 + 6 73 38 + 6
46 26 + 2 74 39 + 4
47 26 + 5 75 40 + 1
MA Coeff 2SD Coeff
Q0 = 10.8592900 Q0 = 1.5059900
Q1 = 3.6392690 Q1 = – 0.1308938
Q2 = –0.6200159 Q2 = 0.0086599
Q3 = 0.2392270 Q3 = – 0.0001130
Q4 = – 0.0338586 Q4 = 0.0000000
Q5 = 0.0018145 Q5 = 0.0000000
Limits
MIN = 17.1 wks
MAX = 40.1 wks
Reference: Hansmann, M., et. al. 1985. Ultrasound Diagnosis in
Obstetrics and Gynecology. Springer-Verlag.

FL Chart, Hohler
9.2 - 44.5 weeks
(mm) (weeks) (mm) (weeks)
0 9.2 44 24.0
1 9.4 45 24.4
2 9.7 46 24.8
3 10.0 47 25.3
4 10.3 48 25.7
5 10.6 49 26.1
6 10.8
7 11.1 50 26.5
8 11.4 51 27.0
9 11.7 52 27.4
53 27.8
10 12.0 54 28.3
11 12.3 55 28.7
12 12.6 56 29.1
13 12.9 57 29.6
14 13.2 58 30.0
15 13.5 59 30.5
16 13.9
17 14.2 60 31.0
18 14.5 61 31.4
19 14.8 62 31.9
63 32.4
20 15.2 64 32.8
21 15.5 65 33.3
22 15.8 66 33.8
23 16.2 67 34.3
24 16.5 68 34.7
25 16.9 69 35.2
26 17.2
27 17.6 70 35.7
28 17.9 71 36.2
29 18.3 72 36.7
73 37.2
30 18.6 74 37.7
31 19.0 75 38.2
32 19.4 76 38.7
33 19.7 77 39.2
34 20.1 78 39.7
35 20.5 79 40.3
36 20.9
37 21.2 80 40.8
38 21.6 81 41.3
39 22.0 82 41.8
83 42.4
40 22.4 84 42.9
41 22.8 85 43.4
42 23.2 86 44.0
43 23.6 87 44.5
MA Coeff 2SD Coeff
Q0 = 9.174068 Q0 = 0.0000000
Q1 = 2.670895 Q1 = 0.0000000
Q2 = 0.159947 Q2 = 0.0000000
Q3 = 0.000000 Q3 = 0.0000000
Q4 = 0.000000 Q4 = 0.0000000
Q5 = 0.000000 Q5 = 0.0000000
Limits
MIN = 9.2 wks
MAX = 44.5 wks
Reference: Hohler, Charles, M.D., Miami, Florida, June, 1982.

Ob Charts
FL Chart, Jeanty
12.6 - 40 weeks
10 12 + 4 45 25
11 12 + 6 46 25 + 3
12 13 + 2 47 25 + 6
13 13 + 4 48 26 + 1
14 13 + 6 49 26 + 4
15 14 + 1 50 27
16 14 + 4 51 27 + 3
17 14 + 6 52 27 + 6
18 15 + 1 53 28 + 1
19 15 + 4 54 28 + 4
20 15 + 6 55 29 + 1
21 16 + 2 56 29 + 4
22 16 + 4 57 29 + 6
23 16 + 6 58 30 + 2
24 17 + 2 59 30 + 5
25 17 + 4 60 31 + 1
26 18 61 31 + 4
27 18 + 2 62 32
28 18 + 5 63 32 + 3
29 19 64 32 + 6
30 19 + 3 65 33 + 2
31 19 + 5 66 33 + 5
32 20 + 1 67 34 + 1
33 20 + 4 68 34 + 4
34 20 + 6 69 35
35 21 + 1 70 35 + 4
36 21 + 4 71 35 + 8
37 22 72 36 + 3
38 22 + 3 73 36 + 6
39 22 + 5 74 37 + 2
40 23 + 1 75 37 + 5
41 23 + 4 76 38 + 1
42 23 + 6 77 38 + 4
43 24 + 2 78 39 + 1
44 24 + 5 79 39 + 4
80 40
MA Coeff 2SD Coeff
Q0 = 9.4211530 Q0 = 0.0000000
Q1 = 3.0516800 Q1 = 0.0000000
Q2 = 0.0890988 Q2 = 0.0000000
Q3 = 0.0009513 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.6 wks
MAX = 40.0 wks

FL Chart, O’Brien
12.0 - 40.0 weeks
10 12 + 0 46 25 + 0
11 12 + 3 47 25 + 3
12 12 + 6 48 26 + 0
13 13 + 1 49 26 + 4
14 13 + 4
15 13 + 6 50 27 + 0
16 14 + 1 51 27 + 2
17 14 + 4 52 27 + 5
18 14 + 6 53 28 + 0
19 15 + 2 54 28 + 3
55 29 + 0
20 15 + 3 56 29 + 3
21 15 + 6 57 30 + 0
22 16 + 1 58 30 + 2
23 16 + 4 59 30 + 5
24 16 + 6
25 17 + 0 60 31 + 0
26 17 + 2 61 31 + 4
27 17 + 4 62 32 + 0
28 18 + 0 63 32 + 3
29 18 + 2 64 33 + 0
65 33 + 3
30 18 + 4 66 34 + 0
31 18 + 6 67 34 + 4
32 19 + 3 68 35 + 0
33 19 + 5 69 35 + 2
34 20 + 0
35 20 + 2 70 35 + 5
36 20 + 5 71 36 + 0
37 21 + 0 72 36 + 3
38 21 + 2 73 37 + 0
39 21 + 5 74 37 + 3
75 38 + 0
40 22 + 0 76 38 + 3
41 22 + 4 77 39 + 0
42 23 + 0 78 39 + 2
43 23 + 3 79 39 + 5
44 24 + 0 80 40 + 0
45 24 + 3
MA Coeff 2SD Coeff
Q0 = 5.184726 Q0 = 0.0000000
Q1 = 9.844899 Q1 = 0.0000000
Q2 = –3.993980 Q2 = 0.0000000
Q3 = 1.041302 Q3 = 0.0000000
Q4 = – 0.116949 Q4 = 0.0000000
Q5 = 0.004815 Q5 = 0.0000000
Limits
MIN = 12.0 wks
MAX = 40.0 wks
Reference: Data adapted from composite mean values for O’Brien (American Journal of Obstetrics and
Gynecology, 1981) from 12 to 23 weeks and for Hohler (submitted to AJOG for publication)
from 23 to 40 weeks.

Ob Charts
FL Chart, Queenan
14.0 weeks - 40.0 weeks
FL Menstrual Age
(mm) (wks + days)
16.6 14
19.9 15
22.0 16
25.2 17
29.6 18
32.4 19
34.8 20
37.5 21
40.9 22
43.5 23
46.4 24
48.0 25
51.1 26
53.0 27
54.4 28
57.3 29
58.7 30
61.5 31
62.8 32
64.9 33
65.7 34
67.7 35
69.5 36
70.8 37
71.8 38
74.2 39
75.4 40
MA Coeff 2SD Coeff
Q0 = 6.511794 Q0 = 0.0000000
Q1 = 5.909238 Q1 = 0.0000000
Q2 = –1.108480 Q2 = 0.0000000
Q3 = 0.172456 Q3 = 0.0000000
Q4 = –0.006786 Q4 = 0.0000000
Q5 = 0.000000 Q5 = 0.0000000
Limits
MIN = 14.0 wks
MAX = 40.0 wks
Reference: O’Brien, G.D., J.T. Queenan et al. 1981. Femur Length to Weeks Gestation for 14 to 40
Weeks. American Journal of Obstetrics and Gynecology, 141: 833.

FL Chart, Tokyo University
FL Fetus Age ±day

(cm) (weeks)
3.23 20 17
3.44 21 18
3.65 22 19
3.87 23 21
4.09 24 22
4.31 25 24
4.54 26 25
4.76 27 25
4.98 28 25
5.19 29 28
5.41 30 30
5.61 31 32
5.82 32 35
6.01 33 38
6.19 34 42
6.37 35 46
6.53 36 50
6.68 37 54
6.82 38 57
6.93 39 60
7.04 40 64

Ob Charts
Foot Chart, Mercer

11 - 40 weeks
Foot Length Menstrual Age
(mm) (weeks)
8 11
9 12
10 13
16 14
16 15
21 16
24 17
27 18
28 19
33 20
35 21
38 22
42 23
44 24
47 25
51 26
54 27
58 28
57 29
61 30
62 31
63 32
67 33
68 34
71 35
74 36
75 37
78 38
78 39
82 40
MA Coeff 2SD Coeff
Q0 = 6.3629150 Q0 = 0.0000000
Q1 = 8.1331350 Q1 = 0.0000000
Q2 = –2.6364520 Q2 = 0.0000000
Q3 = 0.5923926 Q3 = 0.0000000
Q4 = –0.0558040 Q4 = 0.0000000
Q5 = 0.0018668 Q5 = 0.0000000
Limits
MIN = 11.0 wks
MAX = 40.0 wks
Reference: Mercer, B.M., et. al. 1987. Fetal foot length as a predictor of gestational age.
American Journal of Obstetrics and Gynecology. 156:350.

Gestational Sac, Hansmann

6.0 - 14.0 weeks
Sac Menstrual Age Sac Menstrual Age
10 5+6 40 9+7
11 5+7 41 10 + 1
12 6+1
13 6+2 42 10 + 2
14 6+3 43 10 + 3
15 6+4 44 10 + 4
16 6+5 45 10 + 5
17 6+6 46 10 + 6
18 6+7 47 10 + 7
19 7+1 48 11 + 1
49 11 + 2
20 7+2
21 7+3 50 11 + 3
22 7+4 51 11 + 4
23 7+5 52 11 + 5
24 7+6 53 11 + 6
25 7+7 54 11 + 7
26 8+1 55 12 + 1
27 8+2 56 12 + 2
28 8+3 57 12 + 3
29 8+4 58 12 + 4
59 12 + 5
30 8+5
31 8+6 60 12 + 6
32 8+7 61 12 + 7
33 9+1 62 13 + 1
34 9+2 63 13 + 2
35 9+3 64 13 + 3
36 9+4 65 13 + 4
37 9+4 66 13 + 5
38 9+5 67 13 + 6
39 9+6 68 13 + 7
MA Coeff 2SD Coeff
Q0 = 4.2980280 Q0 = 0.0000000
Q1 = 1.6067070 Q1 = 0.0000000
Q2 = –0.0653561 Q2 = 0.0000000
Q3 = 0.0058119 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 6.0 wks
MAX = 14.0 wks
Springer-Verlag.

Ob Charts
Gestational Sac, Hellman

5.0 - 12.2 weeks
Sac Menstrual Age Sac Menstrual Age
(mm) (weeks) (mm) (weeks)
10 5.0 36 8.8
11 5.2 37 8.9
12 5.3 38 9.0
13 5.5 39 9.2
14 5.6 40 9.3
15 5.8 41 9.5
16 5.9 42 9.6
17 6.0 43 9.7
18 6.2 44 9.9
19 6.3 45 10.0
46 10.2
20 6.5 47 10.3
21 6.6 48 10.5
22 6.8 49 10.6
23 6.9
24 7.0 50 10.7
25 7.2 51 10.9
26 7.3 52 11.0
27 7.5 53 11.2
28 7.6 54 11.3
29 7.8 55 11.5
56 11.6
30 7.9 57 11.7
31 8.0 58 11.9
32 8.2 59 12.0
33 8.3 60 12.2
34 8.5
35 8.6
MA Coeff 2SD Coeff
Q0 = 3.622507 Q0 = 0.0000000
Q1 = 1.425010 Q1 = 0.0000000
Q2 = 0.000000 Q2 = 0.0000000
Q3 = 0.000000 Q3 = 0.0000000
Q4 = 0.000000 Q4 = 0.0000000
Q5 = 0.000000 Q5 = 0.0000000
Limits
MIN = 5.0 wks
MAX = 12.2 wks
Reference: Hellman, L.M., et. al. 1969. Growth and Development of the Human Fetus Prior to the
Twentieth Week of Gestation. American Journal of Obstetrics and Gynecology. 103: 784-800.

HC Chart, Campbell
14 - 40 weeks
HC Menstrual Age
(mm) (weeks)
110 14
131 16
156 18
180 20
204 22
226 24
250 26
270 28
288 30
304 32
318 34
330 36
340 38
348 40
MA Coeff 2SD Coeff
Q0 = –5.415342 Q0 = 0.0000000
Q1 = 2.613817 Q1 = 0.0000000
Q2 = –0.096826 Q2 = 0.0000000
Q3 = 0.001693 Q3 = 0.0000000
Q4 = 0.000000 Q4 = 0.0000000
Q5 = 0.000000 Q5 = 0.0000000
–5.415342+2.613817*HC+–0.096826*HC^2+0.001693*HC^3
Limits
MIN = 14.0 wks11.0 cm
MAX = 40.0 wks34.8 cm

Ob Charts
HC Chart, Hadlock
12.2 - 41.9 weeks
HC MA 2 Std HC MA 2 Std HC MA 2 Std
56 12.0 1.2 100 14.7 1.2 144 17.6 1.2

57 12.1 1.2 101 14.7 1.2 145 17.7 1.2
58 12.2 1.2 102 14.8 1.2 146 17.8 1.2
59 12.2 1.2 103 14.8 1.2 147 17.9 1.2
104 14.9 1.2 148 17.9 1.2
60 12.3 1.2 105 15.0 1.2 149 18.0 1.2
61 12.3 1.2 106 15.0 1.2
62 12.4 1.2 107 15.1 1.2 150 18.1 1.5
63 12.4 1.2 108 15.2 1.2 151 18.1 1.5
64 12.5 1.2 152 18.2 1.5
65 12.6 1.2 109 15.2 1.2 153 18.3 1.5
66 12.6 1.2 110 15.3 1.2 154 18.4 1.5
67 12.7 1.2 111 15.4 1.2 155 18.4 1.5
68 12.7 1.2 112 15.4 1.2 156 18.5 1.5
69 12.8 1.2 113 15.5 1.2 157 18.6 1.5
114 15.6 1.2 158 18.7 1.5
70 12.8 1.2 115 15.6 1.2 159 18.8 1.5
71 12.9 1.2 116 15.7 1.2
72 13.0 1.2 117 15.8 1.2 160 18.8 1.5
73 13.0 1.2 118 15.8 1.2 161 18.9 1.5
74 13.1 1.2 119 15.9 1.2 162 19.0 1.5
75 13.1 1.2 163 19.1 1.5
76 13.2 1.2 120 16.0 1.2 164 19.1 1.5
77 13.3 1.2 121 16.0 1.2 165 19.2 1.5
78 13.3 1.2 122 16.1 1.2 166 19.3 1.5
79 13.4 1.2 123 16.2 1.2 167 19.4 1.5
124 16.2 1.2 168 19.5 1.5
80 13.4 1.2 125 16.3 1.2 169 19.5 1.5
81 13.5 1.2 126 16.4 1.2
82 13.6 1.2 127 16.4 1.2 170 19.6 1.5
83 13.6 1.2 128 16.5 1.2 171 19.7 1.5
84 13.7 1.2 129 16.6 1.2 172 19.8 1.5
85 13.7 1.2 173 19.9 1.5
86 13.8 1.2 130 16.6 1.2 174 19.9 1.5
87 13.9 1.2 131 16.7 1.2 175 20.0 1.5
88 13.9 1.2 132 16.8 1.2 176 20.1 1.5
89 14.0 1.2 133 16.8 1.2 177 20.2 1.5
134 16.9 1.2 178 20.3 1.5
90 14.0 1.2 135 17.0 1.2 179 20.3 1.5
91 14.1 1.2 136 17.1 1.2
92 14.2 1.2 137 17.1 1.2 180 20.4 1.5
93 14.2 1.2 138 17.2 1.2 181 20.5 1.5
94 14.3 1.2 139 17.3 1.2 182 20.6 1.5
95 14.3 1.2 183 20.7 1.5
96 14.4 1.2 140 17.3 1.2 184 20.8 1.5
97 14.5 1.2 141 17.4 1.2 185 20.8 1.5
98 14.5 1.2 142 17.5 1.2 186 20.9 1.5
99 14.6 1.2 143 17.6 1.2 187 21.0 1.5

HC Chart, Hadlock
(continued)
188 21.1 1.5 231 25.1 2.1 275 30.0 3.0

189 21.2 1.5 232 25.2 2.1 276 30.2 3.0
233 25.3 2.1 277 30.3 3.0
190 21.3 1.5 234 25.4 2.1 278 30.4 3.0
191 21.4 1.5 235 25.5 2.1 279 30.5 3.0
192 21.5 1.5 236 25.6 2.1 280 30.7 3.0
193 21.5 1.5 237 25.8 2.1 281 30.8 3.0
194 21.6 1.5 238 25.9 2.1
195 21.7 1.5 239 26.0 2.1 282 30.9 3.0
196 21.8 1.5 283 31.0 3.0
197 21.9 1.5 240 26.1 2.1 284 31.2 3.0
198 22.0 1.5 241 26.2 2.1 285 31.3 3.0
199 22.1 1.5 242 26.3 2.1 286 31.4 3.0
243 26.4 2.1 287 31.5 3.0
200 22.2 1.5 244 26.5 2.1 288 31.7 3.0
201 22.3 1.5 245 26.6 2.1 289 31.8 3.0
202 22.3 1.5 246 26.7 2.1
203 22.4 1.5 247 26.8 2.1 290 31.9 3.0
204 22.5 1.5 248 26.9 2.1 291 32.1 3.0
205 22.6 1.5 249 27.0 2.1 292 32.2 3.0
206 22.7 1.5 250 27.1 2.1 293 32.3 3.0
207 22.8 1.5 294 32.5 3.0
208 22.9 1.5 251 27.3 2.1 295 32.6 3.0
209 23.0 1.5 252 27.4 2.1 296 32.7 3.0
253 27.5 2.1 297 32.9 3.0
210 23.1 1.5 254 27.6 2.1 298 33.0 3.0
211 23.2 1.5 255 27.7 2.1 299 33.1 3.0
212 23.3 1.5 256 27.8 2.1
213 23.4 1.5 257 27.9 2.1 300 33.3 3.0
214 23.5 1.5 258 28.0 2.1 301 33.4 3.0
215 23.6 1.5 259 28.2 2.1 302 33.5 3.0
216 23.6 1.5 303 33.7 3.0
217 23.7 1.5 260 28.3 2.1 304 33.8 3.0
218 23.8 1.5 261 28.4 2.1 305 33.9 3.0
219 23.9 1.5 262 28.5 2.1 306 34.1 3.0
263 28.6 2.1 307 34.2 3.0
220 24.0 2.1 264 28.7 2.1 308 34.4 3.0
221 24.1 2.1 265 28.9 2.1 309 34.5 3.0
222 24.2 2.1 266 29.0 2.1
223 24.3 2.1 267 29.1 2.1 310 34.6 3.0
224 24.4 2.1 268 29.2 2.1 311 34.8 3.0
225 24.5 2.1 269 29.3 2.1 312 34.9 3.0
226 24.6 2.1 313 35.1 3.0
227 24.7 2.1 270 29.4 2.1 314 35.2 3.0
228 24.8 2.1 271 29.6 2.1 315 35.3 3.0
229 24.9 2.1 272 29.7 2.1 316 35.5 3.0
273 29.8 2.1 317 35.6 3.0
230 25.0 2.1 274 29.9 2.1 318 35.8 3.0

Ob Charts
HC Chart, Hadlock
(continued)
319 35.9 3.0 332 37.9 2.7 346 40.1 2.7

333 38.0 2.7 347 40.2 2.7
320 36.1 2.7 334 38.2 2.7 348 40.4 2.7
321 36.2 2.7 335 38.3 2.7 349 40.6 2.7
322 36.4 2.7 336 38.5 2.7
323 36.5 2.7 337 38.6 2.7 350 40.7 2.7
324 36.7 2.7 338 38.8 2.7 351 40.9 2.7
325 36.8 2.7 339 39.0 2.7 352 41.1 2.7
326 37.0 2.7 353 41.2 2.7
327 37.1 2.7 340 39.1 2.7 354 41.4 2.7
328 37.3 2.7 341 39.3 2.7 355 41.6 2.7
329 37.4 2.7 342 39.4 2.7 356 41.7 2.7
343 39.6 2.7 357 41.9 2.7
330 37.6 2.7 344 39.7 2.7
331 37.7 2.7 345 39.9 2.7
MA Coeff 2SD Coeff
Q0 = 8.9600000 Q0 = 0.0000000
Q1 = 0.5400000 Q1 = 0.0000000
Q2 = 0.0000000 Q2 = 0.0000000
Q3 = 0.0003000 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.2 wks
MAX = 42.0 wks
Reference: Hadlock, F.P. et al. 1984. Estimating Fetal age: Computer-Assisted Analysis of Multiple

HC Chart, Hansmann
17.9 - 41.6 weeks
HC Menstrual Age
(mm) (weeks + days)
140 17 + 6
150 18 + 5
160 19 + 4
170 20 + 3
180 21 + 2
190 22 + 1
200 22 + 6
210 23 + 5
220 24 + 4
230 25 + 3
240 26 + 2
250 27 + 2
260 28 + 1
270 29 + 1
280 30 + 1
290 31 + 2
300 32 + 3
310 33 + 6
320 35 + 2
330 36 + 6
340 39 + 1
350 41 + 4
MA Coeff 2SD Coeff
Q0 = –12.5869800 Q0 = 0.0000000
Q1 = 3.6772550 Q1 = 0.0000000
Q2 = –0.1398529 Q2 = 0.0000000
Q3 = 0.0022478 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 17.9 wks
MAX = 41.6 wks
Springer-Verlag.

Ob Charts
HC Chart, Hoffbauer
12 - 40 weeks
HC Menstrual Age
(mm) (weeks)
60 12
75 13
90 14
105 15
120 16
135 17
150 18
160 19
180 20
190 21
200 22
210 23
220 24
230 25
240 26
250 27
260 28
270 29
280 30
290 31
300 32
305 33
310 34
320 35
330 36
335 37
340 38
350 39
360 40
Regression Equation
MA Coeff 2SD Coeff
Q0 = 8.9079530 Q0 = 0.0000000
Q1 = 0.5020671 Q1 = 0.0000000
Q2 = 0.0046350 Q2 = 0.0000000
Q3 = 0.0001522 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.0 wks
MAX = 40.0 wks
Reference: Hoffbauer H., et al. 1979. Control of Fetal Development with Multiple Ultrasonic Body
Measures. Contr. Gynec. Obstet. 6:147.

HC Chart, Jeanty
13.3 - 41.7 weeks
HC Menstrual Age HC Menstrual Age
80 13 + 2 225 24 + 3
85 13 + 5 230 24 + 6
90 13 + 7 235 25 + 3
95 14 + 2 240 25 + 8
100 14 + 4 245 26 + 3
105 14 + 6 250 26 + 6
110 15 + 2 255 27 + 3
115 15 + 4 260 28 + 0
120 15 + 6 265 28 + 4
125 16 + 2 270 29 + 1
130 16 + 4 275 29 + 5
135 16 + 6 280 30 + 2
140 17 + 2 285 30 + 7
145 17 + 4 290 31 + 4
150 17 + 7 295 32 + 1
155 18 + 3 300 32 + 6
160 18 + 5 305 33 + 4
165 19 + 1 310 34 + 1
170 19 + 4 315 34 + 8
175 19 + 6 320 35 + 4
180 20 + 2 325 36 + 2
185 20 + 5 330 37 + 0
190 21 + 1 335 37 + 5
195 21 + 4 340 38 + 4
200 22 + 0 345 39 + 2
205 22 + 3 350 40 + 0
210 22 + 7 355 40 + 6
215 23 + 3 360 41 + 5
220 23 + 6
MA Coeff 2SD Coeff
Q0 = 8.8178080 Q0 = 0.0000000
Q1 = 0.5504550 Q1 = 0.0000000
Q2 = – 0.0001829 Q2 = 0.0000000
Q3 = 0.0002846 Q3 = 0.0000000
Q4 = – 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 13.3 wks
MAX = 41.7 wks
Reference: Jeanty, P. and Romero, R.: Obstetrical Ultrasound. Copyright 1984.

Ob Charts
Humerus Chart, Jeanty

12.6 - 40.1 weeks
Humerus Menstrual Age Humerus Menstrual Age
Length (mm) (wks + days) Length (mm) (wks + days)
10 12 + 4 40 24 + 2
11 12 + 6 41 24 + 6
12 13 + 1 42 25 + 2
13 13 + 4 43 25 + 5
14 13 + 6 44 26 + 1
15 14 + 1 45 26 + 5
16 14 + 4 46 27 + 1
17 14 + 6 47 27 + 5
18 15 + 1 48 28 + 1
19 15 + 4 49 28 + 6
20 15 + 6 50 29 + 2
21 16 + 2 51 29 + 6
22 16 + 5 52 30 + 2
23 17 + 1 53 30 + 6
24 17 + 3 54 31 + 3
25 17 + 6 55 32 + 0
26 18 + 1 56 32 + 4
27 18 + 4 57 33 + 1
28 19 + 0 58 33 + 4
29 19 + 3 59 34 + 1
30 19 + 6 60 34 + 6
31 20 + 2 61 35 + 2
32 20 + 5 62 35 + 6
33 21 + 1 63 36 + 4
34 21 + 4 64 37 + 1
35 22 + 0 65 37 + 5
36 22 + 4 66 38 + 2
37 22 + 6 67 38 + 6
38 23 + 3 68 39 + 4
39 23 + 6 69 40 + 1
MA Coeff 2SD Coeff
Q0 = 9.8149570 Q0 = 2.5660180
Q1 = 2.4542960 Q1 = 0.0196600
Q2 = 0.3152320 Q2 = –0.0003650
Q3 = –0.0068960 Q3 = 0.0000000
Q4 = 0.0002902 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 12.6 wks
MAX = 40.1 wks

Outer Orbits Chart, Mayden

11.6 - 39.8 weeks
Predicted Outer Menstrual Age Predicted Outer Menstrual Age
Orbital Diameter (weeks) Orbital Diameter (weeks)
(mm) (mm)
13 11.6 41 23.8
14 11.6 41 24.3
15 12.1 42 24.3
16 12.6 43 24.7
17 12.6 43 25.2
17 13.1 44 25.2
18 13.6
19 13.6 44 25.7
45 26.2
20 14.1 45 26.2
21 14.6 46 26.7
21 14.6 46 27.2
22 15.0 47 27.6
23 15.5 47 28.1
24 15.5 48 28.6
25 16.0 48 29.1
25 16.5 49 29.6
26 16.5
27 17.0 50. 30.0
27 17.5 50 30.6
28 17.9 51 31.0
51 31.5
30 18.4 52 32.0
31 18.9 52 32.5
32 19.4 53 33.0
32 19.4 54 33.5
33 19.9 54 34.0
34 20.4 54 34.4
34 20.4
35 20.9 55 35.0
36 21.3 55 35.4
56 35.9
36 21.3 56 36.4
37 21.8 57 36.9
38 22.3 57 37.3
38 22.3 58 37.8
39 22.8 58 38.3
40 23.3 58 38.8
59 39.3
59 39.8
MA Coeff 2SD Coeff
Q0 = 5.635285 Q0 = 0.0000000
Q1 = 4.391298 Q1 = 0.0000000
Q2 = 0.064272 Q2 = 0.0000000
Q3 = –0.102344 Q3 = 0.0000000
Q4 = 0.022172 Q4 = 0.0000000
Q5 = 0.000000 Q5 = 0.0000000
Limits
MIN = 11.6 wks
MAX = 39.8 wks
Reference: Mayden, K.L., et. al. 1982. Orbital diameters: A new Parameter for Prenatal Diagnosis and
Dating. American Journal of Obstetrics and Gynecology. 144: 289-97.

Ob Charts
Thoracic Circumference, Romero

16.0 - 40 weeks
Thoracic Circumference, Predictive Percentile
Gestational No. 2.5 5 10 25 50 75 90 95 97.5
Age (weeks)
16 5 5.9 6.4 7.0 8.0 9.1 10.3 11.3 11.9 12.4
17 22 6.8 7.3 7.9 8.9 10.0 11.2 12.2 12.8 13.3
18 31 7.7 8.2 8.8 9.8 11.0 12.1 13.1 13.7 14.2
19 21 8.6 9.1 9.7 10.7 11.9 13.0 14.0 14.6 15.1
20 20 9.5 10.0 10.6 11.7 12.8 13.9 15.0 15.5 16.0
21 30 10.4 11.0 11.6 12.6 13.7 14.8 15.8 16.4 16.9
22 18 11.3 11.9 12.5 13.5 14.6 15.7 16.7 17.3 17.8
23 21 12.2 12.8 13.4 14.4 15.5 16.6 17.6 18.2 18.8
24 27 13.2 13.7 14.3 15.3 16.4 17.5 18.5 19.0 19.7
25 20 14.1 14.6 15.2 16.2 17.3 18.4 19.4 20.0 20.5
26 25 15.0 15.5 16.1 17.1 18.2 19.3 20.3 21.0 21.5
27 24 15.9 16.4 17.0 18.0 19.1 20.2 21.3 21.9 22.4
28 24 16.8 17.3 17.9 18.9 20.0 21.2 22.2 22.8 23.3
29 24 17.7 18.2 18.8 19.8 21.0 22.1 23.1 23.7 24.2
30 27 18.6 19.1 19.7 20.7 21.9 23.0 24.0 24.6 25.1
31 24 19.5 20.0 20.6 21.6 22.8 23.9 24.9 25.5 26.0
32 28 20.4 20.9 21.5 22.6 23.7 24.8 25.8 26.4 26.9
33 27 21.3 21.8 22.5 23.5 24.6 25.7 26.7 27.3 27.8
34 25 22.2 22.8 23.4 24.4 25.5 26.6 27.6 28.2 28.7
35 20 23.1 23.7 24.3 25.3 26.4 27.5 28.5 29.1 29.6
36 23 24.0 24.6 25.2 26.2 27.3 28.4 29.4 30.0 30.6
37 22 24.9 25.5 26.1 27.1 28.2 29.3 30.3 30.9 31.5
38 21 25.9 26.4 27.0 28.0 29.1 30.2 31.2 31.9 32.4
39 7 26.8 27.3 27.9 28.9 30.0 31.1 32.2 32.8 33.3
40 6 27.7 28.2 28.8 29.8 30.9 32.1 33.1 33.7 34.2
MA Coeff 2SD Coeff
Q0 = 6.0456510 Q0 = 0.0000000
Q1 = 1.0880140 Q1 = 0.0000000
Q2 = 0.0003387 Q2 = 0.0000000
Q3 = 0.0000000 Q3 = 0.0000000
Q4 = 0.0000000 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 16.0 wks
MAX = 40.0 wks
Reference: Romero. 1987. Journal of OB Gyn. 158:1069, 1072.

Thoracic Diameter, Hansmann

13.6 - 41.4 weeks
Thoracic Diameter Menstrual Age Thoracic Diameter Menstrual Age Thoracic Diameter Menstrual Age
(mm) (wks + days) (mm) (wks + days) (mm) (wks + days)
20 13 + 4 50 22 + 5 80 32 + 4
21 13 + 5 51 22 + 7 81 32 + 6
22 14 + 1 52 23 + 2 82 33 + 1
23 14 + 3 53 23 + 4 83 33 + 4
24 14 + 5 54 23 + 7 84 33 + 7
25 14 + 7 55 24 + 2 85 34 + 2
26 15 + 2 56 24 + 4 86 34 + 4
27 15 + 4 57 24 + 6 87 34 + 7
28 15 + 6 58 25 + 1 88 35 + 2
29 16 + 1 59 25 + 3 89 35 + 5
30 16 + 3 60 25 + 6 90 36 + 1
31 16 + 5 61 26 + 1 91 36 + 3
32 17 + 1 62 26 + 3 92 36 + 5
33 17 + 3 63 26 + 5 93 37 + 1
34 17 + 5 64 27 + 1 94 37 + 4
35 17 + 7 65 27 + 3 95 37 + 7
36 18 + 2 66 27 + 5 96 38 + 2
37 18 + 4 67 28 + 1 97 38 + 5
38 18 + 6 68 28 + 3 98 39 + 1
39 19 + 1 69 28 + 5 99 39 + 4
40 19 + 3 70 29 + 1 100 39 + 7
41 19 + 6 71 29 + 3 101 40 + 3
42 20 + 1 72 29 + 5 102 40 + 6
43 20 + 3 73 30+ 1 103 41 + 3
44 20 + 5 74 30 + 3
45 20 + 7 75 30 + 6
46 21 + 2 76 31 + 1
47 21 + 4 77 31 + 3
48 21 + 7 78 31 + 6
49 22 + 2 79 32 + 1
MA Coeff 2SD Coeff
Q0 = 6.9634960 Q0 = 0.9180432
Q1 = 3.8298530 Q1 = –0.0336696
Q2 = –0.4430650 Q2 = 0.0030782
Q3 = 0.1010238 Q3 = 0.0000000
Q4 = –0.0099702 Q4 = 0.0000000
Q5 = 0.0003773 Q5 = 0.0000000
Limits
MIN = 13.6 wks
MAX = 41.4 wks
Springer-Verlag.

Ob Charts
Tibia Chart, Jeanty

11 - 40 weeks
Tibia Length Menstrual Age Tibia Length Menstrual Age
10 13 + 3 40 25 + 2
11 13 + 5 41 25 + 5
12 14 + 1 42 26 + 1
13 14 + 3 43 26 + 4
14 14 + 6 44 27 + 1
15 15 + 1 45 27 + 4
16 15 + 4 46 28 + 0
17 15 + 6 47 28 + 4
18 16 + 1 48 29 + 0
19 16 + 4 49 29 + 3
20 17 + 0 50 29 + 6
21 17 + 3 51 30 + 3
22 17 + 6 52 30 + 6
23 18 + 1 53 31 + 3
24 18 + 4 54 31 + 6
25 18 + 6 55 32 + 3
26 19 + 2 56 32 + 6
27 19 + 5 57 33 + 3
28 20 + 1 58 33 + 6
29 20 + 4 59 34 + 4
30 21 + 0 60 34 + 6
31 21 + 3 61 35 + 3
32 21 + 6 62 35 + 6
33 22 + 1 63 36 + 4
34 22 + 4 64 37 + 0
35 23 + 1 65 37 + 4
36 23 + 4 66 38 + 0
37 23 + 6 67 38 + 4
38 24 + 3 68 39 + 1
39 24 + 6 69 39 + 5
MA Coeff 2SD Coeff
Q0 = 10.2870000 Q0 = 0.0000000
Q1 = 2.8873990 Q1 = 0.0000000
Q2 = 0.2587258 Q2 = 0.0000000
Q3 = -0.0139916 Q3 = 0.0000000
Q4 = 0.0007752 Q4 = 0.0000000
Q5 = 0.0000000 Q5 = 0.0000000
Limits
MIN = 11.0 wks
MAX = 40.0 wks
Reference: Jeanty, P., et. al. February, 1984. Estimation of Gestational Age from Measurement of Fetal
Long Bones. Journal of Ultrasound Medicine. 3: 75-79.

Tibia Chart, Merz

13 - 42 weeks
Tibia Length Menstrual Age
(mm) (weeks)
9 13
10 14
13 15
16 16
18 17
22 18
25 19
27 20
30 21
32 22
36 23
37 24
40 25
42 26
44 27
45 28
46 29
48 30
51 31
52 32
54 33
57 34
58 35
60 36
61 37
62 38
64 39
65 40
66 41
68 42
MA Coeff 2SD Coeff
Q0 = 4.6722820 Q0 = 0.0000000
Q1 = 14.5027000 Q1 = 0.0000000
Q2 = –7.3699760 Q2 = 0.0000000
Q3 = 2.1782100 Q3 = 0.0000000
Q4 = –0.2874230 Q4 = 0.0000000
Q5 = 0.0144052 Q5 = 0.0000000
Limits
MIN = 13.0 wks
MAX = 42.0 wks
Reference: Merz, E., et. al. Ultrasonic Mensuration of Fetal Limb Bones in the Second and Third
Trimester. J. Clin. Ultrasound. 15:175-183, March-April 1987.

Ob Charts
Ulna Chart, Jeanty

13.1 - 40.3 weeks
Ulna Length Menstrual Age Ulna Length Menstrual Age
10 13 + 1 38 25 + 1
11 13 + 4 39 25 + 4
12 13 + 6
13 14 + 1 40 26 + 1
14 14 + 4 41 26 + 5
15 15 + 0 42 27 + 1
16 15 + 3 43 27 + 5
17 15 + 5 44 28 + 2
18 16 + 1 45 28 + 6
19 16 + 4 46 29 + 3
47 29 + 6
20 16 + 6 48 30 + 4
21 17 + 2 49 31 + 1
22 17 + 5
23 18 + 1 50 31 + 4
24 18 + 4 51 32 + 1
25 19 + 0 52 32 + 6
26 19 + 3 53 33 + 3
27 19 + 6 54 34 + 0
28 20 + 2 55 34 + 4
29 20 + 6 56 35 + 1
57 35 + 6
30 21 + 1 58 36 + 3
31 21 + 5 59 37 + 1
32 22 + 1
33 22 + 5 60 37 + 5
34 23 + 1 61 38 + 2
35 23 + 4 62 39 + 0
36 24 + 1 63 39 + 4
37 24 + 4 64 40 + 2
MA Coeff 2SD Coeff
Q0 = 9.7973180 Q0 = 3.0372120
Q1 = 3.2535710 Q1 = 0.0026310
Q2 = 0.0428870 Q2 = 0.0000000
Q3 = 0.0713840 Q3 = 0.0000000
Q4 = –0.0092650 Q4 = 0.0000000
Q5 = 0.0004399 Q5 = 0.0000000
Limits
MIN = 13.1 wks
MAX = 40.3 wks

Table 7-4 Conversion Chart: Pounds and Ounces to Grams
OZ
LBS 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
0 - 28 57 85 113 142 170 198 255 284 312 340 369 397 425
227
1 454 482 510 539 567 595 624 652 680 709 737 765 794 822 850 879
2 907 936 964 992 1021 1049 1077 1106 1134 1162 1191 1219 1247 1276 1304 1332
3 1361 1389 1417 1446 1474 1503 1531 1559 1588 1616 1644 1673 1701 1729 1758 1786
4 1814 1843 1871 1899 1928 1956 1984 2013 2041 2070 2098 2126 2155 2183 2211 2240
5 2268 2296 2325 2353 2381 2410 2438 2466 2495 2523 2551 2580 2608 2637 2665 2693
6 2722 2750 2778 2807 2835 2863 2892 2920 2948 2977 3005 3033 3062 3090 3118 3147
7 3175 3203 3232 3260 3289 3317 3345 3374 3402 3430 3459 3487 3515 3544 3572 3600
8 3629 3657 3685 3714 3742 3770 3799 3827 3856 3884 3912 3941 3969 3997 4026 4054
9 4082 4111 4139 4167 4196 4224 4252 4281 4309 4337 4366 4394 4423 4451 4479 4508
10 4536 4564 4593 4621 4649 4678 4706 4734 4763 4791 4819 4848 4876 4904 4933 4961
11 4989 5018 5046 5075 5103 5131 5160 5188 5216 5245 5273 5301 5330 5358 5386 5415
12 5443 5471 5500 5528 5556 5585 5613 5642 5670 5698 5727 5755 5783 5812 5840 5868
13 5897 5925 5953 5982 6010 6038 6067 6095 6123 6152 6180 6209 6237 6265 6294 6322
14 6350 6379 6407 6435 6464 6492 6520 6549 6577 6605 6634 6662 6690 6719 6747 6776

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2-D mode configurations 6 to 8
cardiac formulas 67 automatic cycling, for multiple
cardiac measurements 62
cardiac measurements and
calculations 63 averaging, cardiac measurement
values 62
controls, customizing 4
B
A
Binocular Distance chart. See fetal
AC charts. See fetal parameter
parameter charts
charts
biometric measurements
ACUSON
adding optional 48
manuals, in this set vii
customizing MA coefficients
ACUSON/H program, for
for 46
calculating composite menstrual
age 44 biometric ratios, adding
optional 50
ACUSON/M program, for
calculating composite menstrual BPD charts. See fetal parameter
age 44 charts
AEGIS software 28 to 36 brightness, adjusting video 74
capture types and stages, C
creating 34
cables
clips
for VCR installation 75
saving 36
IBM PC-compatible printer
storage protocols 33
interconnect cable 82
store settings,
customizing 34 Quick Disconnect cable 78
functions connecting printers with 79
program-specific, calculation packages,
customizing 33 to 36 customizing 9
system-wide, See also cardiac calculations; OB
customizing 28 to 32 calculations; vascular
network file servers, setting calculations
up 31 Campbell
network printers, setting AC chart 87
up 29 to 30 BPD chart 93
protocol capture type/stage FL chart 119
parameters 35 capture type/stage
system protocol parameters 34 parameters 35
customizing 33 capture types, creating 34
worklist server, setting up 32 cardiac calculations 60 to 72
AIUM Ultrasound Medical Safety automatic cycling, for multiple
brochure 9, 145 measurements 62
ALARA principle 9, 145

averaging measurement D
values 62 data (exam), copying 31
Cardiac Calc Select menu 60 data fields, customizing 18
customizations, overview date (system), resetting 19
of 60
Depth Gain Compensation (DGC)
formulas 67 to 70 curves, customizing 18
2-D mode 67 dialog boxes (Setup), using 3
M-mode 69
display elements,
70
spectral Doppler mode adjusting 21 to 22
measurements and calculations Doppler mode
2-D mode 63 cardiac formulas 70
Doppler mode 66
cardiac measurements and
M-mode 65 calculations 66
selecting (turning on and
off) 63 E
printing report and EFW chart. See fetal parameter
worksheet 62 charts
references 71 EFW Equation, customizing 51
Velocity Time Integral (VTI) exam data, copying 31
calculation 62 Exam Presets 38 to 39
Cerebellum charts. See fetal external VCRs, installing 77
parameter charts
external video
charts, fetal parameter. See fetal
configuration, changing 16
parameter charts
source, selecting 11
cleaning, printers 78
clips F
saving 36 fetal parameter charts 85 to 143
storage protocols 33 AC charts
store settings, customizing 34 Campbell 87
clock (system), resetting 19 Hadlock 88
Color Doppler options, Jeanty 91
customizing 10 Binocular Distance chart,
color levels, adjusting video 74 Jeanty 92
composite menstrual age, BPD charts
programs for calculating 44 Campbell 93
Contacting Siemens ix Hadlock 94
contrast, adjusting video 74 Hansmann 95
controls, for customizing functions Jeanty 96
(Setup menu) 2 Kurtz 97
copying, exam data 31 Yale 100
CRL charts. See fetal parameter Cerebellum charts
charts Goldstein 101
cursor line, customizing 18 McLeary 102
customizing. See setup CRL charts
Hadlock 103
Hansmann 104

Jeanty 105 Foot chart. See fetal parameter
Nelson 106 charts
Robinson 1975 107 foot switch, customizing 11
Robinson 1988 108 formulas
EFW chart, Shepard 110 cardiac calculations 67 to 70
estimated fetal weight (EFW), 2-D mode 67
using charts to estimate 85 M-mode 69
Fibula chart, Jeanty 118 spectral Doppler mode 70
FL charts OB calculations. See fetal
Campbell 119 parameter charts
Hadlock 120 vascular calculations 58
Hansmann 121 Free Form protocol, for clip
Hohler 122 storage 33
Jeanty 123 functions, customizing with Setup
O’Brien 124 menu 2
Queenan 125
G
Foot chart, Mercer 127
gestational age, versus menstrual
Gestational Sac charts age 85
Hansmann 128 Gestational Sac charts. See fetal
Hellman 129 parameter charts
HC charts Goldstein, Cerebellum chart 101
Hadlock 131 graphics brightness, adjusting 21
Hansmann 134 gray test, for adjusting gray
Hoffbauer 135 shades 21
Jeanty 136 growth curves (OB), printing 54
Humerus chart, Jeanty 137
H
menstrual age (MA), using
charts to estimate 85 Hadlock
standard charts, used by system AC chart 88
programs 85 BPD chart 94
Thoracic Circumference chart, CRL chart 103
Romero 139 FL chart 120
Thoracic Diameter chart, HC chart 131
Hansmann 140
Hansmann
Tibia charts
BPD chart 95
Jeanty 141
CRL chart 104
Merz 142
FL chart 121
Ulna chart, Jeanty 143
Gestational Sac chart 128
fetal weight, estimating. See fetal
parameter charts HC chart 134
Fibula chart. See fetal parameter Thoracic Diameter chart 140
charts HC charts. See fetal parameter
file servers (network), setting charts
up 31 headings, changing in OB
FL charts. See fetal parameter reports 43
charts

Hellman, Gestational Sac LMP Percentile Calculation,
chart 129 customizing 52
Hoffbauer, HC chart 135
M
Hohler, FL chart 122
MA coefficients, customizing for
Hospital Information System (HIS) biometric measurements 46
worklist server, setting up 32
manuals, in this set vii
Humerus chart. See fetal parameter
McLeary, Cerebellum chart 102
charts
measurements
I biometric
IBM PC-compatible printers, customizing MA coefficients
installing 82 for 46
Image Presets 38 to 39 optional, adding 48
installing cardiac
printers 12 to 14, 78 to 82 2-D mode 63
IBM PC-compatible averaging 62
printer 82 averaging values for 62
Multi-Imager printer 81 Doppler mode 66
using Quick Disconnect M-mode 65
cable 79
selecting 63
VCRs
OB, selecting 53
external 77
menstrual age (MA)
Sony SVO-9500MD 75 to 77
estimating, using fetal
J parameter charts 85
Jeanty programs for calculating 44
AC chart 91 Mercer, Foot chart 127
Binocular Distance chart 92 Merz, Tibia chart 142
BPD chart 96 M-mode
CRL chart 105 cardiac formulas 69
Fibula chart 118 cardiac measurements and
calculations 65
FL chart 123
monitor
HC chart 136
display, adjusting 21 to 22
Humerus chart 137
tint, adjusting 22
Tibia chart 141
Multi-Imager printer,
Ulna chart 143
installing 81
K
N
key conventions, in this
Nelson, CRL chart 106
manual ix
network file servers, setting
Kurtz, BPD chart 97
up 31
L network printers, setting
languages, converting system to up 29 to 30
other ix
O
laser printers, connecting 82
O’Brien, FL chart 124
lighting (system), customizing 25
OB calculations 42

fetal parameter for IBM PC-compatible
charts 85 to 143 printers 82
See also fetal parameter charts for Multi-Imager 81
measurements and calculations, printing
selecting 53 cardiac calculation report and
OB Calc Select menu, using 42 worksheet 62
printing options 54 OB worksheet and growth
programs for calculating curves 54
composite menstrual age, print control settings,
selecting 44 adjusting 13
references 86 printer configurations,
USER program changing 17
(custom) 45 to 52 printing devices
biometric measurements, controlling 12
adding 48 installing and removing 13
biometric measurements, cus- printing to one device 14
tomizing MA coefficients
programs, for calculating
for 46
composite menstrual age 44
biometric ratios, adding 50
protocol capture type/stage
EFW Equation,
parameters 35
customizing 51
LMP percentile calculation, Q
customizing 52
Queenan, FL chart 125
measurements and equations,
customizing 45 Quick Disconnect cable 78
worksheet comment pages, connecting printers with 79
customizing 53
R
P Radiology Information System
Presets 38 (RIS) worklist server, setting
up 32
Auto Doppler configuration 8
ratios, adding optional
Exam 38
biometric 50
Image 38
references
using and customizing 39
for cardiac calculations 71
printers 12 to 14, 78 to 82
for OB calculations 86
cleaning 78
regression programs and
installing equations, OB 85
connecting printers with Quick reports
Disconnect cable 79
cardiac calculation,
IBM PC-compatible
printing 62
printers 82
installation overview 78 OB calculation, changing
heading 43
Multi-Imager printer 81
vascular calculation 56 to 57
laser, connecting 82
changing study and site
network, setting up 29 to 30 names 57
placement, recommended 78 displaying worksheet 57
safety precautions selecting studies to
include 56

Robinson printers 12 to 14, 78 to 82
CRL chart 1975 107 See also printers
CRL chart 1988 108 printing 12 to 14
Romero, Thoracic Circumference See also printing
chart 139 protocol capture type/stage
parameters 35
S
scale marker appearance,
safety issues, ultrasound 9, 145 changing 19 to 20
scale marker appearance, Setup menu 2 to 3
changing 19 to 20
controls, for customizing
setup functions 2
2-D controls, customizing 4 displaying 2
AEGIS software 28 to 36 Setup dialog boxes, using 3
See also AEGIS software storage servers, in network file
Auto Doppler servers 31
configurations 6 to 8 strip mode
calculation packages, controls, customizing 23
customizing 9 20
scale options for
cardiac study types, customizing 24
calculations 60, 62 to 72 system lighting,
See also cardiac calculations customizing 25
clips vascular calculations 56 to 58
saving 36 See also vascular calculations
storage protocols 33 VCRs 75 to 77
store settings, See also VCRs; video
customizing34
video 11 to 12, 14 to 17
Color Doppler options,
See also VCRs; video
customizing 10
worklist servers, setting up 32
converting system to other
languages ix Setup menu 2 to 3
copying exam data 31 controls, for customizing
functions 2
cursor line, customizing 18
dialog boxes, using 3
data fields, customizing 18
displaying 2
date and time, resetting 19
Shepard, EFW chart 110
Depth Gain Compensation
(DGC) curves, site names, customizing for
customizing 18 vascular calculation report 57
foot switch, customizing 11 Sony Color Page Printer, selecting
as external video source 11
monitor display,
customizing 21 to 22 Sony SVO-9500MD VCR
network file servers, setting installing 75
up 31 settings
OB calculations 42 adjusting 76 to 77
See also OB calculations; fetal recommended 77
parameter charts spectral Doppler mode
Presets, using and cardiac formulas 70
customizing 39

cardiac measurements and V
calculations 66 vascular calculations
Staged protocol, for clip formulas 58
storage 33
report 56 to 57
stages, creating 34
changing study and site
storage servers, in network file names 57
servers 31 displaying worksheet 57
strip mode selecting studies to
controls, customizing 23 include 56
scale options for 20 Vascular Calc Select menu,
study names displaying 56
changing, in vascular VCRs (video cassette

calculation report 57 recorders) 75 to 77
study types, customizing 24 external, installing 77
Super VHS video format 75 Sony SVO-9500MD,

installing 75 to 77
symbols, in this manual ix
Velocity Time Integral (VTI)
system lighting, customizing 25 calculation, in cardiac
studies 62
T
video 11 to 12, 14 to 17
text brightness, adjusting 21
controls
Thoracic Circumference chart. See
fetal parameter charts adjusting brightness, color lev-
els, and contrast 74
Thoracic Diameter chart. See fetal
setting up the VCR
parameter charts
counter 74
Tibia charts. See fetal parameter
external video source,
charts
selecting 11
time (system), resetting 19
formats, supported 75
tint, monitor 22
output levels, adjusting 14
U settings, changing 15
Ulna chart. See fetal parameter external video
charts 143 configuration 16
printer configuration,
ultrasound safety 9, 145
changing 17
USER program (custom,
VCR configuration 15
OB) 45 to 52
biometric measurements W
adding optional 48 worklist server, setting up 32
customizing MA coefficients worksheets
for 46
cardiac calculation,
biometric ratios, adding printing 62
optional 50
OB calculation
EFW Equation,
customizing comment
customizing 51 pages 53
LMP Percentile Calculation, printing 54
customizing 52
vascular calculation,
measurements and equations, displaying 57
customizing 45

Y
Yale, BPD chart 100

ACUSON Aspen
Administrator Manual
Part Number: 07702850
Rev. 1
Language: English

Manual de Administrador Aspen

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ACUSON Aspen™ Ultrasound System

Siemens Medical Solutions USA, Inc.

0503 Administrator Manual iii

iv ACUSON Aspen Ultrasound System 0503

Chapter 1 Customizing System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 2 Customizing On-Board AEGIS Software . . . . . . . . . . . . . . . . . . . 27

Chapter 4 Customizing OB Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

0503 Administrator Manual v

Chapter 5 Customizing Vascular Calculations . . . . . . . . . . . . . . . . . . . . . . . 55

Chapter 6 Customizing Cardiac Calculations . . . . . . . . . . . . . . . . . . . . . . . . 59

Chapter 7 VCR and Printer Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Appendix A OB Calculation Formulas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Appendix B AIUM Medical Ultrasound Safety . . . . . . . . . . . . . . . . . . . . . . . . 145

vi ACUSON Aspen Ultrasound System 0503

The ACUSON Aspen Ultrasound system is designed to help you perform

0503 Administrator Manual vii

viii ACUSON Aspen Ultrasound System 0503

◆ A diamond-shaped bullet indicates steps to follow to

Siemens provides special alphanumeric keys and annotation terms for

0503 Administrator Manual ix

CUSTOMIZING SYSTEM SETUP

Using the Setup Menu 2

0503 Administrator Manual 1

Figure 1-1 Setup Menu

2 ACUSON Aspen Ultrasound System 0503

Figure 1-2 Dialog Box Components

0503 Administrator Manual 3

Figure 1-3 2-D Options

• Select a FOCUS KNOB DIRECTION to customize the behavior of the

4 ACUSON Aspen Ultrasound System 0503

0503 Administrator Manual 5

Figure 1-4 Doppler Configuration Function

6 ACUSON Aspen Ultrasound System 0503

Figure 1-5 Auto-Doppler Configuration Measurements

SIGNAL TYPE SUGGESTED APPLICATION SITE

High Volume Carotid, Aorta

Low Resistance Renal, Ovary

Tri-Phasic Femoral, Brachial Artery

6. Select a signal type which is similar to the waveform you want to

0503 Administrator Manual 7

Table 1-1 Preset Auto Doppler Configurations

Site Names RT CCA RT Ovary RT Femoral RT Kidney LVOT

Maximum ON ON ON ON ON ON ON ON OFF OFF ON ON ON ON ON ON

Minimum ON ON ON ON ON ON ON ON OFF OFF ON ON ON ON ON ON

Angle ON ON ON ON ON ON ON ON OFF OFF ON ON ON ON ON ON

Heart Rate ON ON ON ON ON ON OFF OFF OFF OFF ON ON ON ON ON ON

8 ACUSON Aspen Ultrasound System 0503

0503 Administrator Manual 9

Figure 1-6 Color Doppler Options

10 ACUSON Aspen Ultrasound System 0503

EXTERNAL VIDEO FIRST PRESS OF SECOND PRESS OF

VCR Starts playback Stops playback

• VCR in playback Stops VCR playback Activates printer

• VCR turned off Activates printer Deactivates printer

0503 Administrator Manual 11

[SYSTEM VCR] Selects the system’s VCR.

Figure 1-7 Print Control Soft Key Menu

12 ACUSON Aspen Ultrasound System 0503

FRZ/PRT/FRZ The image freezes, prints, and remains frozen after

Supported Devices lists the

Figure 1-8 Supported Printing Devices

0503 Administrator Manual 13

◆ To adjust the VCR signal output:

Figure 1-9 VCR Output Signal Control Menu