Chison SonoEye P3 User manual

Digital Color Doppler Palm Ultrasound System
Digital Color Doppler Palm Ultrasound System
Model
SonoEye P3
USER MANUAL
Direction: CHUM SonoEye-P3-001a
June.5th,2020
Rev. 1.01
CHISON Medical Technologies Co., Ltd.
We reserve the right to make changes to this manual without prior notice.

Digital Color Doppler Palm Ultrasound System
Regulatory Requirement
This product conforms to the essential requirements of the Medical Device
Directive 93/42/EEC. Accessories without the CE mark are not guaranteed
to meet the Essential Requirements of the Medical Device Directive.
This manual is a reference for the SonoEye P3. Please verify that you are using the latest
revision of this document. If you need to know the latest revision, contact your distributor.

Digital Color Doppler Palm Ultrasound System
TABLE OF CONTENTS
TABLE OF CONTENTS .................................................................................................................................................1
Chapter 1 Introduction.................................................................................................................................................1
1.1 System Overview ...............................................................................................................................................1
1.2 Contact Information..........................................................................................................................................1
Chapter 2 System Safety..............................................................................................................................................2
2.1 Safety Overview.................................................................................................................................................2
2.2 Electrical Safety.................................................................................................................................................3
2.3 Labels..................................................................................................................................................................6
2.3.1 Symbols on Label......................................................................................................................................6
2.3.2 Other Device Labels .................................................................................................................................7
2.4 Patient Environmental Devices ........................................................................................................................7
2.5 Biological Safety ................................................................................................................................................9
2.6 Scanning Patients and Education...................................................................................................................10
2.6.1 Safe Scanning Guidelines.......................................................................................................................10
2.6.2 Understanding the MI/TI Display.........................................................................................................11
Chapter 3 Preparing the System for Use...............................................................................................................16
3.1 Site Requirement..........................................................................................................................................16
3.1.1 Operation Environmental Requirement............................................................................................16
3.1.2 Electrical Requirements......................................................................................................................16
3.2 Downloading and Installing the App.......................................................................................................16
3.3 System Specifications.................................................................................................................................18
3.3.1 Console Overview................................................................................................................................18
3.3.2 Physical Specifications ........................................................................................................................19
3.3.3 Image Modes........................................................................................................................................19
3.3.4 Type.......................................................................................................................................................19
3.3.5 System Configuration..........................................................................................................................19
3.4 System Positioning & Transporting ........................................................................................................21
3.5 Powering the System...................................................................................................................................21
3.5.1 Acclimation Time.................................................................................................................................21
3.5.2 Connecting the Electric Power...........................................................................................................21
3.6 The System.....................................................................................................................................................22
Chapter 4 Control Panel.............................................................................................................................................23
4.1 Overview of Display Area...........................................................................................................................23
4.2 Start a New Exam..........................................................................................................................................24
4.3 Probe................................................................................................................................................................26
4.4 Switching Function......................................................................................................................................27
4.5 Switching Mode.............................................................................................................................................27
4.6 Function Key Introduction .........................................................................................................................27
4.7 Image Parameter Area.................................................................................................................................29
4.8 Cine Control...................................................................................................................................................29
Chapter 5 Imaging........................................................................................................................................................30
5.1 Select Scan Mode.............................................................................................................................................30
5.1.1 System Identify .......................................................................................................................................30
5.1.2 Select Application ...................................................................................................................................30

Digital Color Doppler Palm Ultrasound System
5.1.3 B mode.....................................................................................................................................................30
5.1.4 FHI...........................................................................................................................................................30
5.1.5 B/M Mode................................................................................................................................................30
5.1.6 CFM Mode..............................................................................................................................................30
5.1.7 PW mode .................................................................................................................................................31
5.1.8 B-Lines.....................................................................................................................................................32
5.1.9 Biopsy Guide...........................................................................................................................................32
5.1.10 SonoNeedle............................................................................................................................................32
5.1.11 SuperNeedle...........................................................................................................................................33
5.1.12 SonoRemote...........................................................................................................................................33
5.2 Functional Description of Parameter Adjustment .......................................................................................33
5.3 Parameter Adjustment in PW mode..............................................................................................................34
5.4 After Capturing the Image.............................................................................................................................34
5.4.1 Adding Annotation..................................................................................................................................34
5.4.2Adding BodyMark..................................................................................................................................35
5.4.3Adding Mark...........................................................................................................................................35
Chapter 6 Measurement and Calculation ..............................................................................................................36
6.1 Measurement Methods: ..................................................................................................................................36
6.2 B Mode Measurement.....................................................................................................................................36
6.2.1 Vessel Measurement in B mode..........................................................................................................36
6.2.2 Abdomen Measurement in B mode....................................................................................................37
6.2.3 Cardiac Measurement in B mode.......................................................................................................37
6.3 B/M Mode Measurement................................................................................................................................38
6.4 PW Mode Measurement .................................................................................................................................38
Chapter 7 Cine-Memory..............................................................................................................................................40
7.1 Image Storage..................................................................................................................................................40
7.2 Manual playback.............................................................................................................................................40
7.3 Automatic playback.........................................................................................................................................40
7.4 Cine Save..........................................................................................................................................................40
Chapter 8 Side Menu...................................................................................................................................................41
8.1 Archive .............................................................................................................................................................41
8.2 EasyView..........................................................................................................................................................43
8.3 Report...............................................................................................................................................................44
8.4 Setting...............................................................................................................................................................44
8.4.1 General.................................................................................................................................................45
8.4.2 Language..............................................................................................................................................45
8.4.3 Button Configuration..........................................................................................................................46
8.4.4 Administrator ......................................................................................................................................46
8.4.5 Firmware Update.................................................................................................................................46
8.4.6 Function Management ........................................................................................................................47
8.5 Tutorials...........................................................................................................................................................47
8.6 Demo.................................................................................................................................................................47
8.7 About................................................................................................................................................................48
Chapter 9 System Maintenance ...............................................................................................................................49
9.1 Cleaning............................................................................................................................................................49

Digital Color Doppler Palm Ultrasound System
9.2 System Maintenance........................................................................................................................................49
9.3 Safety Check ....................................................................................................................................................50
9.4 Troubleshooting...............................................................................................................................................50
9.5 Service Responsibility .....................................................................................................................................51
Chapter 10 System ......................................................................................................................................................53
10.1 General Description.........................................................................................................................................53
10.2 Care and Maintenance....................................................................................................................................53
10.2.1 Inspecting Systems................................................................................................................................53
10.2.2 Cleaning and Disinfecting....................................................................................................................54
10.3 System Operation Instructions.......................................................................................................................59
10.4 Service Responsibility .....................................................................................................................................60
AppendixA: THE INFORMATION OF EC REPRESENTATIVE ...........................................................................62
Appendix B:ACOUSTIC OUTPUT REPORT TABLE..............................................................................................63
Appendix C:TRANSDUCER MAXIMUM SURFACE TEMPERATURE...............................................................67
Appendix D: MEASUREMENT RESULTS SUMMARY...............................................................................................68
Appendix E: GUIDANCE AND MANUFACTURER’S DECLARATION ...............................................................69

Digital Color Doppler Palm Ultrasound System
1
Chapter 1 Introduction
This manual contains necessary information for safe system operation.
Read and understand all instructions in this manual before operating the system. Always keep this manual
with the equipment, and periodically review the procedures for operation and safety precautions.
1.1 System Overview
Indications for Use
SonoEye P3 Digital Color Doppler Palm Ultrasound System is intended for diagnostic ultrasound imaging in
B (2D), B/M, CFM, Combined (B+CFM), Pulsed Wave and Fusion Harmonic Imaging modes. It is indicated
for Abdominal, Neonatal Cephalic,Adult Cephalic, Cardiac Adult, Cardiac Pediatric, Lung, TCD.
SonoEye P3 Digital Color Doppler Palm Ultrasound System is intended for use in environments where
healthcare is provided by healthcare professionals.
Contraindication
The system is NOT intended for Ophthalmic use or any use that causes the acoustic beam to pass through
the eye.
1.2 Contact Information
For additional information or assistance, please contact your local distributor or the appropriate
support resource shown below:
CHISON website
www.chison.com
Service Support
CHISON Medical Technologies Co., Ltd..
Tel: [phone]
Fax: [phone]
E-mail: servic[email protected]
Placing an Order CHISON Medical Technologies Co., Ltd.
Tel: [phone]
Fax: [phone]
Email: [email protected]
Manufacturer CHISON Medical Technologies Co., Ltd.
No.228, Changjiang East Road, Block 51 and 53, Phase 5,
Shuofang Industrial Park, Xinwu District, Wuxi, Jiangsu, China
214142
No.9, Xinhuihuan Road, Xinwu District, Wuxi, Jiangsu, China 214028
US Agent Mr. Marco Mu, 2219 Rimland Drive,Suite 301,Bellingham, Barkley Villiage
Bellingham,Washington,98226, UNITED STATES
Phone: [phone], Fax: [phone], Email: us.agent@mid-
link.net MID-LINK INTERNATIONAL CO., LTD
CAUTION Federal law restricts the device to sale by or on the order of a licensed
practitioner or therapist.

Digital Color Doppler Palm Ultrasound System
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Chapter 2 System Safety
2.1 Safety Overview
This section discusses measures to ensure the safety of both the operator and patient. To ensure the safety
of both operator and patient, please read the relevant details in this chapter carefully before operating this
system. Disregarding the warnings or violation of relevant rules may result in personal injury or even loss of
life for operator or patient.
Users should observe the following precautions:
This system complies with Type BF general equipment, and the IEC standard. Please follow Chapter 1
“System Safety” in the user’s manual to use this system properly.
Do not modify this system in any way. The system is prohibited to dismount. Necessary modifications
must be made only by the manufacturer or its designated agents.
This system has been fully adjusted at the factory. Do not adjust any fixed adjustable parts.
In the event of a malfunction, turn off the system immediately and inform the manufacturer or its
designated agents.
Only connect this system, either electronically or mechanically, with devices that comply with the
EN60601-1 standard. Recheck the leakage current and other safety performance indices of the entire
system to avoid potential system damage caused by leakage from a current superposition.
The system does not incorporate any specialized protective measures in the event it is configured with
high-frequency operation devices. The operator should use caution in these types of applications.
The system should be installed only by personnel authorized by the manufacturer. Do not attempt to
install the system by yourself.
Only an authorized service engineer may perform maintenance.
Only a qualified operator, or someone under qualified supervision, should use the system.
Do not use this system in the presence of flammable substances, otherwise an explosion may occur.
Do not continuously scan the same part of a patient or expose the patient to prolonged scanning,
otherwise it may harm the patient.
When using the system for ultrasound testing, use only qualified ultrasound gel that complies with
system standards.

Digital Color Doppler Palm Ultrasound System
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Do not unplug system when the system is in active operation. Always go to EXAM screen when you
need to remove the system.
To prevent from arm or neck injury, the operator should not stay at the same position for too long during
patient scanning without taking break.
Do not put the system near the liquid.
NOTE
*To dispose of this product properly, please call your local service department.
2.2 Electrical Safety
Type of protection against electric shock
Class I Equipment
CLASS I EQUIPMENT in which protection against electric shock does not rely on BASIC INSULATION only,
but includes a protective earth ground. This additional safety precaution prevents exposed metal parts from
becoming LIVE in the event of an insulation failure.
NOTE
The EMISSIONS characteristics of this equipment make it suitable for use in industrial areas and hospitals
(CISPR 11 class A). If it is used in a residential ENVIRONMENT (for which CISPR 11 class B is normally
required) this equipment might not offer adequate protection to radio-frequency communication services.
The user might need to take mitigation measures, such as relocating or re-orienting the equipment.
Degree of protection against electric shock
Type BF Applied part (for Systems marked with BF symbol)
TYPE BF APPLIED PART providing a specified degree of protection against electric shock, with particular
regard to allowable LEAKAGE CURRENT
BF: Isolation from ground; max. Patient leakage current: normal mode ≤100 µA, single fault condition≤500
µA
Level of protection against harmful ingress of water
The IP Classification of System is Ordinary Equipment, immersed part is IPX7, the other part is IPX1.
Safety level when used in the presence of FLAMMABLE ANAESTHETIC MIXED WITH AIR (or WITH
OXYGEN or WITH NITROUS OXIDE):
The Equipment is not suitable for use in the environment with FLAMMABLE ANAESTHETIC MIXED WITH
AIR (or WITH OXYGEN or WITH NITROUS OXIDE)
Conduction Interference

Digital Color Doppler Palm Ultrasound System
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NOTE
Image quality will effect by conducted disturbance. Please do not use the effected image. And put system in
a simpler electromagnetic compatibility environment to start working, if conducted disturbance occurred,
stop using it and change the position for acquiring a better image.
Mode of operation
Continuous Operation
For maximum safety, always follow these guidelines:
Do not remove the protective covers on the system. These covers protect users from hazardous
voltages. Cabinet panels must remain in place while the system is in use. A qualified electronic
technician must make all internal replacements.
Do not operate this system in the presence of flammable gases or anesthetics.
Notice upon Installation of Product
Separation distance and effect from fixed radio communications equipment: field strengths from fixed
transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur
radio, AM and FM radio broadcast, and TV broadcast transmitter cannot be predicted theoretically with
accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site
survey should be considered. If the measured field strength in the location in which the ultrasound system is
used exceeds the applicable RF compliance level as stated in the immunity declaration, the ultrasound
system should be observed to verify normal operation. If abnormal operation is observed, additional
measures may be necessary, such as re-orienting or relocating the ultrasound system or using an RF
shielded examination room may be necessary.
Use either power supply cords provided by or designated by CHISON. Products equipped with a power
source plug should be plugged into the fixed power socket which has the protective grounding
conductor. Never use any adaptor or converter to connect with a power source plug (e.g. three-prong-
to-two-prong converter).
Locate the equipment as far away as possible from other electronic equipment.
Be sure to use only the cables provided by or designated by CHISON. Connect these cables following
the installation procedures (e.g. wire power cables separately from signal cables).
WARNING:
Portable RF communications equipment (including peripherals such as antenna cables and external
antennas) should be used no closer than 30 cm (12 inches) to any part of this medical system, including
cables specified by the manufacturer. Otherwise, degradation of the performance of this equipment could
result.

Digital Color Doppler Palm Ultrasound System
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Notice against User Modification
The user should never modify this product.
User modifications may cause degradation in Electrical Safety. Modification of the product includes
changes in:
Cables (length, material, wiring, etc.)
System configuration/components
User modifications may cause degradation in EMC performance. Modification of the product includes
changes in:
Cables (length, material, wiring, etc.)
System installation/layout
System configuration/components

Digital Color Doppler Palm Ultrasound System
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2.3 Labels
Fig. 2-1: SonoEye P3 Label
2.3.1 Symbols on Label
Icon
Meaning
Refer to instruction manual/booklet.
Caution, consult accompanying documents.
This symbol advises the reader to consult the accompanying documents for
important safety related information such as warnings and pre-cautions that
cannot be presented on the device itself.
The CE mark of Conformity indicates this equipment conforms to the Council
Directive 93/42/EEC.
Serial number of the device.
This symbol is accompanied by the name and the address of the manufacturer
and the manufacturing date of the device in the form YYYY-MM.
IPX7,IPX1
Protection against the effects of immersion
This label indicates immersed part.
Refer to instruction manual.
This symbol indicates that in the united states of America, Federal law restricts
the device to sale by or on the order of a licensed practitioner or therapist.

Digital Color Doppler Palm Ultrasound System
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2.3.2 Other Device Labels
The following table describes the purpose and location of safety labels and other important information
provided on the equipment.
Table 2-1: Symbol Icons
Icon
Meaning
Identification
and Rating
Plate
• Manufacture’s name
• Serial number
Type-BF applied part
2.4 Patient Environmental Devices
Front side :
Power switch
Freeze button, P button, + button, - button
Acceptable Devices
The Patient Environmental devices shown above are specified to be suitable for use within the PATIENT
ENVIRONMENT.
Anyone using the equipment must be able to recognize the ESD symbol and understand how to take the
necessary precautionary procedures, as described in the caution below:
ESD CAUTION:
Sensitive part in system has been labeled with anti-static label, please pay attention on electrostatic
protection.
CAUTION:
DO NOT connect any systems or accessories without approval by CHISON within the PATIENT
ENVIRONMENT.
DO NOT touch patient and devices without IEC/EN 60601-1 approval to avoid the leakage current risk
within the PATIENT ENVIRONMENT.
Unapproved Devices
CAUTION:

Digital Color Doppler Palm Ultrasound System
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DO NOT use unapproved devices.
If devices are connected without the approval of CHISON, the warranty will be INVALID.
The system can’t be used with HF surgical equipment, otherwise the burns to patient may occur.
Any device connected to this system must conform to one or more of the requirements listed below:
IEC standard or equivalent standards appropriate to devices.
WARNING:
Use of this equipment adjacent to or stacked with other equipment should be avoided because it could result
in improper operation. If such use is necessary, this equipment and the other equipment should be observed
to verify that they are operating normally.
CAUTION:Unsafe operation or malfunction may result. Use only the accessories, options and
supplies approved or recommended in these instructions for use.
Peripheral used in the patient environment
The system has been verified for overall safety, compatibility and compliance with the printer which is
Mopria certified.
CAUTION:Printing quality may vary depending on the printer. If there is any quality problem,
Chison will not be responsible.
The system may also be used safely while connected to devices other than those recommended above if
the devices and their specifications, installation, and interconnection with the system conform to the
requirements of IEC/EN 60601-1-1.
The connection of equipment or transmission networks other than as specified in the user instructions can
result in an electric shock hazard or equipment malfunction. Substitute or alternate equipment and
connections require verification of compatibility and conformity to IEC/EN 60601-1-1 by the installer.
Equipment modifications and possible resulting malfunctions and electromagnetic interference are the
responsibility of the owner.
WARNING:
Use of accessories, transducers and cables other than those specified or provided by the manufacturer of
this equipment could result in increased electromagnetic emissions or decreased electromagnetic immunity
of this equipment and result in improper operation.

Digital Color Doppler Palm Ultrasound System
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2.5 Biological Safety
This product, as with all diagnostic ultrasound equipment, should be used only for valid reasons and should
be used both for the shortest period of time and at the lowest power settings necessary (ALARA- As Low As
Reasonably Achievable) to produce diagnostically acceptable images. The AIUM offers the following
guidelines:
Clinical Safety Quoted from AIUM
Approved March 26, 1997
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:
There are no confirmed biological effects on patients or instrument operators caused by
exposures from present diagnostic ultrasound instruments. Although the possibility
exists that such biological effects may be identified in 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.
Heating: Elevating tissue temperature during obstetrical examinations creates medical concerns. At the
embryo development stage, the rise in temperature and the length of time exposed to heat combine to
determine potential detrimental effects. Exercise caution particularly during Doppler/Color exams. The
Thermal Index (TI) provides a statistical estimate of the potential temperature elevation (in centigrade) of
tissue temperature. Three forms of TI are available: Soft Tissue Thermal Index (TIS), Bone Thermal Index
(TIB).
Soft Tissue Thermal Index (TIS). Used when imaging soft tissue only, it provides an estimate of potential
temperature increase in soft tissue.
Bone Thermal Index (TIB). Used when bone is near the focus of the image as in the third trimester OB
examination, it provides an estimate of potential temperature increase in the bone or adjacent soft tissue.
Cavitation: Cavitation may occur when sound passes through an area that contains a cavity, such as a
gas bubble or air pocket (in the lung or intestine, for example). During the process of cavitation, the sound
wave may cause the bubble to contract or resonate. This oscillation may cause the bubbles to explode and
damage the tissue. The Mechanical Index (MI) has been created to help users accurately evaluate the
likelihood of cavitation and the related adverse effects.
MI recognizes the importance of non-thermal processes, cavitation in particular, and the Index is an attempt
to indicate the probability that they might occur within the tissue.

Digital Color Doppler Palm Ultrasound System
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2.6 Scanning Patients and Education
The Track-3 or IEC60601-2-37 output display standard allows users to share the responsibility for the safe
use of this ultrasound system. Follow these usage guidelines for safe operation:
In order to maintain proper cleanliness of the systems, always clean them between patients.
Always use a disinfected sheath on all EV/ER systems during every exam.
Continuously move the system, rather than staying in a single spot, to avoid elevated temperatures in
one part of the patient’s body.
Move system away from the patient when not actively scanning.
Understand the meaning of the TI, TIS, TIB and MI output display, as well as the relationship between
these parameters and the thermal/cavitation bioeffect to the tissue.
Expose the patient to only the very lowest practical transmit power levels for the shortest possible time
to achieve a satisfactory diagnosis (ALARA - As Low As Reasonably Achievable).
2.6.1 Safe Scanning Guidelines
Ultrasound should only be used for medical diagnosis and only by trained medical personnel.
Diagnostic ultrasound procedures should be done only by personnel fully trained in the use of the
equipment, in the interpretation of the results and images, and in the safe use of ultrasound (including
education as to potential hazards).
Operators should understand the likely influence of the machine controls, the operating mode (e.g. B-
mode, color Doppler imaging or spectral Doppler) and system frequency on thermal and cavitation
hazards.
Select a low setting for each new patient. Output should only be increased during the examination if
penetration is still required to achieve a satisfactory result, and after the Gain control has been moved
to its maximum value.
Maintain the shortest examination time necessary to produce a useful diagnostic result.
Do not hold the system in a fixed position for any longer than is necessary. It should be removed from
the patient whenever there is no need for real-time imaging or spectral Doppler acquisition. The frozen
frame and Cine loop capabilities allow images to be reviewed and discussed without exposing the
patient to continuous scanning.
Take particular care to reduce output and minimize exposure time of an embryo or fetus when the
temperature of the mother is already elevated.
Take particular care to reduce the risk of thermal hazard during diagnostic ultrasound when exposing:

Digital Color Doppler Palm Ultrasound System
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an embryo less than eight weeks after gestation; or the head, brain or spine of any fetus or neonate.
Operators should continually monitor the on-screen thermal index (TI) and mechanical index (MI) values
and use control settings that keep these settings as low as possible while still achieving diagnostically
useful results. In obstetric examinations, TIS (soft tissue thermal index) should be monitored during
scans carried out in the first eight weeks after gestation, and TIB (bone thermal index) thereafter.
MI>0.3 There is a possibility of minor damage to neonatal lung or intestine. If such exposure is
necessary, reduce the exposure time as much as possible.
MI>0.7 There is a risk of cavitation if an ultrasound contrast agent containing gas micro-spheres is
being used. There is a theoretical risk of cavitation without the presence of ultrasound contrast agents. The
risk increases with MI values above this threshold.
TI>0.7 The overall exposure time of an embryo or fetus should be restricted in accordance with
Table 2-2 below as a reference:
TI
Maximum exposure
time (minutes)
0.7
60
1.0
30
1.5
15
2.0
4
2.5
1
Table 2-2 Maximum recommended exposure times for an embryo or fetus
Non-diagnostic use of ultrasound equipment is not generally recommended. Examples of non-
diagnostic uses of ultrasound equipment include repeated scans for operator training, equipment
demonstration using normal subjects, and the production of souvenir pictures or videos of a fetus. For
equipment of which the safety indices are displayed over their full range of values, the TI should always
be less than 0.5 and the MI should always be less than 0.3. Avoid frequent repeated exposure of any
subject. Scans in the first trimester of pregnancy should not be carried out for the sole purpose of
producing souvenir videos or photographs, nor should their production involve increasing the exposure
levels or extending the scan times beyond those needed for clinical purposes.
Diagnostic ultrasound has the potential for both false positive and false negative results. Misdiagnosis is
far more dangerous than any effect that might result from the ultrasound exposure. Therefore,
diagnostic ultrasound system should be performed only by those with sufficient training and education.
2.6.2 Understanding the MI/TI Display
Track-3 follows the Output Display Standard for systems that include fetal Doppler applications.
The acoustic output will not be evaluated on an application-specific basis, but the global
maximum de-rated Ispta must be ≤ 720 mW/cm2and either the global maximum MI must be ≤
1.9 or the global maximum de-rated Ispta must be ≤ 190 W/cm2. An exception is for ophthalmic
use, in which case the TI = max (TIS_as) is not to exceed 1.0; Ispta.3 ≤50mW/cm2, and MI ≤ 0.23.

Digital Color Doppler Palm Ultrasound System
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Track-3 gives the user the freedom to increase the output acoustic power for a specific exam, and
still limit output acoustic power within the global maximum de-rated Ispta ≤ 720 mW/cm2under
an Output Display Standard.
For any diagnostic ultrasonic systems, Track-3 provides an Output Indices Display Standard. The
diagnostic ultrasound systems and its operator’s manual contain the information regarding an
ALARA (As Low As Reasonably Achievable) education program for the clinical end-user and the
acoustic output indices, MI and TI. The MI describes the likelihood of cavitation, and the TI offers
the predicted maximum temperature rise in tissue as a result of the diagnostic examination. In
general, a temperature increase of 2.5°C must be present consistently at one spot for 2 hours to
cause fetal abnormalities. Avoiding a local temperature rise above 1°C should ensure that no
thermally induced biologic effect occurs. When referring to the TI for potential thermal effect, a TI
equal to 1 does not mean the temperature will rise 1 degree C. It only means an increased
potential for thermal effects can be expected as the TI increases. A high index does not mean that
bioeffects are occurring, but only that the potential exists and there is no consideration in the TI for
the scan duration, so minimizing the overall scan time will reduce the potential for effects. These
operator control and display features shift the safety responsibility from the manufacturer to the
user. So it is very important to have the Ultrasound systems display the acoustic output
indices correctly and the education of the user to interpret the valueappropriately.
RF: (De-rating factor)
In Situ intensity and pressure cannot currently be measured. Therefore, the acoustic power
measurement is normally done in the water tank, and when soft tissue replaces water along the
ultrasound path, a decrease in intensity is expected. The fractional reduction in intensity caused by
attenuation is denoted by the de-rating factor (RF),
RF= 10(-0.1 a f z)
Where a is the attenuation coefficient in dB cm-1 MHz-1, f is the transducer center frequency, and
z is the distance along the beam axis between the source and the point of interest.
De-rating factor RF for the various distances and frequencies with attenuation coefficient 0.3dB
cm-1 MHz-1 in homogeneous soft tissue is listed in the following table. An example is if the user
uses 7.5MHz frequency, the power will be attenuated by .0750 at 5cm, or 0.3x7.5x5=-11.25dB. The
De- rated Intensity is also referred to as ‘.3’ at the end (e.g. Ispta.3).
Distance Frequency(MHz)
(cm) 1 3 5 7.5
1
0.9332 0.8128 0.7080 0.5957
2
0.8710
0.6607
0.5012
0.3548
3
0.8128
0.5370
0.3548
0.2113
4
0.7586
0.4365
0.2512
0.1259
5
0.7080
0.3548
0.1778
0.0750

Digital Color Doppler Palm Ultrasound System
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6
0.6607
0.2884
0.1259
0.0447
7
0.6166
0.2344
0.0891
0.0266
8
0.5754
0.1903
0.0631
0.0158
I’=I*RF Where I’ is the intensity in soft tissue, I is the time-averaged intensity measured in water.
Tissue Model:
Tissue temperature elevation depends on power, tissue type, beam width, and scanning mode. Six
models Tissue temperature elevation depends on power, tissue type, beam width, and scanning
mode. Six models are developed to mimic possible clinical situations.
Thermal Models Composition Mode Specification Application
1
TIS Soft tissue Unscanned
Large aperture (>1cm2)
Liver PW
2
TIS Soft tissue Unscanned
Small aperture (<1cm2)
Pencil System
3
TIS Soft tissue Scanned Evaluated at surface Breast color
4
TIB
Soft tissue and bone
Scanned
Soft tissue at surface
Muscle color
5
TIB
Soft tissue and bone
Unscanned
Bone at focus
Fetus head PW
Soft tissue:
Describes low fat content tissue that does not contain calcifications or large gas-filled spaces.
Scanned: (auto-scan)
Refers to the steering of successive burst through the field of view, e.g. B and color mode.
Unscanned:
Emission of ultrasonic pulses occurs along a single line of sight and is unchanged until the transducer is
moved to a new position. For instance, the PW mode.
TI:
TI is defined as the ratio of the In Situ acoustic power (W.3) to the acoustic power required to raise tissue
temperature by 1°C (Wdeg), TI = W.3/Wdeg.
Three TIs corresponding to soft tissue (TIS) for abdominal; bone (TIB) for fetal and neonatal cephalic; have
been developed for applications in different exams.
An estimate of the acoustic power in milliwatts necessary to produce a 1°C temperature elevation in soft
tissue is: W
deg = 210/fc, for model 1 to 4, where fc is the center frequency in MHz.
W
deg = 40 K D for model 5 and 6, where K (beam shape factor) is 1.0, D is the aperture
diameter in cm at the depth of interest.
MI:
Cavitation is more likely to occur at high pressures and low frequencies in pulse ultrasound wave in the
tissue, which contais the bubble or air pocket (for instance, the lung, intestine, or scan with gas contrast
agents). The threshold under optimum conditions of pulsed ultrasound is predicted by the ration of the peak
pressure to the square root of the frequency.
MI = Pr’ / sqrt(fc)

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Pr’ is the de-rated (0.3) peak rare-fractional pressure in Mpa at the point where PII is the maximum, and
fc is the center frequency in MHz. PII is the Pulse Intensity Integral that the total energy per unit area carried
by the wave during the time duration of the pulse. The peak rare- fractional pressure is measured in
hydrophone maximum negative voltage normalized by the hydrophone calibration parameter.
Display Guideline:
For different operation modes, different indices must be displayed. However, only one index needs to be
shown at a time. Display is not required if maximum MI is less than 1.0 for any setting of the operating mode,
or if maximum TI is less than 1.0 for any setting of the operating mode. For TI, if the TIS and TIB are both
greater than 1.0, the scanners need not be capable of displaying both indices simultaneously. If the index
falls below 0.4, no display is needed.
Display and Report in Different Mode
Located on the upper middle section of the system display monitor, the acoustic output display provides the
operator with real-time indication of acoustic levels being generated by the system.
Only display and report TIS or TIB and start from 0.4 if maximum TI > 1.0, display in increments of 0.2 for
values of indices of 2.0 or less, and 0.5 for values of indices greater than 2.0.
Below is a simple guideline for the user when TI exceeds one limit exposure time to 4(6-TI) minutes based
on the ‘National Council on Radiation Protection. Exposure Criteria for Medical Diagnostic Ultrasound: I.
Criteria Based on Thermal Mechanisms. Report No.113 1992’.
Operator Control Features:
The user should be aware that certain operator controls may affect the acoustic output. It is recommended
to use the default (or lowest) output power setting and compensate using Gain control to acquire an image.
Other than the output power setting in the soft-menu, which has the most direct impact on the power; the
PRF, image sector size, frame rate, depth, and focal position also slightly affect the output power. The
default setting is normally around 70% of the allowable power depending on the exam application mode.
Controls Affecting Acoustic Output
The potential for producing mechanical bioeffects (MI) or thermal bioeffects (TI) can be influnced by certain
controls.
Direct: The Acoustic Output control has the most significant effect on Acoustic Output.
Indirect: Indirect effects may occur when adjusting controls. Controls that can influence MI and TI are
detailed under the Bioeffects portion of each control in the Optimizing the Image chapter.
Always observe the Acoustic Output display for possible effects.
Best practices while scanning
HINTS: Raise the Acoustic Output only after attempting image optimization with controls that have no
effect on Acoustic Output, such as Gain and STC.

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WARNING: Be sure to have read and understood control explanations for each mode used before
attempting to adjust the Acoustic Output control or any control that can effect Acoustic Output.
Use the minimum necessary acoustic output to get the best diagnostic image or measurement during an
examination. Begin the exam with the system that provides an optimum focal depth and penetration.
Acoustic Output Default Levels
In order to assure that an exam does not start at a high output level, the system initiates scanning at a
reduced default output level. This reduced level is preset programmable and depends upon the exam icon
and system selected. It takes effect when the system is powered on or New Patient is selected. To modify
acoustic output, adjust the Power Output level on the Soft Menu.