FujiFilm SonoSite SII Owner's manual

Doppler and ECG
User Guide Supplement

SonoSite, the SonoSite logo, SonoSite SII are trademarks and registered trademarks of FUJIFILM SonoSite, Inc. in various jurisdictions.
FUJIFILM is a registered trademark of FUJIFILM Corporation. Value from Innovation is a trademark of FUJIFILM Holdings America
Corporation.
All other trademarks are the property of their respective owners.
Part number: P21465-05
Publication date: June 2019
Copyright © 2019 FUJIFILM SonoSite, Inc. All rights reserved.
Manufacturer
FUJIFILM SonoSite, Inc.
21919 30th Drive SE
Bothell, WA 98021 USA
T: [phone] or
[phone]
F: 1-425-951-1201
EC Authorized Representative
FUJIFILM SonoSite B.V.
Joop Geesinkweg 140
1114 AB Amsterdam,
The Netherlands
Australia Sponsor
FUJIFILM SonoSite Australasia Pty Ltd
114 Old Pittwater Road
BROOKVALE, NSW, 2100
Australia
Caution United States federal law restricts this device to sale by or on the order of a
physician.

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Introduction 1
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SonoSite SII Doppler and ECG User Guide
Supplement
Introduction ..................................................................................................................................................... 1
Document conventions ........................................................................................................................................................................... 2
Getting Help .................................................................................................................................................................................................. 2
Getting Started ............................................................................................................................................... 3
Preparing the system ............................................................................................................................................................................... 3
System controls ........................................................................................................................................................................................... 4
Intended uses ............................................................................................................................................................................................... 4
System Setup .................................................................................................................................................. 5
Cardiac Calculations setup ..................................................................................................................................................................... 5
Presets setup ................................................................................................................................................................................................ 5
Imaging ............................................................................................................................................................ 6
2D imaging .................................................................................................................................................................................................... 6
PW and CW Doppler imaging ............................................................................................................................................................. 6
Imaging modes and exams available by transducer ............................................................................................................... 9
ECG ................................................................................................................................................................................................................. 15
Measurements and calculations ................................................................................................................ 16
Doppler measurements ........................................................................................................................................................................ 16
General calculations ............................................................................................................................................................................... 19
Arterial calculations ................................................................................................................................................................................ 20
Cardiac calculations ................................................................................................................................................................................ 21
Measurement references ........................................................................................................................... 34
Measurement accuracy ........................................................................................................................................................................ 34
Measurement publications and terminology ............................................................................................................................ 35
Cleaning and disinfecting ........................................................................................................................... 43
Cleaning and disinfecting the ECG cable and slave cable ................................................................................................. 43
Safety ............................................................................................................................................................ 43
Electrical safety classification ............................................................................................................................................................ 43
Electrical safety ......................................................................................................................................................................................... 43
Compatible accessories and peripherals ..................................................................................................................................... 44
Acoustic output ........................................................................................................................................... 45
Guidelines for reducing TI ................................................................................................................................................................... 45
Output display .......................................................................................................................................................................................... 46
Acoustic output tables .......................................................................................................................................................................... 48
Introduction
This user guide supplement provides information on PW and CW Doppler modes and the ECG option, now
available with the SonoSite SII ultrasound system.

2Introduction
Document conventions
The document follows these conventions:
A WARNING describes precautions necessary to prevent injury or loss of life.
A Caution describes precautions necessary to protect the products.
A Note provides supplemental information.
Numbered and lettered steps must be performed in a specific order.
Bulleted lists present information in list format but do not imply a sequence.
Single-step procedures begin with .
For a description of labeling symbols that appear on the product, see "Labeling Symbols" in the ultrasound
system user guide.
Getting Help
For technical support, please contact FUJIFILM SonoSite as follows:
Printed in the U.S.
Phone
(U.S. or Canada)
877-657-8118
Phone
(outside U.S. or
Canada)
425-951-1330, or call your local representative
Fax [phone]
Email [e-mail]
Web www.sonosite.com
Europe Service Center Main: [phone]
English support: [phone]
French support: [phone]
German support: [phone]
Italian support: [phone]
Spanish support: [phone]
Asia Service Center [phone]

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Getting Started 3
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Getting Started
Preparing the system
Components and connectors
You can now connect an ECG cable to the back of the system.
Connector block (see detail below)
Battery
Transducer connector ports
USB ports RJ45
Network port
HDMI out DC
power in
Printer
output
Mounting holes
Power switch
Connector block detail
ECG
port

4Getting Started
System controls
Intended uses
Cardiac Imaging Applications
You can use the licensed FUJIFILM SonoSite ECG function to display the patient's heart rate and to provide
a cardiac cycle reference when viewing an ultrasound image.
1 Control
knobs Turn to adjust gain, depth, cine buffer, brightness, and more,
depending on context. Current
functions appear on-screen above
the knobs.
2 Freeze key Press and hold to freeze or
unfreeze the image.
3 Touchpad When the touchpad is lit, use it to
control items displayed on the
screen. Double-tap the touchpad
to switch between functions.
4Touchpad
key Works in conjunction with the touchpad. Tap to activate an item
on-screen, or to switch between
functions.
5 Print key Available only when a printer is
connected to the system. Tap to
print from a live or frozen scan.
6 Save keys Tap one of these keys to save an
image or a clip.
7 Image mode Tap one of these keys to change
the imaging mode.
8 System
controls Change system settings, switch transducers, add labels, or see
patient information.
9Image,ECG,
and Doppler
controls
Use these to adjust the image,
select the ECG function, or select
the Doppler imaging mode.
10 Touchscreen Use the touchscreen the same
way you would use the touchpad.
WARNING Do not use the SonoSite ECG to diagnose cardiac arrhythmias or to provide
long-term cardiac monitoring.
1
2
4
6
57
8
9
3
9
10

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System Setup 5
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System Setup
Cardiac Calculations setup
On the Cardiac Calculations settings page, you can specify measurement names that appear in the Tissue
Doppler Imaging (TDI) calculations menu and on the report page. See “Cardiac calculations” on page 21.
To specify cardiac measurement names
Under TDI Walls on the Cardiac Calculations settings page, select a name for each wall.
Presets setup
The Presets setup page has settings for general preferences.
Doppler Scale
Select cm/s or kHz.
Duplex
Specifies the screen layout for displaying the M Mode trace and the Doppler spectral trace:
1/3 2D, 2/3 Trace
1/2 2D, 1/2 Trace
Full 2D, Full Trace
Live Trace
Select Peak or Mean velocity trace.

6Imaging
Imaging
2D imaging
PW and CW Doppler imaging
Pulsed wave (PW) Doppler and continuous wave (CW) Doppler imaging modes are optional features. The
default Doppler imaging mode is PW Doppler. In cardiac exams, you can select the CW Doppler or TDI
Doppler on-screen control.
PW Doppler is a Doppler recording of blood flow velocities in a range specific area (sample volume) along
the length of the beam. CW Doppler is a Doppler recording of blood flow velocities along the length of the
beam.
To display the D-line
1Tap the Doppler control at the bottom of the touchscreen.
2Do any of the following as needed:
Adjust controls.
Drag your finger on the touchscreen or touchpad to position the D-line and gate where desired.
Horizontal movements position the D-line. Vertical movements position the gate.
To change the gate size, repeatedly press the right knob or tap the on-screen control above the knob
until Gate appears, and then turn the knob to the gate size you want. To correct the angle, repeatedly
press the right knob or tap the on-screen control above the knob until Angle appears, and then turn
the knob to the correct angle.
Table 1: 2D controls
Control Description
Guide Guide is not available when the ECG cable is connected.
ECG Displays the ECG signal.
This feature is optional and requires a FUJIFILM SonoSite ECG cable.
Note If the D-line does not appear, make sure that the image isn’t frozen.
WARNING We do not recommend angle correction for the cardiac exam type.

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Imaging 7
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To display the spectral trace
1Tap Doppler to display the D-line.
2Do one of the following:
In PW Doppler - Tap PW Dop.
In CW Doppler - Tap CW Dop.
In TDI Doppler - Tap TDI Dop.
In any Doppler mode - Tap Update.
The time scale above the trace has small marks at 200 ms intervals and large marks at one-second
intervals.
3Do any of the following as needed:
Adjust the sweep speed (Med, Fast, Slow).
Tap Update to toggle between the D-line and spectral trace.
Doppler controls
Note Moving the baseline, scrolling, or inverting the trace while the image is frozen
will clear displayed cardiac output results.
Table 2: Doppler on-screen controls
Control Description
PW Dop,
CW Dop,
TDI Dop
Toggle between PW Doppler, CW Doppler, and TDI Doppler.
The current selection appears in the upper left-hand screen.
CW Doppler and TDI Doppler are available only in cardiac exams.
Gate Settings depend on transducer and exam type.
Use the right knob to adjust the Doppler gate size. The Doppler gate size indicator is on
the upper left-hand screen.
Angle Press the right knob to select Angle, and then turn the knob to choose between: 0°,
+60°, or -60°. We do not recommend angle correction for the cardiac exam type.
Steering Select the desired steering angle setting. Settings available depend on the transducer. The
PW Doppler angle correction automatically changes to the optimum setting.
-15 and -20 have an angle correction of -60°.
0has an angle correction of 0°.
+15 and +20 have an angle correction of +60°.
You can manually correct the angle after selecting a steering angle setting.
Available on select transducers.

8Imaging
Spectral trace controls
Volume Increases or decreases Doppler speaker volume (0-10).
Zoom Magnifies the image.
Table 3: Spectral trace on-screen controls
Control Description
Scale Press the right knob to select Scale, and then turn the knob to choose the desired
velocity setting [pulse repetition frequency (PRF)] in cm/s or kHz.
Line Press the right knob to select Line, and then turn the knob to set the baseline position.
(On a frozen trace, the baseline can be adjusted if Trace is off.)
Invert Press the right knob to select Invert, and then turn the knob to vertically flip the spectral
trace. (On a frozen trace, Invert is available if Trace is off.)
Volume Increases or decreases Doppler speaker volume (0-10).
Wall Filter Settings include Low, Med, High.
Sweep
Speed
Settings include Slow, Med, Fast.
Trace Displays a live trace of the peak or mean. Specify peak or mean on the Presets setup
page. Select Above or Below to position the trace above or below the baseline.
Table 2: Doppler on-screen controls (continued)
Control Description

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Imaging 9
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Imaging modes and exams available by transducer
Table 4: Imaging modes and exams available by transducer
Transducer Exam typea
Imaging mode
2Db
M Mode CPDcColorcPW
Dopplerd
CW
Doppler
C8x Pro 
C11x Abd 
Art 
Neo 
Nrv 
Ven 
C35x Abd 
Msk 
Nrv 
OB 
Spn 
aExam type abbreviations are as follows: Abd = Abdomen, Art = Arterial, Bre = Breast, Crd = Cardiac, Gyn =
Gynecology, Msk = Musculoskeletal, Neo = Neonatal, Nrv = Nerve, OB = Obstetrical, Oph = Ophthalmic, Orb =
Orbital, SmP = Small Parts, Sup = Superficial, TCD = Transcranial Doppler, Ven = Venous.
bThe optimization settings for 2D are Res, Gen, and Pen.
cThe optimization settings for CPD and Color are low, medium, and high (flow velocity range) with a range of PRF
settings for Color depending on the setting selected.
dFor the cardiac exam type, PW TDI is also available. See “Doppler controls” on page 7.
eFor more information refer to the P11x Transducer User Guide, included with the P11x transducer. The P11x
transducer is not licensed for use in Canada.

10 Imaging
rC60xi standard/
armored
Abd 
Gyn 
Msk 
Nrv 
OB 
Table 4: Imaging modes and exams available by transducer (continued)
Transducer Exam typea
Imaging mode
2Db
M Mode CPDcColorcPW
Dopplerd
CW
Doppler
aExam type abbreviations are as follows: Abd = Abdomen, Art = Arterial, Bre = Breast, Crd = Cardiac, Gyn =
Gynecology, Msk = Musculoskeletal, Neo = Neonatal, Nrv = Nerve, OB = Obstetrical, Oph = Ophthalmic, Orb =
Orbital, SmP = Small Parts, Sup = Superficial, TCD = Transcranial Doppler, Ven = Venous.
bThe optimization settings for 2D are Res, Gen, and Pen.
cThe optimization settings for CPD and Color are low, medium, and high (flow velocity range) with a range of PRF
settings for Color depending on the setting selected.
dFor the cardiac exam type, PW TDI is also available. See “Doppler controls” on page 7.
eFor more information refer to the P11x Transducer User Guide, included with the P11x transducer. The P11x
transducer is not licensed for use in Canada.

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Imaging 11
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HFL38xi standard/
armored
Art 
Bre 
Lung 
Msk 
Nrv 
Oph 
SmP 
Ven 
HFL50x Bre 
Msk 
Nrv 
SmP 
Table 4: Imaging modes and exams available by transducer (continued)
Transducer Exam typea
Imaging mode
2Db
M Mode CPDcColorcPW
Dopplerd
CW
Doppler
aExam type abbreviations are as follows: Abd = Abdomen, Art = Arterial, Bre = Breast, Crd = Cardiac, Gyn =
Gynecology, Msk = Musculoskeletal, Neo = Neonatal, Nrv = Nerve, OB = Obstetrical, Oph = Ophthalmic, Orb =
Orbital, SmP = Small Parts, Sup = Superficial, TCD = Transcranial Doppler, Ven = Venous.
bThe optimization settings for 2D are Res, Gen, and Pen.
cThe optimization settings for CPD and Color are low, medium, and high (flow velocity range) with a range of PRF
settings for Color depending on the setting selected.
dFor the cardiac exam type, PW TDI is also available. See “Doppler controls” on page 7.
eFor more information refer to the P11x Transducer User Guide, included with the P11x transducer. The P11x
transducer is not licensed for use in Canada.

12 Imaging
HSL25x Art 
Lung 
Msk 
Nrv 
Oph 
Sup 
Ven 
ICTx Gyn 
OB 
Table 4: Imaging modes and exams available by transducer (continued)
Transducer Exam typea
Imaging mode
2Db
M Mode CPDcColorcPW
Dopplerd
CW
Doppler
aExam type abbreviations are as follows: Abd = Abdomen, Art = Arterial, Bre = Breast, Crd = Cardiac, Gyn =
Gynecology, Msk = Musculoskeletal, Neo = Neonatal, Nrv = Nerve, OB = Obstetrical, Oph = Ophthalmic, Orb =
Orbital, SmP = Small Parts, Sup = Superficial, TCD = Transcranial Doppler, Ven = Venous.
bThe optimization settings for 2D are Res, Gen, and Pen.
cThe optimization settings for CPD and Color are low, medium, and high (flow velocity range) with a range of PRF
settings for Color depending on the setting selected.
dFor the cardiac exam type, PW TDI is also available. See “Doppler controls” on page 7.
eFor more information refer to the P11x Transducer User Guide, included with the P11x transducer. The P11x
transducer is not licensed for use in Canada.

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Imaging 13
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L25x standard/
armored
Art 
Lung 
Msk 
Nrv 
Oph 
Sup 
Ven 
L38xi standard/
armored
Art 
Lung 
Nrv 
SmP 
Ven 
Table 4: Imaging modes and exams available by transducer (continued)
Transducer Exam typea
Imaging mode
2Db
M Mode CPDcColorcPW
Dopplerd
CW
Doppler
aExam type abbreviations are as follows: Abd = Abdomen, Art = Arterial, Bre = Breast, Crd = Cardiac, Gyn =
Gynecology, Msk = Musculoskeletal, Neo = Neonatal, Nrv = Nerve, OB = Obstetrical, Oph = Ophthalmic, Orb =
Orbital, SmP = Small Parts, Sup = Superficial, TCD = Transcranial Doppler, Ven = Venous.
bThe optimization settings for 2D are Res, Gen, and Pen.
cThe optimization settings for CPD and Color are low, medium, and high (flow velocity range) with a range of PRF
settings for Color depending on the setting selected.
dFor the cardiac exam type, PW TDI is also available. See “Doppler controls” on page 7.
eFor more information refer to the P11x Transducer User Guide, included with the P11x transducer. The P11x
transducer is not licensed for use in Canada.

14 Imaging
P10x Abd 
Crd    
Neo 
P11xeArt 
Ven 
rP19x standard/
armored
Abd 
Crd    
Lung 
OB 
Orb 
TCD 
Table 4: Imaging modes and exams available by transducer (continued)
Transducer Exam typea
Imaging mode
2Db
M Mode CPDcColorcPW
Dopplerd
CW
Doppler
aExam type abbreviations are as follows: Abd = Abdomen, Art = Arterial, Bre = Breast, Crd = Cardiac, Gyn =
Gynecology, Msk = Musculoskeletal, Neo = Neonatal, Nrv = Nerve, OB = Obstetrical, Oph = Ophthalmic, Orb =
Orbital, SmP = Small Parts, Sup = Superficial, TCD = Transcranial Doppler, Ven = Venous.
bThe optimization settings for 2D are Res, Gen, and Pen.
cThe optimization settings for CPD and Color are low, medium, and high (flow velocity range) with a range of PRF
settings for Color depending on the setting selected.
dFor the cardiac exam type, PW TDI is also available. See “Doppler controls” on page 7.
eFor more information refer to the P11x Transducer User Guide, included with the P11x transducer. The P11x
transducer is not licensed for use in Canada.

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Imaging 15
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ECG
ECG is an option and requires a FUJIFILM SonoSite ECG cable.
To use the ECG
1Connect the ECG cable to the ECG connector on the back of the ultrasound system. ECG turns on
automatically if the system is in live imaging mode.
2Tap the ECG control at the bottom of the touchscreen.
The ECG controls appear on the screen.
3Adjust controls as desired.
ECG controls
WARNINGS Do not use the SonoSite ECG to diagnose cardiac arrhythmias or to provide
long-term cardiac monitoring.
To avoid electrical interference with aircraft systems, do not use the ECG cable
on aircraft. Such interference may have safety consequences.
Caution Use only accessories recommended by FUJIFILM SonoSite with the system.
Connecting an accessory not recommended by FUJIFILM SonoSite can damage
the system.
Note The ECG signal may take up to one minute to restabilize after defibrillator use on
the patient.
Table 5: ECG on-screen controls
Control Description
Show/Delay/
Hide
Turns on and off ECG signal with and without the Delay line.
ECG Gain Tap the ECG gain control , and then tap the up or down arrows to increase or
decrease the ECG Gain from 0-20.
Position Press the right knob to select Position, and then turn the knob to set the position of
the ECG signal.
Sweep Speed Settings are Slow,Med, and Fast.

16 Measurements and calculations
Measurements and calculations
You can perform basic measurements in any imaging mode and can save the image with the measurements
displayed. Except for the M Mode HR measurement, the results do not automatically save to a calculation
and the patient report. To save measurements as part of a calculation, you can first begin a calculation and
then measure.
Doppler measurements
The basic measurements that you can perform in Doppler imaging are:
Velocity (cm/s)
Pressure Gradient
Elapsed Time
+/x Ratio
Resistive Index (RI)
Acceleration
You can also trace manually or automatically. For Doppler measurements, the Doppler scale must be set to
cm/s on the Presets setup page.
To measure Velocity (cm/s) and Pressure Gradient
This measurement involves a single caliper from the baseline.
1On a frozen Doppler spectral trace, tap Calipers.
A single caliper appears.
Delay Tap Delay, then select the position of the delay line on the ECG signal by tapping
one of the icons. The delay line indicates where the clip acquisition is triggered.
Select Save to save the current position on the ECG signal. (You can change the
position of the delay line temporarily. Starting a new patient information form or
cycling system power reverts the delay line to the most recently saved position.)
Clips Tap Clips, then tap Time to change the clips control to ECG. With ECG, you have
the option to capture clips based on the number of heart beats. Tap the beats
control, then the up or down arrows, to select the number of beats. If Time is
selected, capturing is based on number of seconds. Select the time duration.
Table 5: ECG on-screen controls
Control Description

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Measurements and calculations 17
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2Drag your finger on either the touchpad or the touchscreen to position the caliper to a peak velocity
waveform.
To measure Velocities, Elapsed Time, Ratio, and Resistive Index (RI) or Acceleration
1On a frozen Doppler spectral trace, tap Calipers.
A single vertical caliper appears.
2Using the touchpad or the touchscreen, position the caliper to a peak velocity waveform. Tap to set
the position.
A second vertical caliper appears.
3Drag your finger on either the touchpad or the touchscreen to position the second vertical caliper at the
end diastole on the waveform, and then tap .
To make a correction, tap Delete above the right knob or press the right knob.
Elapsed time between the times indicated by the two calipers is calculated. Measured velocities are given
as results, and a generic ratio between the velocities indicated by the two calipers is calculated.
If the absolute value of the earlier velocity is less than that of the later velocity identified by the calipers,
Acceleration is calculated; otherwise, in non-cardiac exams, RI is calculated.
To measure time duration
1On a frozen Doppler spectral trace, tap Calipers.
2Navigate to the second page by tapping the arrow.
3Select Time .
A vertical caliper appears.
4Using the touchpad or the touchscreen, position the caliper where desired, and then tap .
A second vertical caliper appears.
5Using the touchpad or the touchscreen, position the second caliper where desired.
To perform manual trace measurements in Doppler
1On a frozen Doppler spectral trace, tap Calipers.
2Navigate to the second page by tapping the arrow.

18 Measurements and calculations
3Tap Manual .
A single caliper appears.
4Using the touchpad or the touchscreen, position the caliper at the beginning of the desired waveform,
and then tap to activate the trace.
5Using the touchpad or the touchscreen, trace the waveform, and then tap Set or .
To make a correction, tap Undo or Delete.
To perform automatic trace measurements in Doppler
1On a frozen Doppler spectral trace, tap Calipers.
2Navigate to the second page by tapping the arrow.
3Tap Auto .
A vertical caliper appears.
4Using the touchpad or the touchscreen, position the caliper at the beginning of the desired waveform,
and then tap .
A second vertical caliper appears.
5Using the touchpad or the touchscreen, position the caliper at the end of the desired waveform, and then
tap Set.
To make a correction, tap Undo or Delete.
Automatic trace results
Depending on the exam type, the results from automatic tracing include the following:
WARNING
When using the touchpad to trace a shape, be careful not to touch until you
are finished with the trace. Doing so may complete the trace prematurely, causing
an incorrect measurement and delay of care.
Velocity Time Integral (VTI) Cardiac Output (CO)
Peak Velocity (Vmax) Peak Systolic Velocity (PSV)
Mean Pressure Gradient (PGmean) Time Average Mean (TAM)
Mean Velocity on Peak Trace (Vmean) +/x or Systolic/Diastolic (S/D)