Gammex 405 GSX LE User manual

User’s Guide
405 GSX LE
Precision Resolution
Grey Scale Phantom

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Table of Contents
Introduction...............................................................................................................................3
Caringforyour405GSXLE....................................................................................................4
Scanningyour405 GSXLE....................................................................................................5
AGuidedTourofyour405GSXLE...........................................................................................6
EvaluatingthePhantom...........................................................................................................7
Target Specifications..........................................................................................................12
Cystic Targets....................................................................................................................12
GreyScaleTargets..................................................................................................................12
PinTargets............................................................................................................................12
ResolutionTargetGroup.......................................................................................................12
Phantom Specifications......................................................................................................14
Physical Specifications.......................................................................................................14
TissueMimickingBackground Material................................................................................14
HarmonicImaging.................................................................................................................15
GreyScaleApplications...........................................................................................................16
System Linearity.................................................................................................................17
Quantitative Measurement.................................................................................................19
Baseline Test.....................................................................................................................19
SubsequentTests..................................................................................................................19
Qualitative Measurement....................................................................................................21
Phantom Desiccation.........................................................................................................22
Charts and Graphs..............................................................................................................22
Product Warranty...............................................................................................................23
Sales and Service...............................................................................................................24

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Introduction
The 405 GSX LE phantom provides users with a wide range of criteria to evaluate
the performance of their ultrasound machine. The advanced tissue mimicking gel
used in the phantom has been developed to provide a smoother background texture
than conventional gels. The gel reduces backscatter and is fully compatible with the
latest tissue harmonics equipment and technology. The phantom utilizes an advance
composite film scanning surface that improves transmission properties, thus allowing
more of the ultrasound beam to be received and transmitted.
The 405 GSX LE phantom is designed to be used for quality control purposes when
monitoring these important image characteristics:
1. axial resolution
2. lateral resolution
3. dead zone target imaging
4. vertical and horizontal distance accuracy
5. image uniformity
The triangular grey scale targets in the phantom can be used to test the resolution of
high performance ultrasound scanners.
Unique to the 405 GSX LE are two horizontal cross fibers located in the middle of the
phantom. These fibers have been included to assist the user in aligning the transducer
and can be used as a reference “marker” to ensure that QA tests are performed
consistently every time.
Limitations of Use
The 405 GSX LE is designed to be used to aid in the quality control testing and monitor-
ing of high performance ultrasound systems only. It is not to be used to make diagnostic
decisions.

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Caring for your 405 GSX LE
Phantom comes ready to scan. Do not remove surface material.
Store your 405 GSX LE with cover closed securely.
Always attach the scanning surface cover and store the phantom out of direct sunlight
when it is not in use.
Store your 405 GSX LE at 35º–105ºF (2º–40ºC).
Freezing temperatures will damage the phantom and high temperatures will accelerate
desiccation.
Weigh your 405 GSX LE to monitor desiccation.
Weigh the phantom when you first receive it and then every 6 months. Record the
values on the data sheet.
Do not drop or damage the phantom.
Return the phantom for inspection and/or repair if it has been dropped or damaged.
Physical damage to the case will cause premature desiccation.
Gammex recommends annual servicing of your 405 GSX LE to ensure proper
operation. Our qualified service technicians will check for desiccation and provide any
needed rejuvenation, scanning/certification to original specifications, and repairs.

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Scanning your 405 GSX LE
• Always place the phantom on a stable, level surface for scanning.
• The phantom comes ready to scan. Do not peel off the surface material.
• Use water or a generous amount of coupling gel to ensure good transmission.
Do not use mineral oil, baby oil or lanolin-based gels as a coupling medium. Poor
transmission is a result of insufficient coupling.
• Do not press the transducer into the scanning surface. This damages the
scanning surface and will shorten the life of the phantom. For curved transduc-
ers, use water or a thick gel layer.
• Clean the scanning surface immediately after use. Use a soft cloth or paper towel
and soap and water, if needed.
Caution:
Do not press the transducer
into the scanning surface.

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A Guided Tour of your 405 GSX LE
The Precision Resolution Grey Scale Phantom, 405 GSX LE, provides a means for
monitoring the image quality of ultrasound scanning systems. The tissue mimicking
gel in the 405 GSX LE is ultrasonically similar to human tissue. This allows the use of
normal scanner control settings and ensures that the performance measured, closely
approximates the scanner’s performance in a clinical examination.
Scanning is the best way to familiarize yourself with the features and functions of the
405 GSX LE. A guided tour is provided on the following pages.

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Evaluating the Phantom
Remember
A 4.5 MHz probe will provide a good overall view of the phantom for this demonstration.
1. Turn the handle out of the way and slide the cover off the phantom.
2. To couple with water, fill the dam with distilled water. For a better image quality,
use gel.
3. Rest the transducer on the scanning surface. Adjust the scanner to display the
full depth of the phantom.
You may notice that the tissue echoes near the bottom of the phantom fade
into noise. The depth at which usable echoes disappear is called the depth of
penetration. The depth markers on the phantom label will help you determine
the depths of the targets.
• The phantom comes ready to scan. Do not peel off surface mate-
rial.
• Never press the transducer into the scanning surface.
• Always clean and dry the scanning surface after each use. Never leave
coupling gel or water on the scanning surface for more than a few
hours.
• Do not use mineral oil, baby oil, or lanolin-based gels as a coupling
medium.

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4. Move the transducer across the scanning surface while observing the locations
of the targets.
Notice how the smooth texture of the tissue mimicking gel emphasizes image
non-uniformities and artifacts, making them easier to detect. Scanning an area
without targets is a good way to test for image uniformity.
Decrease gain controls to highlight pin targets.
5. Scan the vertical pin targets and freeze the image. Use the electronic calipers to
measure the distance between two of the vertical pin targets. Repeat for two of
the horizontal pin targets. The vertical pins have 2 cm spacing while the horizon-
tal pins have 3 cm spacing.
Use these pin targets to determine vertical distance accuracy and horizontal
distance accuracy. Note that the highest dead zone pin you can see should be
the point of reference not the scanning surface.
6. Freeze an image of the resolution target group at 1 cm. Examine the horizontal
row of pins at the top of the target group. The pins that are closest together
without touching indicates the scanner’s lateral resolution.
Repeat this procedure with the other resolution target groups. Notice how lateral
resolution is narrowest in the focal zone. For a transducer whose focal zone is in
the area between the resolution targets, an alternate test can be performed.

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Freeze an image of the vertical pin targets. Use the electronic calipers to
measure the horizontal width of the pin targets in the near, mid and far fields of
the image.
Notice how the pin targets are narrowest in the focal zone. The pin width demon-
strates the width of the ultrasound beam at that depth and approximates the
lateral resolution of the scanner.
7. Decrease the image depth and examine the axial resolution target group at 3 cm.
Notice how the images of the lower pin targets may begin to merge. The smallest
distance between two pins that can be clearly resolved with no vertical overlap is
called the scanner’s axial resolution.

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Pin targets are resolved axially if an imaginary horizontal line can be drawn
between the targets without touching either target. The targets on the left are not
resolved. The targets on the right are resolved.
Examine the other axial resolution target groups and compare the resolution at
various depths. Axial resolution may change with depth.
8. Scan the nearest cystic target group. Each target should be round with a clean
black appearance and well defined edges. Bright specular echoes at the top and
bottom of the targets are normal.
Measure the dimensions of the 6 mm cystic target to check the image geometry.
Use the calipers to measure from top to bottom and side to side. Repeat with the
other cystic target groups as part of the cyst imaging test.
9. Decrease image depth to the minimum and examine the dead zone target group.
The dead zone targets can be used to measure lateral resolution in the extreme
near field of the transducer. Note the highest dead zone pin you can see should
be the point of reference - Not the scanning surface.
Unresolved Resolved

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10. Scan the four grey scale targets and observe the difference in their grey levels.
Adjust the gain control and observe how this affects the brightness of the targets.
Notice how noise in the anechoic target becomes apparent as the gain increases.
If your system has image “post-processing” capabilities, observe how the contrast
between targets changes with different settings. Adjust the gain control to the
lowest noise level. This is the point at which you eliminate noise in the anechoic
cyst (lower the gain until it just disappears). Record this gain setting and use it for
future grey scale measurements. Freeze the image and visually evaluate the grey
scale targets. Match each target with a step on the grey bar in the image. Make a
hard copy and compare the hard copy with the image on the scanner.
11. When you are done scanning the phantom, empty the water dam or completely
clean off the coupling gel with a soft cloth or paper towel. Replace the cover and
secure by lifting the handle to protect the phantom.
Noise in low scatter cyst
-6 dB +6 dB
1 2 3 4
low
scatter high
scatter

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Target Specifications
Cystic Targets
Diameters.........................................................................................................2,4,and 6 mm
Placement................................................................................................3,8,and14cmdeep
Speed of sound..................................................................................................1540±10 m/s
Attenuation coefficient........................................................................0.05±0.01 dB/cm/MHz
Grey Scale Targets
Dimensions................................................................................................9.5x9.5x13.4mm
Placement..............................................................................................................4 cm deep
Speed of sound..................................................................................................1540±10 m/s
Temperaturedependenceonspeedofsound...........................................................1.5m/s/ºC
Contrast
..................................low scatter, -6 dB, +6 dB, high scatter relative to background
Pin Targets
Diameter....................................................................................................................0.1 mm
Verticalspacing.....................................................................................2cmat2–16cmdeep
Horizontalspacing..........................................................................3 cm at 2and 12 cm deep
Cross fibers...............................................................................0.2 mm at 2 and 6 cm deep
Resolution Target Group
.................................................................................................at3,8, and 14cmdeep
All acoustic measurements made at 4.5 MHz, 22ºC.
Due to our philosophy of continuous quality improvement,
all specifications are subject to change.

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Phantom Specifications
Physical Specifications
Weight................................................................................................Approx.2.8kg(6lbs.5oz.)
Dimensions.................................................................................................23.2x8.25x18.5cm
..........................................................................................................(9.25x3.25x7.25in.)
Scanningsurface..................................................................................................CompositeFilm
Casematerial................................................................................................ExtrudedABSplastic
Pintargetmaterial........................................................................................Nylonmonofilament
Tissue Mimicking Background Material
Water-based gel with appearance of human tissue.
Speedofsound............................................................................................................1540±10m/s
Attenuationcoefficient..................................................................................0.7±0.05dB/cm/MHz
...............................................................................................0.5±0.05dB/cm/MHz
............................................................................... refer to phantom side label
Nonlinearityparameter(B/A)............................................................................................6.6±0.3
.......................................................6.7 (Accepted value for human liver tissue)
All acoustic measurements made at 4.5 MHz, 22ºC.
Due to our philosophy of continuous quality improvement,
all specifications are subject to change.

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Harmonic Imaging
Harmonic imaging has become an important addition to the medical ultrasound
community. Harmonic imaging is when a pulse is sent from the transducer at a nominal
(fundamental) frequency, but the signal received by the transducer is twice that fre-
quency, which is the second harmonic. The result is that better resolution is attained
at any given depth than if the reception had been at the fundamental frequency, as in
conventional ultrasound.
There are three tissue properties that determine the effectiveness of harmonic imaging:
1. pulse propagation speed
2. attenuation (rate of pulse energy loss with depth)
3. the value of the nonlinearity parameter: B/A
In order for phantoms to present valid resolution results for harmonic imaging, these
three properties must adequately correspond to human tissue. Attenuation increases
with frequency and much of the propagation involves the fundamental frequency, so in
harmonic imaging, there is enhanced resolution without as much attenuation as there
would be if the higher frequency were used to generate the pulses at the transducer.
So, higher frequency resolution occurs for greater depths within the subject than if
conventional ultrasound was used.
The ratio of B/A quantifies the rate of transfer with respect to propagation distance of
ultrasonic fundamental frequency energy to harmonic frequencies. The greater the
amplitude, the greater the energy transfer rate; thus, the beam profile for the harmonic
is smaller than for the fundamental, which means better lateral and elevational resolu-
tion.
Tissue-mimicking phantoms will be appropriate for assessing harmonic imaging only
if B/A for the tissue-mimicking material in the phantom adequately approximates that
of soft tissues. Recently, we have developed the capacity to measure the value of B/A
for the tissue-mimicking materials in Gammex phantoms and have found it to lie in the
range for human soft tissue, meaning B/A is between 6 and 71.
_____________________________________________
1Gong, X. F., Zhu, Z. M., Shi, T., Huang, J. H. (1989) Determination of the acoustic
nonlinearity parameter in biological media using FAIS and ITD methods, J. Acoust. Soc.
Am. 86 (1), pp 1-5.

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Grey Scale Applications
Metastases are sometimes slightly hyperechoic or hypoechoic compared with the sur-
rounding tissue. If the scanner is not measuring grey levels accurately, the metastases
may not be detected. The Quantitative Measurement ensures that the grey level signal
is measured consistently. The Qualitative Measurement ensures that grey levels are
displayed on the monitor consistently. By performing these tests, the user can determine
the optimal system settings for measuring grey levels, which can then be used in clinical
applications.

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System Linearity
Ultrasound systems use special processing circuits to translate the amplitude of echoes
into brightness levels on the video monitor. These circuits use mathematical functions
that often produce an S-shaped curve when graphed. As shown in the figure below,
each echo level produces a corresponding brightness level on the monitor.
An S-shaped curve is used to translate echo levels into brightness levels on the video
display. Notice how each echo level, –X, 0 and +X dB produce the corresponding bright-
ness values B–, Boand B+.
As long as the shape of the curve remains constant, the contrast, or difference in bright-
ness between different echo levels, will remain constant. If the shape of the S-curve
changes, the relative image brightness for each echo level will also change.
For example, image post-processing techniques help the user identify subtle tissue vari-
ations by modifying the shape of the S-curve to emphasize certain ranges of echo levels.
Degradation in the system hardware can also affect the shape of the curve and produce
unexpected variations in the contrast between echo levels. The distortion in the information
displayed to the user may affect the interpretation of the ultrasound image. This is why it is
important to do quality measurement with as little post-processing as possible. An example
of these distortions is shown on the following page.

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Changes in the shape of the S-curve result in different brightness levels for the same
echo levels. Notice how the positions of the original brightness levels B–, Boand B+
have moved to B–1, Bo1and B+1.
Changes in the system response can be identified by measuring the average pixel
value of the grey scale targets and the background material as displayed on the video
monitor. Pixel values can be estimated by eye or measured with image analysis tools
provided on some ultrasound instruments or computers equipped with video “frame
grabbers” and special software.

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Quantitative Measurement
A target’s brightness level can be most accurately measured using electronic methods.
The user defines a region of interest and the scanner determines the average pixel
value. To reduce the effect of speckle and small variations in the targets, several
measurements are taken and averaged.
Note: If your system does not have a region of interest (ROI) tool, you will not be able
to perform this test. As an alternative, refer to the Qualitative Measurement section of
this document (on page 21).
Note: All values determined by the quantitative measurement test depend on scanning
technique. Great care should be taken to perform the test in the same manner each
time.
Method
Define a region of interest and measure the average echo level.
Procedure
Baseline Test
1. Scan the grey scale targets and display them as large as possible. Freeze the
image.
2. Measure the echo level of the anechoic target. Adjust the system gain so that the
measurement is approximately 1. This ensures that the system’s noise floor is
barely reaching the visible level.
3. Record this setting and reuse for all subsequent tests.
Subsequent Tests
1. Scan the grey scale targets and display them as large as possible. Adjust the
system control settings as recorded on the data sheet.
2. Freeze the image and place the region of interest (ROI) tool completely inside
the grey scale target image. The ROI should be approximately 2/3 – 3/4 the
diameter of the circle, and it should be centered in the circle.

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3. Measure and record the echo level of each target.
4. Measure and record the echo level of the background material directly beside
the anechoic target. Use as close to the same ROI as the target as possible.
Unfreeze the image.
5. Perform this process three times and record the average echo level for each grey
scale target and for the background material on the data sheet.
Analysis
Contact your service engineer if target 2, 3, or 4 varies from the baseline by 10% or
more.