GE Invenia ABUS User manual

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Invenia™ABUS
Scan Station Positioning Guide

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Scanner Assembly
The active scan area is clearly visible through the view window on the scanner assembly. The transducer
width represents the actual area of the breast being scanned.
The transducer and disposable membrane are the only parts of the scanner assembly that come in
contact with the patient.
Multi-axis Lock
Abort Scan
Start Scan
View Window
Reverse Curve™
Transducer
Increase
Compression
Decrease
Compression
About this Guide
This guide is for sonographers, technologists and other trained clinical care providers
using the Invenia ABUS Scan Station. It describes techniques and procedures for
obtaining optimal image quality during each breast exam.
• The disposable membrane is intended for one time use and is changed for each patient.
• Always check to make sure a membrane has been replaced on the scanner assembly.
• If the membrane is torn or damaged in any way, do not use.
• The transducer and membrane are the only parts of the scanner assembly that come into
contact with the patient.
Changing the Membrane
Active Scanning Area

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Positioning for an Invenia ABUS Exam
• Lay the patient supine and elevate the head if needed to create a breast mound.
• Turn patients head away from the side being scanned.
• Place the patients arm above their head. If the patient has difficulty raising their arm, it may be placed
at a 90-degree angle.
• Ultrasound coupling lotion is applied to the breast in a thick, even layer creating a “white” appearance
on the skin.
• Apply lotion liberally to the entire surface of the breast, making sure there are no air bubbles trapped
around the nipple.
• Lotion should be applied to the areola and nipple in a circular motion for 3-4 rotations using the three
middle fingers to reduce the potential of air bubbles and associated nipple shadowing. Avoid using a
spoon or tongue depressor.
• Lotion is re-applied before each view to maintain coupling.
Note: Ultrasound coupling lotion reduces the incidence of air bubbles, which commonly cause artifact in
conventional ultrasound gel. Therefore, gel is not recommended.
An angled wedge sponge is used to position the patient, so the breast tissue is equally distributed
on the chest wall and the nipple is pointing up. Use of a pillow is optional.
The breast should appear:
• Equally sloped in all directions
• Without asymmetric mounding or tilting
• With the nipple pointing up to the ceiling
Ultrasound Coupling Lotion

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The Six Scanning Views
Superior
Upper Outer
Quadrant
Inferior
Lateral
Medial
AP
Standard Views
View Type Description Transducer Positioning
AP Central tissue: includes
nipple. Nipple is centered.
Lotion is applied to the
entire breast surface.
Center the scanner assembly on the breast using the nipple-positioning arrow
as a guide. Transducer placement is at the inferior edge of the nipple. Bring the
Scanner Assembly straight down on the breast flattening the tissue equally on
all sides.
Lateral Lateral tissue: includes
nipple and superior tissue
to include axillary tail. Nipple
is in the inferior-medial
corner. Lotion is applied
from nipple to lateral
breast surface, to include
axilla
Scanner assembly placement is shifted towards the axilla and laterally. Bring the
scanner assembly straight down on the breast flattening the tissue equally on
all sides. Tilt superior, then laterally making contact with the lateral edge of the
breast. Apply pressure snugging the transducer into the lateral edge. Transducer
should be angled to follow the contour of the body.
If breast shape and body habitus do not allow good superior compression, the
scanner assembly can be placed at the lateral edge and rolled down onto the
breast without displacing the tissue medially. For larger breasts, if the nipple
is outside the field of view, a second lateral view should be done to include the
nipple.
Medial Medial tissue; includes
nipple and inferior tissue
including inframmary fold.
Nipple is superior and
medial to the nipple-
positioning arrow. Lotion
is applied from nipple to
sternum extending below
the inframammary fold.
Move to the opposite side of the patient turning the scanner assembly around.
Position scanner assembly so it extends 4-5 cm (1½-2 in.) below the inframammary
fold. Bring scanner assembly straight down then tilt medially aligning the bottom
edge of assembly with the sternum. Nipple should be superior to the transducer
and slightly above the nipple-positioning arrow. Apply even pressure flattening
the tissue equally then apply pressure snugging the transducer into the medial
edge. Transducer should be angled to follow the contour of the body.
Additional Views
View Type Description Transducer Positioning
Superior Superior tissue: used when
the AP view does not cover
superior tissue. Nipple will
appear in the center at
the inferior edge. Lotion is
applied from the clavicle
to the nipple.
Shift the scanner assembly towards the patient’s head so that the superior edge
of the assembly is just below the clavicle. Center the scanner assembly on the
breast using the nipple-positioning arrow as a guide. Bring the scanner assembly
straight down flattening the tissue equally on all sides. The nipple will appear in
the center at the inferior edge of the active scan area.
Inferior Inferior tissue: nipple will
appear in the center at
the superior edge of the
active scan area. Lotion
is applied from the nipple
to 5 cm (2 in.) below
inframammary fold.
Center the scanner assembly on the breast using the nipple-positioning arrow
as a guide. Shift the scanner assembly inferior so it extends 4-5 cm (1½-2 in.)
below the inframammary fold. Bring the scanner assembly straight down flattening
the tissue equally on all sides, then apply superior pressure flattening out the
inframammary fold. The nipple will appear in the center at the superior edge
of the active scan area.
Upper Outer
Quadrant
Superior and lateral tissue;
includes axillary tail. The
nipple may not appear in
the active scan area or will
be at the lower inner edge.
Lotion is applied to the
upper outer quadrant of
the breast extending into
the axilla.
A rolled towel can be placed behind the scapula to flatten out the armpit. Place
the scanner assembly superior and lateral to the breast extending up into the
axilla. Bring the scanner assembly straight down into the axilla following the
contour of the body. The nipple may not appear in the active scan area or will
be at the lower inner edge.
Depending on the indication, an Invenia ABUS
exam may be Bilateral or Unilateral. A standard
screening exam is Bilateral and is typically
composed of three standard views: AP (Anterior-
Posterior), LAT (Lateral), and MED (Medial).
Depending on breast size, additional views such
as SUP (Superior), INF (Inferior) and UOQ (Upper
Outer Quadrant) may be required to accommodate
all breast tissue.
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AP View
• This view includes the central tissue and nipple.
• Lotion is applied to the entire breast surface.
• Center the scanner assembly on the breast
using the nipple-positioning arrow as a guide.
Transducer placement is at the inferior edge
of the nipple. Bring the scanner assembly
straight down on the breast flattening the
tissue equally on all sides.
Lateral View
• This view includes lateral and superior tissue
including the axillary tail. The nipple is in the
inferior-medial corner of the scanner assembly.
• Lotion is applied from the nipple to the lateral
breast surface including the axilla.
• Scanner assembly placement is shifted towards
the axilla and laterally. Bring the scanner
assembly straight down on the breast flattening
the tissue equally on all sides, tilt superior, then
laterally making contact with the lateral edge
of the breast. Apply pressure snugging the
transducer into the lateral edge. The transducer
should be angled to follow the contour of the
body.
• If breast shape and body habitus do not allow
good superior compression, the scanner
assembly can be placed at the lateral edge
and rolled down onto the breast without
displacing the tissue medially.
• For larger breasts, if the nipple is outside the
field of view, a second lateral view should be
done to include the nipple.
AP Acquisition
Lateral Acquisition Lateral Coronal Reconstruction
AP Coronal Reconstruction

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Medial View
• This view includes medial tissue, the nipple and
inferior tissue including inframmary fold (IMF).
Move to the opposite side of the patient turning
the scanner assembly around.
• Lotion is applied from the nipple to the sternum
extending below the IMF.
• Position scanner assembly so it extends 4-5 cm
(1½- 2 in.) below the IMF. Bring scanner assembly
straight down then tilt medially aligning the
bottom edge of scanner with the sternum.
Nipple should be superior to the transducer
and slightly above the nipple-positioning arrow.
Apply even pressure flattening the tissue equally
then apply pressure snugging the transducer
into the medial edge. Transducer should be
angled to follow the contour of the body.
Superior View
• This view is used when the AP view does not
cover superior tissue. The nipple will appear in
the center at the inferior edge.
• Lotion is applied from the clavicle to the nipple.
Shift the scanner assembly towards the
patient’s head so that the superior edge
of the assembly is just below the clavicle.
• Center the scanner assembly on the breast
using the nipple-positioning arrow as a guide.
Bring the scanner assembly straight down
flattening the tissue equally on all sides. The
nipple will appear in the center at the inferior
edge of the active scan area.
Medial Acquisition
Superior Acquisition
Medial Coronal Reconstruction

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Inferior View
• This view is used when the AP view does not
cover the inferior tissue. The nipple will appear
in the center at the superior edge of the active
scan area.
• Lotion is applied from the nipple to 5 cm (2 in.)
below the inframammary fold (IMF).
• Center the scanner assembly on the breast
using the nipple-positioning arrow as a guide.
Shift the scanner assembly 4-5 cm (1½-2 in.)
below the IMF. Bring the scanner assembly
straight down flattening the tissue equally on
all sides, then apply superior pressure flattening
out the IMF. The nipple will appear in the center
at the superior edge of the active scan area.
Upper Outer Quadrant View
• This view includes superior and lateral tissue
and also the axillary tail. The nipple may not
appear in the active scan area or will be at the
lower inner edge. A rolled towel can be placed
behind the scapula to flatten out the armpit.
• Lotion is applied to the upper outer quadrant of
the breast extending into the axilla.
• Place the scanner assembly superior and lateral
to the breast extending up into the axilla. Bring
the scanner assembly straight down in the axilla
following the contour of the body. The nipple
may not appear in the active scan area or will
be at the lower inner edge.
Inferior Acquisition Upper Outer Quadrant Acquisition

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Apply Compression
• Minimum bed height should be 30” to achieve proper compression. The compression range indicator
arrows on the articulating arm notify the user when the arm is at its lowest point and compression
cannot be applied.
• Avoid wedging the breast tissue, which causes the ultrasound beam to penetrate the tissue at an
angle, which may result in shadowing, artifact and false positives.
• Begin by establishing optimal manual contact and compression of the breast, then activate compression
assist while gradually releasing manual compression.
• There are 3 levels of compression that can applied one level at a time using the increase button on the
right handle of the scanner assembly. The arm locks as pressure is added.
• Manual compression is recommended for women who are not able to tolerate any levels of compression,
such as women with fibrocystic breast tissue, islands of dense breast tissue or women with moderate
to large size cysts/masses.
• Compression level 2 is recommended for most breast tissue. Once the scan has begun, if the transducer
slides or lifts, abort the scan and decrease to a lower level of compression.
• Compression applied to the breast should be sufficient to flatten out the tissue, but not uncomfortable
for the patient. Confirm patient comfort at each level.
• Pressure can be released one level at a time using the decrease compression button on the right handle
or red abort button on the left handle for quick release.
• The breast should be compressed firmly, flattening the tissue equally on all sides.
• The transducer can be tilted medial or lateral to optimize contact.
• Review the image on the touchscreen to make sure there is contact all across the transducer and that
the tissue is level.
• Press the green start scan button on the left handle to begin the scan. The multi-axis lock engages
when the button is pressed.
• The transducer will move to the inferior edge and scan across the breast from the inferior to the superior
edge in 30 seconds.
• When the transducer reaches the superior edge the compression will automatically release and the
transducer is then lifted off the breast.
• If the transducer moves from the superior to inferior edge, press the red abort button to stop the scan.
Then correct the orientation icon on lower right corner of the touchscreen and repeat the scan.
• The scanner assembly should not slide, roll, or lift during scanning.
• Ultrasound coupling lotion is reapplied to the breast before each view.
• The patient is re-positioned with the angled wedge sponge for each side scanned.
• Remind the patient they can breathe normally but should refrain from talking or moving during
the scan to avoid motion artifacts.
Good contact across the transducer Poor contact across the transducer
Begin the Scan
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Scanning Tips
• Minimum bed height should be 30” to achieve proper compression. The compression range indicator
arrows on the articulating arm notify the user when the arm is at its lowest point and compression
cannot be applied.
• Always check to make sure a membrane has been replaced on the scanner assembly.
• Select proper depth to avoid tissue exclusion. Depth can be evaluated by visualizing the chest wall at
the time of initial transducer placement. If the chest wall is not visualized a deeper depth should be
selected.
• Keep the nipple inside the active scan area whenever possible.
• The active scan area should have as much skin contact as possible.
• Breast tissue should be kept level without tilting or mounding.
• Avoid wedging the breast tissue, which causes the ultrasound beam to penetrate the tissue at an
angle which may result in shadowing, artifact and false positives.
• Begin by establishing optimal manual contact and compression of the breast, then activate compression
assist while gradually releasing manual compression.
• Compression level 2 is recommended for most breast tissue. Once the scan has begun, If the transducer
slides or lifts, abort the scan and decrease to a lower level of compression.
• Manual compression is recommended for women who are not able to tolerate any levels of compression,
such as women with fibrocystic breast tissue, islands of dense breast tissue or women with moderate
to large size cysts/masses.
• If the breasts are large and tissue extends more than 15 cm from the nipple, it will be necessary to
obtain views that do not include the nipple in order to ensure coverage of all the tissue. Additional
views include: SUP, INF and UOQ or a second LAT.
• When the breasts are large, the operator obtains a view that includes as much tissue as possible with
the nipple visible and then obtains a second volume of the same view farther in the direction that the
breast tissue extends away from the nipple.
• The transducer should not slide, roll or lift during scanning.
• Remind the patient they can breathe normally but should refrain from talking or moving during the
scan to avoid motion artifacts.
For a complete summary of Invenia ABUS Scan Station operation and positioning information, please
refer to the Invenia ABUS Scan Station Basic User Manual (DOC. No. 4700-0014-00).
© 2014 General Electric Company – All rights reserved.
General Electric Company reserves the right to make changes in specifications and
features shown herein, or discontinue the product described at any time without notice
or obligation. Contact your GE Representative for the most current information.
GE, GE monogram, Invenia, and Reverse Curve are trademarks of General Electric
Company.
GE Medical Systems Ultrasound & Primary Care Diagnostics, LLC, a General Electric
company, doing business as GE Healthcare.
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March 2014
4700-0017-00 Rev 01
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