SonoSite titan User manual

Ultrasound System User Guide

ii
Manufactured by
SonoSite, Inc.
21919 30th Drive SE
Bothell, WA 98021
USA
T: 1-888-482-9449 or 1-425-951-1200
F: 1-425-951-1201
SonoSite Ltd
Alexander House
40A Wilbury Way
Hitchin
Herts SG4 OAP
UK
T: [phone]
F: [phone]
“TITAN” and “SonoSite TITAN” are trademarks of SonoSite, Inc.
Kensington is a registered trademark of Kensington Technology Group.
CompactFlash is a registered trademark of Symbol Technologies.
Non-SonoSite product names may be trademarks or registered trademarks of their respective owners.
SonoSite products may be covered by one or more of the following U.S. patents: 4454884, 4462408, 4469106, 4474184, 4475376,
4515017, 4534357, 4542653, 4543960, 4552607, 4561807, 4566035, 4567895, 4581636, 4591355, 4603702, (4607642), 4644795, 4670339,
4773140, 4817618, 4883059, 4887306, 5016641, 5050610, 5095910, 5099847, 5123415, 5158088, 5197477, 5207225, 5215094, 5226420,
5226422, 5233994, 5255682, (5275167), 5287753, 5305756, 5353354, 5365929, 5381795, 5386830, 5390674, 5402793, (5,423,220),
5438994, 5450851, 5456257, 5471989, 5471990, 5474073, 5476097, 5479930, 5482045, 5482047, 5485842, 5492134, 5517994, 5529070,
5546946, 5555887, 5603323, 5606972, 5617863, (5634465), 5634466, 5636631, 5645066, 5648942, 5669385, (5706819), 5715823, 5718229,
5720291, 5722412, 5752517, 5762067, 5782769, 5800356, 5817024, 5833613, 5846200, 5860924, 5893363, 5916168, 5951478, 6036643,
6102863, 6104126, 6113547, 6117085, 6142946, 6203498 B1, 6371918, 6135961, 6364839, 6383139, 6416475, 6447451, 6471651, 6569101,
6575908, 6604630, 6648826, D0280762, D0285484, D0286325, D0300241, D0306343, D0328095, D0369307, D0379231, D456509,
D461895. Other patents pending.
P03322-07 11/2004
Copyright 2004 by SonoSite, Inc.
All rights reserved. Printed in the USA.
Caution: United States federal law restricts this device to sale by or on the order of a physician.

iii
Contents
Chapter 1: Introduction
About the User Guide ...............................................................................1
Conventions Used in This User Guide ..................................................2
Symbols and Terms Used in This User Guide ......................................2
Upgrades and User Guide Updates .......................................................2
Customer Comments ................................................................................2
About the System ......................................................................................3
About the System Software .....................................................................5
Chapter 2: Getting Started
Healthy Scanning Guidelines ..................................................................7
System Preparation .................................................................................10
Installing or Removing Battery .....................................................10
Installing and Removing the CompactFlash Card .....................11
Using AC Power/Charging Battery .............................................12
Turning System On/Off .................................................................12
Connecting and Removing the Transducer .................................13
System Controls .......................................................................................14
Screen Layout ..........................................................................................16
General Interaction .................................................................................18
Touchpad ..........................................................................................18
Context Menus .................................................................................18
Remappable Controls .....................................................................19
Annotation and Text .......................................................................19
Forms ........................................................................................................21
System Setup ............................................................................................21
Chapter 3: Imaging
Patient Information .................................................................................41
Transducer, Exam Type, and Imaging Mode .....................................43
Transducer Preparation ..........................................................................45
General Use ......................................................................................45
Invasive Use .....................................................................................46
Modes ........................................................................................................47
2D Imaging .......................................................................................47
M Mode Imaging .............................................................................50
Color Doppler Imaging ..................................................................52
Pulsed Wave (PW) and Continuous Wave (CW)
Doppler Imaging .............................................................................54
ECG Monitoring ......................................................................................57
Annotation ...............................................................................................58
Biopsy .......................................................................................................59

iv
Image Storage .......................................................................................... 60
Save to CompactFlash .................................................................... 60
Print to Local Printer ...................................................................... 60
Image Review .......................................................................................... 61
Patient List ....................................................................................... 61
Patient Images ................................................................................. 62
Chapter 4: Measurements and Calculations
Measurements ......................................................................................... 63
2D Measurements ........................................................................... 63
M Mode Measurements ................................................................. 65
Doppler Measurements .................................................................. 68
Calculations ............................................................................................. 72
Percent Reduction Calculations .................................................... 72
Volume Calculation ........................................................................ 74
Volume Flow Calculation .............................................................. 76
Gyn Calculations ............................................................................. 78
OB Calculations ............................................................................... 81
Vascular Calculations ..................................................................... 89
Cardiac Calculations ....................................................................... 92
Patient Report ....................................................................................... 101
Chapter 5: DICOM Connectivity
TITAN System Setup for DICOM ...................................................... 105
Ethernet Connection ............................................................................. 105
DICOM Setting Backup ....................................................................... 105
DICOM Configuration ......................................................................... 106
Configuring Locations .................................................................. 106
Configuring Archivers ................................................................. 109
Configuring Printers ..................................................................... 112
Configuring Worklist Servers ..................................................... 116
Configuring Procedures ............................................................... 119
Importing and Exporting Configurations ................................. 120
Reviewing the Network Log ....................................................... 121
DICOM Usage ....................................................................................... 122
DICOM Image Archive and Print .............................................. 124
Patient Information ....................................................................... 126
DICOM Worklists ......................................................................... 127
Chapter 6: Safety
Ergonomic Safety .................................................................................. 129
Electrical Safety ..................................................................................... 129
Equipment Safety ................................................................................. 131
Battery Safety ........................................................................................ 131
Biological Safety .................................................................................... 132
Electromagnetic Compatibility (EMC) .............................................. 133
Manufacturer’s Declaration ......................................................... 134

v
The ALARA Principle ...........................................................................137
Applying ALARA ..........................................................................137
Direct Controls ...............................................................................138
Indirect Controls ............................................................................138
Receiver Controls ...........................................................................138
Output Display ......................................................................................139
Related Guidance Documents .....................................................140
Acoustic Output Measurement ...........................................................140
In Situ, Derated, and Water Value Intensities ...........................141
Tissue Models and Equipment Survey ......................................141
Intended Uses ........................................................................................142
About the Acoustic Output Table .......................................................144
Acoustic Output Tables ................................................................146
Global Maximum Derated ISPTA and MI Values ....................155
Acoustic Measurement Precision and Uncertainty ..................157
Labeling Symbols ..................................................................................158
Chapter 7: Troubleshooting and Maintenance
Troubleshooting ....................................................................................161
Software Licensing ................................................................................163
Obtaining a License Key ......................................................................169
Installing a License Key ........................................................................170
Maintenance ...........................................................................................171
Recommended Disinfectant .........................................................171
Safety ...............................................................................................171
Cleaning and Disinfecting the Ultrasound System ..................172
Cleaning and Disinfecting Transducers .....................................173
Sterilizable Transducers ...............................................................174
Cleaning and Disinfecting Transducer Cables ..........................175
Cleaning and Disinfecting the Battery .......................................176
Chapter 8: References
Display Size ............................................................................................189
Caliper Placement .................................................................................189
2D Measurements .................................................................................189
Sources of Measurement Errors ..........................................................191
Acquisition Error ...................................................................................191
Algorithmic Error ..................................................................................191
Terminology and Measurement Publications ...................................191
Cardiac References ................................................................................192
Obstetrical References ..........................................................................196
Gestational Age Tables .................................................................197
Growth Analysis Tables ...............................................................199
Ratio Calculations ..........................................................................200
General References ................................................................................201

vi
Chapter 9: Specifications
System Dimensions .............................................................................. 203
Display Dimensions ............................................................................. 203
Transducers ........................................................................................... 203
Imaging Modes ..................................................................................... 203
Applications .......................................................................................... 204
Image Storage ........................................................................................ 204
Accessories ............................................................................................ 204
Hardware, Software, and Documentation ................................ 204
Cables .............................................................................................. 205
Peripherals ............................................................................................. 205
Medical Grade ............................................................................... 205
Non-Medical Grade ...................................................................... 205
Temperature, Pressure, and Humidity Limits ................................. 205
Operating Limits: System ............................................................ 205
Shipping/Storage Limits: System without Battery .................. 205
Operating Limits: Battery ............................................................ 205
Shipping/Storage Limits: Battery .............................................. 205
Operating Limits: Transducer ..................................................... 206
Shipping/Storage Limits: Transducer ....................................... 206
Electrical ................................................................................................. 206
Battery .................................................................................................... 206
Electromechanical Safety Standards .................................................. 206
EMC Standards Classification ............................................................ 206
Airborne Equipment Standards ......................................................... 207
DICOM Standard .................................................................................. 207
HIPAA Standard .................................................................................. 207
Chapter 10: Glossary
Terms ...................................................................................................... 209
Acronyms ............................................................................................... 211
Index ....................................................................................................... 217

Chapter 1: Introduction 1
Introduction
Chapter 1: Introduction
Please read the information in this user guide before using the TITANTM high-resolution ultrasound
system. It applies to the ultrasound system, and transducers.
About the User Guide
This user guide is a reference for using the ultrasound system. It is designed for a reader familiar
with ultrasound techniques; it does not provide training in sonography or clinical practices. Before
using the system, you must have ultrasound training.
The user guide covers the preparation, use, and maintenance of the ultrasound system, transducers,
and accessories. Refer to the manufacturers’ instructions for specific information about peripherals.
The user guide includes a table of contents and an index to help you find the information that you
need. The user guide is divided into the following chapters:
Chapter 1 “Introduction” Contains general information about the user guide and the
system. Customer assistance information is also included.
Chapter 2 “Getting Started” Contains information on healthy scanning practices, basic
operation, and changing system settings.
Chapter 3 “Imaging” Contains detailed information about preparing for the
exam, entering patient information, adjusting imaging
modes, annotating images, saving images and reviewing
patient images.
Chapter 4 “Measurements
and Calculations”
Contains information on performing measurements and
calculations in the different imaging modes.
Chapter 5 “DICOM
Connectivity”
Contains instructions for configuring and using DICOM.
Chapter 6 “Safety” Contains information required by various regulatory
agencies, including information about the ALARA (as low
as reasonably achievable) principle, the output display
standard, acoustic power and intensity tables, intended
uses, and other safety information.
Chapter 7 “Troubleshooting
and Maintenance”
Contains information to assist in the correction of
problems with system operation. Also contains
information about proper care of the system, transducers,
and accessories.
Chapter 8 “References” Contains information about measurement accuracy and
the sources from which the system measurements and
calculations are derived.

2Chapter 1: Introduction
Introduction
Conventions Used in This User Guide
These conventions are used in this user guide:
•A Warning describes precautions necessary to prevent injury or loss of life.
•A Caution describes precautions necessary to protect the products.
•When the steps in the operating instructions must be performed in a specific order, the steps are
numbered.
•Bulleted lists present information in list format, but they do not imply a sequence.
•The system handle is on the front of the system, and the battery compartment is on the back of
the system.
Symbols and Terms Used in This User Guide
Symbols and terms used on the system, are explained in “Screen Layout” on page 16,Chapter 5,
“DICOM Connectivity”and/or Chapter 10, “Glossary.”
Upgrades and User Guide Updates
SonoSite may offer software upgrades, new features, and improvements to the system performance.
User guide updates accompany the upgrade software and provide detailed information on the
enhancements.
Customer Comments
Questions and comments are encouraged. SonoSite is interested in your feedback regarding the
system and the user guide. Please call SonoSite at 1-888-482-9449. If you are outside the USA, call
the nearest SonoSite representative. You can also send electronic mail (e-mail) to SonoSite at the
following address: [email protected].
Chapter 9 “Specifications” Contains system and accessory specifications and agency
approvals. Specifications for recommended peripherals
can be found in the manufacturers’ instructions.
Chapter 10 “Glossary” Contains definitions of ultrasound system terms and
features.

Chapter 1: Introduction 3
Introduction
About the System
The ultrasound system has multiple configurations and feature sets. All are described in this user
guide but not every option may apply to your system. System features are dependent on your
system configuration, transducer, and exam type.
Figure 1 TITAN System Front View
5
4
3
1
2
Table 1: System Front Features
Number Feature
1 Control panel
2 Transducer connection
3Handle
4Display
5 CompactFlash™ slots (front for image storage, back for system and transducers
updates, import/export OB tables, user names/passwords, and DICOM
configurations)

4Chapter 1: Introduction
Introduction
Figure 2 TITAN System Back View
The TITAN system is a portable, software-controlled, ultrasound system using all-digital
architecture. The system is used to acquire and display high-resolution, real-time ultrasound
images: 2D, color power Doppler (CPD), directional color power Doppler (DCPD), Color Doppler
(Color), Tissue Harmonic Imaging (THI), M Mode, pulsed wave (PW) Doppler, and continuous
wave (CW) Doppler. The system has cine buffer, image zoom, labeling, biopsy, measurements,
calculations, a USB connection for image transfer, image storage, image review, printing, recording,
and the ability to archive Doppler with audio output to a videotape.
Currently, the system supports the following broadband transducers:
•C8/8-5 MHz 8 mm microcurved array
•C11/8-5 MHz 11 mm microcurved array
•C15/4-2 MHz 15 mm microcurved array
•C60/5-2 MHz 60 mm curved array
•HST/10-5 MHz 25 mm linear array
•ICT/8-5 MHz 11 mm intracavitary array
•L25/10-5 MHz 25mm linear array
•L38/10-5 MHz 38 mm linear array
System accessories include the following: TITAN mobile docking system, TITAN MDS Lite, TITAN
mini-dock, Triple Transducer Connect, a power supply, a battery, ECG cable, video and printer
cables, SiteLink Image Manager 2.2 software, and DICOM connectivity. See the TITAN Accessory
User Guide for information on the accessories.
1
3 42
Table 2: System Back Connectors
Number Feature
1 DC input connector
2 I/O connector
3Battery
4ECGconnector

Chapter 1: Introduction 5
Introduction
System peripherals include medical grade (conforming to the requirements of EN60601-1) and
non-medical (commercial) grade products. System medical grade peripherals include a printer,
VCR, and DVD. System non-medical grade peripherals include a CompactFlash card and a
Kensington Security Cable. System setup instructions for the use of peripherals are covered in
Chapter 2, “System Setup” on page 21.
Manufacturer’s instructions accompany each peripheral. Instructions for the use of peripherals with
the system are covered in the TITAN Accessory User Guide.
About the System Software
The ultrasound system contains software that controls its operation. A software upgrade may be
required. SonoSite will provide you with a CompactFlash card containing the software. Typically
new software provides new capabilities. A single CompactFlash card can be used to update one or
more systems. Software upgrades use the back CompactFlash slot on the right hand side of the
system. CompactFlash cards installed in the front CompactFlash slot do not upgrade the system.

6Chapter 1: Introduction
Introduction

Chapter 2: Getting Started 7
Getting Started
Chapter 2: Getting Started
This chapter contains information on healthy scanning practices, basic operation, and changing
system settings.
Healthy Scanning Guidelines
These guidelines are intended to assist you in the comfort and effective use of your ultrasound
system.
Warning: Use of an ultrasound system may be linked to musculoskeletal disordersa,b,c.
Use of an ultrasound system is defined as the physical interaction between the
operator, the ultrasound system, and transducer.
When using an ultrasound system, as with many similar physical activities, you
may experience occasional discomfort in your hands, fingers, arms, shoulders,
eyes, back, or other parts of your body. However, if you experience symptoms such
as constant or recurring discomfort, pain, throbbing, aching, tingling, numbness,
burning sensation, or stiffness, do not ignore these warning signs. Promptly see a
qualified health professional. Symptoms such as these can be linked with
musculoskeletal disorders (MSDs). MSDs can be painful and may result in
potentially disabling injuries to the nerves, muscles, tendons, or other parts of the
body. Examples of MSDs include carpal tunnel syndrome and tendonitis.
While researchers are not able to definitively answer many questions about MSDs,
there is a general agreement that certain factors are associated with their
occurrence including: preexisting medical and physical conditions, overall health,
equipment and body position while doing work, frequency of work, duration of
work, and other physical activities that may facilitate the onset of MSDsd. This
chapter provides guidelines that may help you work more comfortably and may
reduce your risk of MSDse,f.
a. Magnavita, N., L. Bevilacqua, P. Mirk, A. Fileni, and N. Castellino. “Work-related Musculoskeletal Complaints in
Sonologists.” Occupational Environmental Medicine. 41:11 (1999), 981-988.
b. Craig, M. “Sonography: An Occupational Hazard?” Journal of Diagnostic Medical Sonography. 3
(1985),121-125.
c. Smith, C.S., G.W. Wolf, G. Y. Xie, and M. D. Smith. “Muscoskeletal Pain in Cardiac Ultrasonographers: Results of
a Random Survey.” Journal of American Society of Echocardiography. (May1997), 357-362.
d. Wihlidal, L.M. and S. Kumar. “An Injury Profile of Practicing Diagnostic Medical Sonographers in Alberta.”
International Journal of Industrial Ergonomics. 19 (1997), 205-216.
e. Habes, D.J. and S. Baron. “Health Hazard Report 99-0093-2749.” University of Medicine and Dentistry of New
Jersey. (1999).
f. Vanderpool, H.E., E.A. Friis, B.S. Smith, and K.L. Harms. “Prevalence of Carpal Tunnel Syndrome and Other
Work-related Muscoskeletal Problems in Cardiac Sonographers.” Journal of Medicine. 35:6 (1993), 605-610.

8Chapter 2: Getting Started
Getting Started
Position the System
To promote comfortable shoulder, arm and hand postures, consider the following:
•Use the TITAN mobile docking system to support the weight of the ultrasound system.
To minimize eye strain, consider the following:
•When the exam/procedure allows, position the system within reach.
•Adjust the angle of the system/display to minimize glare from overhead or outside lighting.
To minimize neck strain, consider the following:
•If using a stand, adjust the stand height such that the display is at or slightly below eye level.
Position Yourself
To support your back, consider the following:
•Use a chair that has support for your lower back.
•Use a chair that adjusts to your work surface height and promotes a natural body posture.
•Use a chair that allows for quick height adjustments.
•Always sit or stand in an upright manner. Avoid bending or stooping.
To minimize reaching and twisting, consider the following:
•Use a bed which is height adjustable.
•Position the patient as close to you as possible.
•Face forward. Avoid twisting your head or body.
•Move your entire body front to back and position your scanning arm next to or slightly in front
of you.
•Stand for difficult exams to minimize reaching.
To promote comfortable shoulder and arm postures for your scanning arm, consider
the following:
•Keep your elbow close to your side.
•Relax your shoulders in a level position.
•Support your arm using a support cushion or pillow, or rest it on the bed.
To minimize neck bending and twisting, consider the following:
•Position the ultrasound system/display directly in front of you.
•Provide an auxiliary monitor for patient viewing.

Chapter 2: Getting Started 9
Getting Started
Go Lightly
To promote comfortable hand, wrist, and finger postures for your scanning arm,
consider the following:
•Hold the transducer lightly in your fingers.
•Minimize the pressure applied on the patient.
•Keep your wrist in a straight position.
Take Breaks
Minimizing scanning time and taking breaks can be very effective in allowing your body to recover
from physical activity, which can help you avoid any MSDs. Some ultrasound tasks may require
longer or more frequent breaks. One way of taking a break is to stop and relax. However, simply
changing tasks can help some muscle groups relax while others remain or become active.
To vary your daily activities, consider the following:
•Plan your work so there are breaks in between ultrasound exams.
•Work efficiently when performing an ultrasound exam by using the software and hardware
features correctly. Learn more about these features in Chapter 3 of this guide.
•Keep moving. Avoid sustaining the same posture by varying your head, neck, body, arm, and
leg positions.
Exercise
Targeted exercises can strengthen muscle groups, which may help you avoid MSDs. Contact a
qualified health professional to determine stretches and exercises that are right for you.

10 Chapter 2: Getting Started
Getting Started
System Preparation
Installing or Removing Battery
The battery comprises six lithium-ion cells plus electronics, a temperature sensor, and battery
contacts.
If the battery is being installed for the first time, it will need to be charged.
Figure 1 Insert Battery into System
To install the battery:
1Turn the system upside down.
2Place the battery into the battery compartment, at a slight angle. See Figure 1.
3Slide the battery forward until it locks into place.
4Push down on the two locking levers to secure battery.
To remove battery:
1Push up on the two locking levers.
2Slide the battery back.
3Lift the battery from the compartment.
Warning: To avoid injury to the operator and to prevent damage to the ultrasound system,
inspect the battery for leaks prior to installing.
Locking levers

Chapter 2: Getting Started 11
Getting Started
Installing and Removing the CompactFlash Card
Images are saved to a CompactFlash card and are organized in a patient list. The images in the
patient list are organized alphabetically by the patient name and ID. Images are archived from the
system to a PC using a USB or Ethernet connection. Images on the CompactFlash card cannot be
read directly from a CompactFlash card reader.
To install the CompactFlash card:
1Verify the ejector pin is fully pushed in.
2Insert the CompactFlash card into the front slot on the ultrasound system. See Figure 1 on
page 3.
The front slot is used to store images. The back slot is used to update systems/transducers and
to import/export DICOM configuration information and OB Tables.
The CompactFlash card is ready to use when the save icon and the image memory counter, showing
the remaining available memory, are displayed on the screen.
To remove the CompactFlash card:
1Turn off the ultrasound system before removing the card.
2Press the ejector pin in the front card slot to position it to the outside of the system. See Figure 1
on page 3.
3Press in the ejector pin to eject the CompactFlash card.
Note: If the CompactFlash card does not eject properly, try a new card.
4Remove the card.
5Push in the ejector pin to avoid damaging the ejector pin.
Warning: To prevent loss of data, loss of images, or damage to the CompactFlash card, turn
the ultrasound system off before removing the CompactFlash card. When the
CompactFlash card is removed before turning off the ultrasound system, the
system must be restarted.

12 Chapter 2: Getting Started
Getting Started
Using AC Power/Charging Battery
The battery charges when the system is connected to the AC power supply. If the system is off and
connected to AC power, a completely discharged battery will fully charge in 2.5 to 3.5 hours. If the
system is on and connected to AC power, a completely discharged battery will fully charge in 5 to
6hours.
The system can run on AC power and charge the battery in three ways.
•Connected directly to the system
•Connected to the mini-dock (See the TITAN Accessory User Guide.)
•Connected to the docking system (See the TITAN Accessory User Guide.)
To operate the system using AC power (directly to system):
1Connect the DC power cable from the power supply to the connector on the system. See Figure 2
on page 4.
2Connect the AC power cord to the power supply and connect to a hospital-grade electrical
outlet.
Turning System On/Off
To turn the system on/off:
1Locate the Power key on the top left side of the system. See Figure 3 on page 14.
2Press the Power key once to turn on and once to turn off.
To wake up the system:
To conserve battery life, the system is configured to go into sleep mode. The system goes into sleep
mode when the lid is closed or if the system has not been touched for a preset amount of time. Press
any key, touch the touchpad, or open the lid to wake up the system. To adjust the time for sleep
delay, see “To set up Audio and Battery:” on page 28.
Warning: The equipment shall be connected to a center-tapped single phase supply circuit
when users in the United States connect the equipment to a 240V supply system.
Caution: Verify the hospital supply voltage corresponds to the power supply voltage range.
See “Electrical” on page 206.
Caution: Do not use the system if an error message appears on the display. Note the error
code and turn off the system. Call SonoSite or your local representative.

Chapter 2: Getting Started 13
Getting Started
Connecting and Removing the Transducer
Figure 2 Connect the Transducer
To connect the transducer:
1Turn the system upside down (if not in docking system).
2Pull the transducer latch up and rotate it clockwise.
3Align the transducer connector with the connector on the bottom of the system.
4Insert the transducer connector into the system connector.
5Turn the latch counterclockwise.
6Press the latch down, securing the transducer connector to the system.
To remove the transducer:
1Pull the latch up and rotate it clockwise.
2Pull the transducer connector away from the system.
Warning: The transducer connector can become hot during operation. This is normal.
Operate the system in the docking system or on a flat, hard surface to allow air flow
past the connector.
Caution: The electrical contacts inside the system transducer connector may be damaged by
foreign material. Keep foreign material out of the connector.

14 Chapter 2: Getting Started
Getting Started
System Controls
Figure 3 System Controls
Update
M Mode
Doppler
Color
2D
Zoom
THI
Depth
Record
Enter
Delete
PictoText
Shift
Caps
Tab
Freeze
Caliper
Calcs Print
Save
1
2
3
4
6
7
8 9 11 12 13
14
15
17
16
18
19
20
5
10
Table 1: System Controls
Number System Control Description
1 Power Turns system on and off.
2 Alphanumeric Use to enter text and numbers.
3 Annotation Text Turns the keyboard on and off for text entry.
Picto Turns the pictographs/pictograph marker on and
off.
Arrow Displays an arrow that can be moved and rotated
within the image area.
4 THI Turns Tissue Harmonic Imaging on and off.
5 Depth Depth Adjusts the imaging depth for 2D.
Depth Up Decreases imaging depth.
Depth Down Increases imaging depth.