 Good morning everyone, and welcome to the next lecture. We are going to be talking about 3D acquisition specifically for LB and RB, and we are going to go into the summary of the different ways of acquire those images in the Philips and in the G machines. Again, I have no disclosures to discuss with the audience, and the objective is how to acquire the datasets of the LB and the RB in both machines. And once more, I recommend you to go to the website from the University of Toronto, which was developed from the Toronto General Hospital. Once you go there, you can see that we have the model for 3DTE, and once there, you can go and select the acquisition of the 3D datasets, and then you will have the difference between the EPIC 7 and the BB9, and again this page is for free and anyone can access it anytime. So we are going to start with the acquisition modes in the Philips EPIC Q7, and we are going to be talking about four different modes. X-Plane, Live 3D, Full Volume, and 3D Zoom. I would like to start with the acquisition mode of the X-Plane. So again, the X-Plane is a mode that is going to allow us to perform a simultaneous scanning and display of two perpendicular plates. In the example that we are seeing, we have the four chamber view, where we have the right ventricle and the left ventricle. So here is where is the X-Plane knob, and then you can press it, and in the X-Plane, the primary plane, which is the one that is on the left side, is the reference to the plane, and the secondary plane is by default at 90 degrees with respects to the primary plane, which is the one that we see in the right side of the screen. Again, a tip for this method is like if you start at 90 degrees, the secondary plane, because it goes 90 degrees or more with the primary plane, the secondary plane is always going to be a reversal image, because you are going above 180 degrees. So choose to be aware of that when you are using this mode. This is an example of an acquisition of an X-Plane for the left ventricle in the transgastric sororaxis view. So what you want to do is you want to get this transgastric sororaxis view of the left ventricle, put it exactly in the middle, and then press the X-Plane button, and then you will be able to generate these two pictures. This next example is for a right ventricle transgastric sororaxis view, and then they're exactly the same. You can see the line on the left plane for the transgastric sororaxis of the RV, and then the image generated on the right is a 90-degree increase of the right ventricle, and you can see simultaneously both images and see how this right ventricle is behaving. The next mode that I'm presenting is the Live3DV. Again, a Live3DV acquisition mode produces a very small size 3D volume allowing for a mid spatial and high temporal resolution, although it may not be sufficient to contain the entire structure of interest. In this case, the right or the left ventricle. This modality often is often used as a 3D image test, or you can use it to guide the placement of wires or devices through the ventricles, for example. The Live3DV mode generates a 60-degree lateral width, which is going to be like that, and a 30-degree elevation width depth, and the height of a 90% of the 2D plane. So in this example, we have the four chamber view. You can press the Live3DV button, and then the 3D image is going to generate, and when you do that, the 3D volume moves to the center position by default. But clicking a second time, you can change these to the position in the front, and pressing again will return to the back position of the image that you acquire. The elevation width can be accomplished by turning the elevation width knob. The functionality of this knob can be changed to widen or narrow the lateral width by pressing the lateral width button, and the knob has more than one function, and then the yellow color will indicate which function is activated. The 3D dataset can be contained over one bit, which means real-time or open multiple consecutive hard bits, two, four, or six bits, which is considered easy to gate. As per recommendation of the guidelines, four bits is ideal. The multi-bit acquisition will increase your temporal and sparsing resolution, but it's subject to something that we call stitch artifacts. If when you acquire one bit on the next bit, if there is a movement, for example, the respiratory inspiration or respiration, this actually can generate different planes for the images. The default settings is one bit, and you can use the 3D knob to change the number of bits over the volume over which the volume is acquired. The next mode is going to be the full volume mode. The full volume mode is commonly used in the assessment of larger structures, such as the ventricles, which is the interest of the lecture. The use of this mode, you will need to press the full volume knob that we are going to show you in a second. Remember, this mode is going to generate a large 3D dataset with the width and elevation equal to the width and depth of the two D-referenced planes, and this mode is going to display a primary to D-reference plane and a secondary plane at 90 degrees. So again, we have here the same example of the four chamber view. We press the full volume button, then we get this image where you have the reference planes, the 2D reference planes, and the layout is three images, and then the elevation and width can be changed by using the elevation and width knob. The functionality can again be altered to achieve lateral width by pressing the lateral width knob, and the maximum that can be increased is up to 120 degrees, no more than that. And depending on how much size of the image do we think, the quality of the image is going to be worse or better. And again, in this setting, the 3D dataset can be obtained over one, two, four, and six speeds using the 3D op knob, and giving the large size of the volume dataset for a bent recall is indicating it's almost required in this setting if you want to get a good quality image so you are able to analyze the bent recall. Those are examples of left ventricular full volumes. The image that you can see in the left side is a layout with three small icons where you have the 3D image on top, the 2D primary reference plane on the left, and the 2D at 90 degrees 2D reference plane. In the right side of the screen what we can see is a single icon which represents the 3D image. It's very important for you to understand that so we are able to see the structure of interest, the machine itself gives you that BU so you can see in this case the left ventricle without giving you the anterior part of the heart. So automatically the image is cropping half. If you want to get the rest of the image, you need to reset crop and then you will be able to get the full left ventricle. But this is not of our interest because you want to be sure that you include the whole left ventricle in this image. This example is for a right ventricle full volume acquisition and again it's a layout with three small icons. You can divide it into one or you can divide it into four and again the four is normally reserved for the left ventricle because you can see the left ventricle from the apex app if you want to assess a specific segment over there. But definitely we can obtain images from the right ventricle to here with this kind of volume. Next I would like to introduce to you the 3D zoom mode. The 3D zoom mode is commonly used for the assessment of individual valves and smaller structures. And despite in this case we are talking about the bentricles, you can definitely use this type of 3D technology to assess specific parts of the of the bentricles like an inflow cannula for an elbow in the apex of the LB when apical LB thrombus or a pacemaker device on the right ventricle. To begin to use the 3D zoom acquisition we should press the 3D zoom button that I'm going to show you in a second. And again remember for this kind of mode the 3D zoom will allow us to specifically determine a region of interest by selecting two simultaneous perpendicular 2D planes. In this example now is the four chamber view and the first step of the 3D zoom acquisition is to replace the reference 2D as the primary plane and the secondary plane and 90 degrees as we are seeing in the example. Remember that by default the region of interest is going to be half the width and half the depth of the primary and secondary planes and it appears in the center as a green dotted outline. Using the trackball you can move anywhere on the primary plane the region of interest and this will be in the corresponding movements in the secondary plane. This trackball can actually be used to change the height and width of the region of interest. In this example the region of interest is adjusted over the mitral valve in the primary and secondary planes and you can use this mode to visualize specific areas. Again remember once you have select the region of interest that you want you need to press again 3D zoom to acquire the 3D data set volume. The next part of the lecture we are going to be talking about acquisitions but this time in the GE BB-E9 including the multi-D mode, bird's view, medium and large volumes and the 4D zoom. The first mode from the GE machine that I would like to introduce to you is the multi-D. So the multi-dimension of multi-D mode of acquisitions is going to allow simultaneous scanning and display of multiple 2D planes. The default multi-D setting is by plane where the primary plane on the left is the reference 2D plane and the secondary plane on the right is at 90 degrees to the primary plane. This is an example of a right ventricle modified 4 chamber view with multi-D adquisition. You start on the left primary reference plane and then the plane on the right is 90 degrees increase with respect to the other. The next mode from the GE is going to be the bird's view. The bird's view is going to produce a various model size narrow 3D volume dataset with high spatial and temporal resolution but it's mostly going to be insufficient to contain a medium or larger structures like it happened with the live 3D from the Philips. It's normally often used as a 3D image test and to guide the placement of wires of devices. In this example from the 4 chamber view the default volume is 50 degrees of lateral width and only 10 degrees of elevation and depth. The 3D volume originates from the front of the 2D scanning plane and the yellow arrow indicates the angle at which these planes are being 3D. The elevation plane can be adjusted on the center by pressing front or to the back by pressing back and the size of the volume can be changed by turning the volume size knob. Lateral and elevation width are changed by five degrees increment. Finally on this mode as we said on the Philips the 3D dataset can be obtained over one bit real time or over multiple bits. The default setting in the GE is again one bit and if you want to get to obtain more bits you need to press the multi-bit knob as you just have seen and then you will be able to go as max as six bits. From those six bits remember the recommendation from the guidelines is to take at least four bits especially in bigger structures. This is an example of a real-time one-bit acquisition but again remember that you can get it to actually increase the numbers of bits and increase the temporal resolution of the image. In this case this is an example of a right ventricle acquisition from the birds video. The next mode that I would like to introduce to you is the medium and large volume display. The medium and large volume is used to assess larger structures as the ventricles is equivalent to the full volume of the of the Philips. The medium is going to generate a medium 3D dataset which normally have a lateral and elevation width set at 35 degrees. The large goes up from 35 to 60 degrees. In this example we can see after pressing this is medium 35 per 35 and you will generate the 3D image on the left side the reference the 2D reference plane and when we press large we go to 60 over 60, much larger structures okay. The lateral and elevation width are increased or decreased simultaneously and equally and the medium and the large 3d volume datasets can be obtained over again one bit or multiple bits as we found on the Philips. In this method desegigating it's almost necessary to get a good quality image to obtain an adequate temporal resolution okay. You can see as we increase the number of bits in the example how the image can be better but this method again is subject to a stitch artifact. This is an example of a GLB large volume acquisition and this is an example of our right ventricle large volume acquisition. Thank you very much for listening to the lecture and I will be happy to answer your questions at the at the end of the section.