 Good evening everyone. We are presenting these lectures for the TE Fellows lectures as part of the National Board of Ecco exam preparation for the Advanced PTE. So we are going to be talking about 3D imaging and strain today for the 23rd of June 2021. I have now these closures to discuss with you and and no conflicts of interest of these lectures is going to be how to obtain a 3D data set on a Philips ECHIP7 or an GE Bbid E9. We are going to see the applications that we can do with those 3D images and we are going to go to understand a little bit about strain. So I recommend you this web page. This is actually free. It's developed by the University of Toronto from part of the PEC group. Unfortunately, we are updating the the web page now because it's dependent on flash technology and we are going to try to actually get it update, but here you can actually go through the 3D TE as you can see there. And then once you open that you have all the acquisition modes and manipulations both for the EPIC and the Bbid E9. Okay, let's just start. So the acquisition on the Philips EPIC Q7 is the one that we use in most of our cases. So you're going to have your video monitor or you're going to have your touch screen. You're going to have your control panel. Okay, and in the module you're going to be able to get an anatomy called 3D mode that you can actually cut and see the structures. The echocardiography much generated. The panel, what nodes to use and the text explaining exactly what we're going to be doing. So let's just start with this. So for the EPIC, the first thing that we need to do before doing 3D is your 2D optimization. Okay, we are going to select the focus, which is right here, okay? And then you have it over there. You're going to go up and down and focus on the structure that you want. In this case, if you want the mitre valve is going to be around here. If you want the LB, so you're going to focus over here to get the best image possible, okay? So now gain, you're going to use this knob over here, okay? And then when you have it, you can rotate to the left or to the right. You can see the amount of gain that you are actually getting that recommendation between 50 and 55, don't over gain. Otherwise, the image is not going to be good once we have set the focus and the gain, okay? So we go to the different acquisitions modes that we have. We are going to start with the first 3D mode that we have, which is the explain and you have it over there. So when we start with this, I'm going to show you over there. So it's going to be here in the tactile, which is going to be over there. And then the moment that you do that you're going to have, for example, from the 4th chamber view, you're going to generate a 90 degrees forward view. If you start from a 90 degrees view, you will actually go over the 118, you will get a reverse image. There is a recommendation, there is a little function up there on the tactile screen, which says write reversal, and then you can use that. For example, if you start from the long axis view of the arctic valve here, instead of going 90 degrees forward, which is going to be an inverted image of 45 degrees, you go write invert, and then you will get the 45 degrees here. So that's very handy for the minor valve to have 2 views, for the arctic valve to have 2 views, for the LV to have the 2 views of it. And you can see both views simultaneously, okay? So those are examples of the acquisition modes that's explained from LV, from the trans-gastric short axis view, and then automatically we are getting a 90 degrees view, and it's very easy to actually assess the whole walls in both 2 views. Something, if you go to the 4th chamber view and you get that 2th chamber view, you can actually do a Simpsons by plane to estimate your ejection fraction. Another example on when to use X-plane is for the right ventricle, again from the trans-gastric RV plane, so you actually cut it, you get 90 degrees, you can see the tricuspid moving towards the septum, and you can see the function of the right ventricle. So, regarding the first, the second acquisition mode for 3D on the epic, we talk about X-plane, now we are going to talk about live 3D, okay? The important part of live 3D, again, is going to be a small size, it's only 30 per 60, which means 60 degrees here, and elevation from ourselves to down there, is going to be only 30 degrees, this is the 30 degrees here, okay? It's a real-time 1-bit, but you can gate to obtain more bits, but it's going to be retrospective, and your elevation on planes, okay? So, regarding the elevation on planes, and that's what we are going to show here, you can have it front, which you can see almost anything, because you are at the surface of the heart, by default, it's in the center, okay? And then you can have it back, okay? Those are the three possibilities that we have over there. And then the elevation, you can actually do lateral, which is going to give you a wider image, okay? So, you have it over there, okay? And then you can actually do it by width or by lateral, okay? So, once we want to gate the image, and that's a perfect example over here, what we normally do when we have 1-bit, and I'm going to post it over here, if you only get 1-bit, you have 60 width, 60 degrees width per 30 degrees elevation now. So, when you get this image here in one single bit, you have a line density. So, imagine that you have 10 cuts of a city scanner over this image. So, that's one bit. So, your frequency is not going to be 70, it's going to be much less, okay? The moment that we actually gate, and we go over here, to actually determine the gating, down there. So, you can gate to 1, 2, 3, 4, 5, and 6-bits. Recommendation as per the American Society of Effectors is to go to 4-bits, okay? And then we have it over there, and then at least 4-bits. So, when you go there, this line is going to get 1-bit, the next bit is going to get the same thing, but then we are only taking, if you are doing, for example, 6-bits, we are dividing this image in 6, and you get the 10 lines in a 6 of the image, then the next 10 lines in another 6 of the image, the next 10 lines in another 6 of the image, like that. So, at the end, you end up having 60 lines instead of 10. So, the quality increased dramatically, and you are right. So, the same thing here, the cuts are much lower, and as you can see here, as part of the video, if you start over here, your frequency is only 18. The moment that we go, and we trigger 2-2, we are increasing to more than 30 hertz, and then if I go to 4, again, it's 53, and then when I go to 6, which is over here, it's up to 70 French. Okay? So, just have that in mind. And then the elevation that they wanted to discuss with you, you have the elevation over here, okay? And that's how much do you want to include from that, depending on what's the structure that you are analyzing. Okay? Those are examples of live 3D. So, again, 60 degrees by 30, so it's ideal for, for example, placing cutters, or guiding, not so good for bulbs, because you can actually get the whole bulb, but the Arctic bulb is a possibility when you are actually putting a guy wire through it. You can use color tool, this one is an X8, with a single bit, you get up to 16 hertz. In color, it's recommended to go up to 15 hertz or more. That will never happen with an X7, and you will need to actually get to get a proper image. So, have this course explained, the live 3D, and we are going to go with the full volume, okay? With the full volume. First thing that you will notice is the sector goes to 90 width, and then elevation is going to go up to 92. So, this is for volume, like the recommendation for full volume is mostly like for big ventricles, like the right ventricle of the left ventricle ideally, okay? It's one bit, but you can always get, okay? And because it's so huge, your frequency is going to actually be decreased compared to the live 3D, okay? So, again, we are going to be able to maximize up to 120 width one, and those nodes are going to be here when you go over there, okay? And you see there are the loops that we are going to go. So, let's just start with this, okay? So, we go through the 4-chamber view. You select the full volume, and the full volume is going to be here. When you press, you get automatically a 4-chamber view, and then the view of the elevational view, which is the equivalent to the 2-chamber view here, you generate this view over here. And again, if you work with the elevational width, so you can actually increase the size of what you are doing, okay? Or decrease the size, depending on the structure, and you can go from side to side, from up to down, and then you optimize very much as much as you want with that, okay? Next thing, if we beat, and we decide to actually increase our quality, again, let's just hold it here, and we have it there. So, we start like that. We are at 1-bit, that's 9-earth, your frequency much lower than the light 3D mode, okay? And then the moment that we go to 2-bits, which is over here, we see how this increase. The same thing happened when we go to the 4-bits. Add a little bit more, which is here, and then 6-bits, which is your maximum, okay? Which is the recommendation. Problem with that is the stitch artifact that you can actually generate. Those are examples of LV full volume. Again, when you have those three images, you can go to the tactile screen, and then select only this image here, if you want. I normally recommend you to have this, so you know you are not foreshortening your Leventicon, for example, a little bit here. You can actually increment your size here, and then you will be able to generate any image like that. And then going through the 3DQA advance, so you are able to generate a 3D ejection fraction of the Leventicon. Another example is for the Leventicon. The subboard is not designed for the Leventicon. You can make a similar assessment for the Leventicon, and choose generate by a strain your fraction area change, and you can actually get here an estimation of the EF, but this is not validated by the guidelines. Another example of full volume, ideally, is when you want to actually assess a valve that is licking, and you want to assess the regurgitation. The recommendation is to go to full volume. You are just going to provide the best definition. And then, same principle, you start with just a simple full volume view, and then you actually place color on the image, and automatically, I would recommend you always, when you do that, to go up to 6 bits. And you can see here this is a X7, and it's basically generating 12 hertz. So you need 6 bits to generate 12 hertz, with the X8 Pro, you were able to generate 16 hertz with a single bit. So that's part of their quality. And with that, you can actually measure your vena contract area here, and up to here, using multiplane reconstruction with QLAV. So, 3D full volume, again, 4 chamber. You don't really, if you are interested in the LB, I will focus on the LB. I will take off the screen this. So the more tissue that you take, the less good it's going to be your image. But this is just as appropriate to show you how that works. So we are getting almost the four structures here, the four chambers, and the two valves. If I can't speed up my trial. So, again, remember, the picture that is showing you is removing this part from here. So you can see the heart, and we got this four chamber view here, removing the part that you have there. So, this is seen from here down, okay? And then when we have it here, that's the image that we are going to be able to generate. So you go here, you select on the tactile screen only this. You put the track down. So you are seeing it from there. You reset your crop, which is here. And then by resetting this, you are adding this piece here, so the anterior part. And then what you got, that's the view that we were getting. So you were only seeing the heart from here. And then what we generate, okay? Your tachaspid, your mitral, your pulmonic, and your aortic, and you can see the four valves from the atrium into the ventricles, okay? So go there, select from the three icons, only one, which is the 3D image. Use the track bone, bring it down. So you are looking from the atrium now, and then rotate until you put this with the aortic valve looking north. And then you can actually arrange yourself and get the whole structures of the heart. Okay, the last 3D mode that we have in the Phillips is the 3D zoom. It's very recommended for mitral or trackaspid valve. You can use it for the aortic valve too. Okay, so you go there, that's the 3D zoom. You press, you have a region of interest. Just pressing the track bone with the left side knob. You can actually move the position of the box or already use the size. So position and size, and then you use the track bone to actually do that. And then you have to click knobs here, and the action that you are making should actually be prompted here under the screen, okay? So this is an example of a 3D zoom of an aortic valve, which is ideal. For example, in this case a bicaspid valve, which has a little roughly between the left and the right coronary casp. And we know that because this is the intratial septum. Okay, so we know this is the non-coronary casp. This is the right and this is the left. You can put color on it. And this is actually taken from here, okay? So this is taken from the long axis. Automatically generates a short axis view. And the view here and then you can use and manipulate the image that you are getting. To understand a little bit better the 3D zoom, okay, we already talked about this little sector here. So what we are going to generate, okay, is this little sector here. And we have it. Okay, the moment that we have it, this is for the front chamber. This is the elevation with how much we are taking. I recommend you to take the hole. So increase your elevation up to getting everything. Normally it's recommended to get up to the left atrial appendix. So you can orient yourself. And then when you see it, you are trained to get this view here with the artic valve on top. So how do we do that? So recommendation when we do this is you're going to get just the image of the mitral valve from the side. So you track down your bone. You rotate, set, you put it up. And then you have your artic valve on top and you generate this view of the mitral valve left atrial appendix, tricuspid and pulmonic. And in this case, specifically, I think everyone can see here that there is a little prolapse on P2. And those are the scallops of the mitral valve we are using 3D zoom. So that was the introduction for the Felix Epic 7. So now we are going to talk a little bit on how to manage the GBB9. It's not the last model like, but it's the one that we have as backup in VR. So I think it's important for you to know how to do it. So, and again, that's how the console looks like, the video monitor. This is like the tactile screen. And then you have your knobs and panel control over here. And the model is going to be explained in the same way. Okay. So the first thing, we are going to do the same, exactly the same thing. Okay. Whenever we are doing a 3D image, the G is actually the same. Optimize your focus, optimize your cane. So here is where you're going to find the focus. And you have it there. Focus on the mitral, focus on the LB, focus on the tachaspid, wherever you want to go. And then when you're going to actually go to the cane, is the 2D knob here. And then you can actually increase to the right to the left to know how much you are actually getting there. Okay. So the next thing is the first mode. So this is called MULT-TD, which is the equivalent to the X-Plane in Philips. Okay. So let's just go ahead and just did a little video on how to do that. So we have it there. MULT-TD, you have the knob. And again, 90 degrees from the 4-chamber view, anterior, inferior wall. And then you generate this. Ideally recommended for guidance, for catheter placements, or lectures to see both views of the left ventricle simultaneously, or of the mitral valve, of the aortic valve. But most of this technology is used for for advancing catheters, mitra clips. Okay. Those are examples of MULT-TD, of the right ventricle using the G machine. And now the second 3D mode that we can use in the G is the bird's eye. So again, it's a little bit different. That will be probably the equivalent to the equivalent to the live 3D. The size of the 3D dataset that we're going to generate is small, it's very small, but it has only 10 degrees of elevational width, which it gives you like high spatial and temporal resolution. That's good. It's normally made for one-beat acquisition and you can actually have the elevational plane on the front, on the center, or on the back of the heart, depending on what you want to do. So for the bird's eye, the problem is it's so thin that normally, like whenever you go more deep than 10 degrees from your image, from your pyramid block, you are not able to actually be able to see a catheter or anything. And then the yellow arrow is showing you where you are actually looking at. And from where? And again, the elevational can be center and then you have back, front, and if none of those are selected, by default, it's center, okay? And you have it there, the same thing. And you see how the image changes, depending on what you are passing here. So another important thing, and you're going to watch it now, from those modes, it's the multi-beat button. So when you press it, we are going to gate. So instead of one bit, you're going to go to two, to six bits, and then the quality of the image actually increases. But again, the same problem that we will have, those second, third, and four bits are going to be retrospectively acquired. And despite that you increase your frame rate, the main problem that you're going to face is the possibility of a steep artifact. So you always need to actually switch off the vent. Before doing that, and you definitely need the patient to be still if you can switch off the vent and then be sure that the surgeon is not moving the patient. Those are examples of beer tie. So you see it's only like 10 degrees of elevation on here, of elevation, only 10 degrees, and up to 50 instead of 30, okay? That's our right ventricle. So the next mode is the medium, large volume. So this will be the equivalent to the full volume. But the advantage is like medium is a little decreased actor, which is the example that we are going to put here. It's 35 per 35, and the latch is 60 per 60. While in the Philips, the large is 90 per 90. So let me just play the video here so you guys can see how that works. Medium volume or large volume is going to be selected. In this case, we select medium. So it's going to be 35 per 35. And you see that you barely can see the mitral valve with those volumes, okay? The moment that you select the large, so the mitral valve is coming in view because it's 60 per 60, which is more appropriate. Maybe the arctic valve 35 or 35, you can actually do it. And then again, with this function, which is the delimitional. So you can actually increase how much you want to actually increase your image, okay? And again, once you get the image, you can always bit and acquire retrospectively up to four bits, a minimum of four bits, which is the recommendation, okay? To increase the quality of your image. And you see how this image is much better with four bits than the one that we were getting with one bit before. Okay, those are examples of medium volume acquisitions, as was telling you, 35 per 35 is normally better to actually catch. It's compatible to being able to actually get the whole arctic valve in view. You can even do, like depending on the software that you have in your GE, you can definitely do the calculation of the route. I don't think how important is that for us because it's measuring it in mid-systole. And we know like the route, the LBOT diameter and the annular system mid-systole, but the sinotubular junction, sinosapal salva, and the astandina art needs to be measuring in diastole. So you can generate this model and you can generate an area. So I think this is important for like if you are doing a tabby to assess the area in real time. But other than that, I don't see any other other functionality. So when you go to a larger volume, it's normally recommended to get the whole ventricle inside. And again, you will actually be able to generate a 3D EF with the end diastolic and systolic stroke volume on cardiac output. So if you use the right ventricle, GE has a contract with Tontem so you can generate with this package automatically in 30 seconds just positioning here, here, here and some other views that are a little bit different from over there. So you can generate this model here and you will automatically get your TAPC, your fraction air change, your reaction fraction and your end diastolic and systolic volumes plus the dimensions, which is very handy. But again, Phillips has a Purchase Tontem so probably we are going to be seeing that in the new Phillips machine very soon. So we have discussed the multi-D, the bird's view, the medium to large volumes and then the 4D. So the 4D is going to be the equivalent to the 3D zoom from Phillips. Okay, and basically what it's going to do, you go there, you have a 3D preparation and it's basically the same thing. Region of interest, you select the size and the position of it. And then when you're happy with the position, always we are going to be seeing it from here so I recommend to go as close to the valve as you can, including those things up to here and up to here. So you can arrange yourself a little bit and then once you are happy with it, you can actually see size and position. Okay, and then once you're happy, the thing that you can generate is something like that, okay. So this again, the arrow indicates where are you seeing this. Okay, monitor valve, LSD, or the valve on top. You can use the same thing with color, a little bit different compared to the Phillips, but basically the same objective. So what can we do with those 3D things? So some examples. So for example, it's important if you go for a tower, as we can see in the example here, you can measure the annulus of the RT-12 in mid-systole. You can use your X-plane to be sure that you are cutting because the annulus should be measured where, so it should be measured here, okay. So as we know, this is the non-cornering, the right and the left. So between the non and the left in the middle and in the middle of the RCA, that's where you should actually measure. So probably this using X-plane, you know for sure where you are cutting. Here is a guess because it's 2D. When you can go there, do multiplane reconstruction. So you take a 3D image of this, you go to 3DQ and then here you measure and automatically will give you the diameter by 3D or it will give you the LBOT area directly. For example, for calculations of RT-walt-vestinosis. Another example is the possibility of doing planimetry of the mitraval to estimate mitraval-vestinosis. Level one indication is to do it by pressure halftime of planimetry when it's a lot of calculation. Pressure halftime is probably the best option, but if you have concomitant, moderate RT-recogitation or severe, it's not accurate. So then you can go to get a 3D image of the mitraval, go on multiplane reconstruction, green, red and blue plane and then trace the area. And this is compatible with severe mitra-vestinosis. Another thing that is commonly used is for an ASD. So you can go there, you can see the color, you can do two multiplane reconstruction again, measure the size and then get an accuracy with accuracy what is going to be the shape and the distance of this area to actually select which sample actual device is going to be better to actually close this ASD. So we are going to finish the 3D lecture with a 3D strain. So again, I recommend you to go to the American Society of Technical Beginners' Guide to Strain, which was actually from one of the meetings that I actually attended in the echo classes from the ASC. So basically what is a strain? So a strain is the deformation from an applied force. You have here a very good example, okay, and the definition of a strain is going to be so between the length at a given point in time, which is your L1, okay, and the baseline of length. So if you have your heart, which is when we start, and then with systole, it gets smaller. So what we are going to do is we are going to get this dimension and I'm going to put an example. Imagine this is 5 centimeters and this is the standard one, which is 10 centimeters. So you are at 10 centimeters, you go to systole, and then you compress it up to 5 centimeters of 5 minus 10 divided by 10, which is the original distance, which gives you a 50% decrease, okay. So to understand this better, it's how do we measure this? So we are measuring by a speckle tracking. So you go, you take a small section of the monocardion and you have it there, and you take a speckle here. So the speckle goes between systole and diastole, and it moves from one place to the other. So the machine calculates from one to the other. So you have the tool and then it moves, and it moves and it calculates how much it moves. So types of strain, we have longitudinal. That's the one that we are always going to be assessing in our eco machine. You have circumferential and you have radial. We are only assessing the longitudinal because it's the one that is associated with the outcomes in cardiac surgery and in cardiac patients. Circumferential and radial. So longitudinal, so it goes from up and I'm going to post this here. So you have a starting and then when you get the systole, so it gets a shrink. So it's shortening. So the longitudinal is always going to be negative. Okay, the more negative, the better. So there's your circumferential strain, which we have here. Okay, so that's the one that is apparently coming down as you compress and then it's how it goes smaller when you go down. So this one actually is going to be negative too during systole. I know it's always going to be measured in systole. And the last one is the radial, which is positive because during contraction it's going to be thick. Normal values, the important one that you need to remember is anything more negative than minus 20 is going to be normal. Anything that is bigger than minus 20, minus 10, minus five, is going to be abnormal. Circumferential radial has different values, but the ones that we are going to be measuring here is the longitudinal strain. Okay, so first thing, if you want with the Philips and the LB function, you have the four chamber view, the two chamber view, and the long axis view of the RT valve. So you include the whole identical. You focus on that. You have a little square here that I want you to select. Once you have a quieter image, a quieter image, a quieter image, so you freeze, you select, select, select, then you go to the chamber motion quantification on the tactile screen. And then after that, you go there and you replace your points. So they are going to ask you for the mitral valve base, and then the apex, same thing here and here, same thing here and here. You will go one by one, okay? In the order that you have, select those little squares here. So normally it starts AP, AP cal 4, which is the keyvalent for us, which is the four chamber view for TE. So you select there, okay? And you have it there. The AP 2, which is the AP cal 2, and then you have AP 3. And then remember the marker here, don't go from the base of the matter, because then you will include the RT canal, you need to go to the base of the septum, okay? Once you get the three of them, you accept, accept, accept, accept, and then you will go to global results that is going to be on the top of the screen and looks for the bullseye. So what you do is, for example, that's a four chamber view, so you're generated, you put here, here, and here your markers, you accept, and then it's giving you a minus 20.3%, okay? Which is the average. So this is the peak, segment and straining match of the four chamber view, okay? Which the machine is going to call it AP 4, and then this is the color and color of the region of interest. And automatically it gives you an ejection fraction and then the acetylic and ansiastolic volume, okay? This is an example of a strain in the two chamber view, so pointer here, pointing here, pointing here, and then you click, it will give you that, and automatically accept, you're happy with the tracing, and then you have minus 27%, and again, and the acetylic and ansiastolic, and the ejection fraction. So here, okay, so this is diastolic, this is systolic, so the segments should shrink and get more, the more shrink it gets, the better. You just start to see segments that come up here up during systolic, those are these kinetics, and not shrinking on the opposite, they are actually getting longer. So this is another way of actually assessing your strain here. This is an example of a long axis view strain, okay, and then you have it here, and when you finish and you do three of them, you go to global results, and what happens is this, so you will generate automatically an ejection fraction by plane, you can see the whole 17 segments, red is good, red means shrink, and then you have the classification here, blue is bad, blue means that less is shrinking, and even increasing in size, and then you get by biplane, 76.1% in this case. This is a normal case of a strain, that there are normal cases of a strain, as you can see here, all these segments they suppose in diastole to be up here, the maximum diameter, and then decrease, and then increase, and as you can see in both examples here, here and here, they are all over the place, you can see a lot of blue, because instead of actually shrinking, instead of going actually smaller, they actually go up during systole, which when you go to the results, and you have it here, 42%, 42.4%, and then you go to global results, and as you can see here, all these sections here in systole, they are actually increasing inside, there are these kinetic, same thing with the little tip of the apex, and the only working sections are probably over here, here, a little bit over here. So, right ventricle. So, the thing with the right ventricle is that the strain is defined, is actually designed for the LV, but there are validation of, there are validations of the right ventricle, of the left ventricle strain used for LV. There are many, many papers on that. So, you go to the modify for chamber, okay, and I'm going to show you which one it is, and then you go to chamber motion quantification again. So, for chamber, you tilt the probe towards the right of the patient, you generate an image like that, and then once you get a good image with no stitching, so you acquire the image, you freeze, you select the image afterwards, and you go to chamber motion quantification. Once you're there, you select AP3. It's the one that works better to recognize the right ventricle, rather than AP4, which is the for chamber, okay, and you place the markers. When you place the markers, you have there, there. Normally, you're going to generate something like that. As you can see, this normally is a little bit more, and then you need to adjust this. You can actually click here on those points and bring them a little bit more interior, and then you can actually click here and make this thinner. So, the recommendation is to take this at the level of dendocardium and not increase, not make it very big. So, you want actually to stick the myocardium if you can over there, with dendocardium in those lines. So, once you have it over there, you accept, and once you accept, you get something like that. In this case, you're going to get the six elements. The recommendation is not to take the interventricular septum, because it's mostly related to LB function. So, what you can go here is when you go here, you press the right knob of the trackball, and then it will automatically gives you a non-value, and then you can actually just focus on those three. But then the percentage is not going to show up here, because it's designed to actually get it from the six segments. You will need to do it manually. So, this has an R.84 agreement with MRI for function and for predicted outcomes. And it's well-validated. So, when we use the G string, what we are going to find is we have the modified 4-chamber again. So, you select the same picture that you were able to get. You acquire the image, then you select the image, and the next thing that we are going to go is go to measures, and go to AFI, which is Automated Function Imaging. When you go to AFI, you go to the long parasternal axis, and then once you get it over there, you have select this point, this point here, and this point here. When you have it there, you place the points, and then you wait, and automatically the machine will actually take two, three seconds, so you need to be patient. And then after that stone, what is going to generate is this. Okay, this is the color and color region of interest. This is the pixel mental strain, and it's going to give you that. And again, you're going to get a value here. It's from the six segments. You want only pay attention to those three areas here. Okay. And then the segmental region of strain curves, again the same system, all the segments coming down and down. Then you are able to generate a curve anatomical color and mode too. So that was the lecture for today. And I hope you guys have enjoyed it. And if you have any questions, feel free to actually send me an email or just text me. I will be happy to answer your questions. Thanks. Bye.