Chison Q9 4D Imaging: Ultrasound Training Bonus Chapter
May 20, 2015 by Brian Gill
4D Imaging Tutorial on the Chison Q9
In this final installment of the Chison Q9 Training Video Series, you’ll learn how to operate the machine in 4D mode, and learn some tips about getting the best 4D ultrasound image.
For a more in-depth tutorial on learning how to create great 4D ultrasound images, see our training library.
Links to all parts of the series can be found below the video.
Part 1: Chison Q9 System Introduction & Overview
Part 2: 2D Imaging & Optimization
Part 3: Doppler & M-Mode
Part 4: Measurements & Annotations
Part 5: Review & Save Images
Part 6: Exam Review & Export
Part 7: System Customization
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Transcript to 4D Ultrasound Video Training on the Chison Q9:
4D imagining on the Chison Q9. First you’re going to want to choose your proper OB preset.
Most the time, you’ll want to choose mid pregnancy preset for any fetus after its first trimester. This is great for 22 to all the way up to the full pregnancy. You can choose late pregnancy and try that as well, but right now I’m just going to use the mid pregnancy because that’s what I would use most of the time.
I’ll double-click to enter it and go to my 2D image. Now in order to get a great 4D image, you have to get a good 2D image first. And this on 40, if you want to get baby’s face, that nose needs to be pointing up. If you get something of the side of the face, what you’re going to end up with is a 4D image of the side of the baby’s face.
So if I don’t see that nose pointing up, what I’m going to get– and I’ll show you when I to go into 4D– and I’ll show you this is just a moment– negative 4D image of the profile of the baby’s face. And that’s not what I’m looking for. I want to get the full baby’s face. In order to do that– we’ll go back to 2D here– I want to make sure that that baby’s nose is pointing up. And here I have it. So once I have that, I’m ready to go into 4D imaging.
First thing I do is press 4D. And I’m not ready to go live yet. What I have here is a region-of-interest box. I can use the trackball to move it around. And what I’m looking at in this region-of-interest box or the ROI or whatever you might see– it will come up with this box and this green line is going to say, I’m going to keep anything below this green line. Anything above it, I’m going to delete from the image.
So it’s only going to show me anything within these yellow parameters and this green line coming across the top. If I don’t, and I have the green line down, and I going into live view, I’m going to be cutting off part of the baby’s face. As you’ll see, this green line cuts it off here. If I move it down even more it’s completely cutting off the face.
So I really want to make sure that green line is above the baby’s face. And the purpose of that is to cut out any obstructions up here. You might see a placenta, a uterus, or anything else, could be umbilical cord in front of the face that you do not want to show as part of whatever it is you’re looking at, in this case the baby’s face. So you want to get this as close as possible between the baby’s face and any other obstruction.
Next you want to use what’s called the curve. This green line can also be bent. So if I hit it, it’ll turn to a dash line and I can move it up and down to kind of curve it around or conform to anything that might be obstructing the baby’s face so I can get right in between the placenta or whatever. And I can move that green dot to change it. There, to really make sure I get just the baby’s face and nothing else in between.
Also note, however, that if there is an arm, a foot, or something with a bone in it, that is above the baby’s face, you’ll see dark lines coming down the screen. There’s really no way to avoid that. The reason is, is that ultrasound can’t see through bone. The bone just reflects all those ultrasound waves back. And what it’s going to create is a shadow on the face.
So when you have that and you go into 4D, you’ll see that half the baby’s face is missing into this just dark area. So if you have a foot, an arm, or anything in front of the face, chances of you getting a good image are slim. And at that point, what you might want to do is move your region-of-interest box above that arm so you can actually see the arm in front of the face, because sometimes you’ll get a thumb sucking or something of that sort that looks actually pretty cool.
But otherwise, you want to change mom’s position or wait and see if the baby moves around and gets that arm or foot or whatever obstruction [? part of the ?] face. Also, if there’s cord on the face, it will show up as part of the face. And it kind of gives a strange look to the face, so you want to let them know that is the umbilical cord things and it’s not a deformation, typically of the baby’s face.
So once we have that– I’ve got my green line and I’m happy with what I’ve got. I’ve got my nose pointing up and I’m ready to go to 4D, I’ll press this live key here. And this takes me into a split screen view that shows me my 2D image alongside by 4D image.
This blue dot here represents the very middle of the image. So that is showing this 2D portion of the image right here. So if I move back and forth, you’ll see the middle of the image here, showing the baby’s face. If I scroll over, it’s black because there’s nothing here in my 2D image to show that part of the baby’s face. So I want to make sure I keep that in the middle and keep that line right there.
Sometimes you’ll see, that when you go into 4D, the baby will actually be upside down and will show up like this. In that case this direction set is what you want to switch to either 90 or 180 degrees to get the baby upright. And also, if it’s upside down, you may not recognize what it is you’re looking at. So if you don’t see what you’re seeing– what you think you should be seeing– try flipping that upside down and see if you can catch the baby’s face in there at that point. Now once I have this and I know I’m ready to go, I can go to a full screen image by clicking here.
I can always go back to that double screen image by clicking here. I want that full screen image, I’ve got it upright, and now I want to make some changes to the image to make it look the way I want it to look. The default may have the depth view. I prefer the surface view, which gives you that sepia tone that you’re so used to seeing in all the 4D imaging. Next I may want to change my bias.
I’ll press this arrow key to get my pointer up. If I adjust this bias, it brightens up my image a little bit and makes it look a little better. You may find that it’s too bright, so you’ll want to set that to your own preferences as to what you like to see. Next you’ll look at the threshold here. And this will make your image very bright or very, very dark.
What the threshold does– and I found that the default setting works pretty well– is it basically say, how much of the image do you want to see? When there’s a lot of artifacts in the image or a lot of gray dots when you’re back in that 2D image, and you turn the threshold up high, it’s going to show all those dots and give you a fuzzy image. Now if you turn it too low, you’re only going to get very, very strong echoic signals. And that’s going to show you just the baby’s face. You might lose eyes, you might lose part of the mouth.
So you want to find a balance and it’s very subjective as to what you want to see. You want to find a balance in between there where you get the best image. You may find that the default works, or you may find that the default does not work. You also have virtual HD option. To turn it on, I’m going to press down here. And now, I have what’s called virtual HD, which is supposed to be a more realistic image of the baby.
What this does is it provides a virtual light source. Right now, this blue dot represents a light source coming from the right side I can move this light source around by pushing down here. And you’ll see the light is here. Now it’s up here and you’ll see how that affects the baby’s face. Now it’s up here and the shadows now come down from that side.
Here now comes from the other side. And you can make your adjustments around this way to show how that light source affects the baby’s face in various ways. Now you may or may not change the dynamic range. This is something you probably don’t want to mess with a whole lot. It will change how the image appears– either very soft or very grainy. But typically, you don’t want to do that. If you want to change your frame rate to something faster, you’ll push this key here and it’ll go to a fast frame rate where you’ll get a lot more images on the baby.
But it’s going to reduce your imaging quality. We’re going to go ahead and turn off the virtual HD and put my frame rate back to normal. So once I’ve seen what I like to see, I’m going to hit freeze. And now I can go to the C loop scroll. It may allow you to do it immediately or it may pull up this pointer here. You want to push this pointer button down and now I can use the trackball to scroll back through the image.
And if I get an image that I like, I’ll press the Save key and it will appear over here in the clipboard. If I want to save that entire clip, it shows me that I have 11 frames here. I’ll press this Clip Save, and now that’s going to show up here as that entire clip. If I have my pointer active, I can go over, press Enter, and it’s going to show me this clip and play the clip that I just saved.
And once I have those images that I like, I can export those, which are in a previous movie in the training series, put them on a USB drive or export them to whatever media I may want to export. And that’s the 4D training on the Chison Q9 Ultrasound Machine. Thank you for watching.