The Script of ZST + Presentation. MIS Upstream Marketing Team [ 日期 ]

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1 1 The Script of ZST + Presentation MIS Upstream Marketing Team [ 日期 ] 1

The Script of ZST + Presentation Since Mindray was founded to develop ultrasound business, core technology has always been the engine to drive the innovations and improvements for our products, and

In 2013, minday has acquired Zonare company, well known as the founder of Zone Sonography Technology (ZST), based in Silicon Valley.

2 The Script of ZST + Presentation Since Mindray was founded to develop ultrasound business, core technology has always been the engine to drive the innovations and improvements for our products, and that is also the most important factor to make Mindray stand on the top tiers in ultrasound industry. In 2013, minday has acquired Zonare company, well known as the founder of Zone Sonography Technology (ZST), based in Silicon Valley. Within 2-year development, through the cross-ocean cooperation between United State and China, all the scientists and engineers have worked together to make another great jump from ZST to ZST +. Today, such presentation will appear all the answers for ZST + from such four parts: 1. Why ZONE Sonography 2. What is ZONE Sonography 3. Key Pillars of ZST + platform 4. Evolution of ZONE Sonography First of all, let us review the development of real-time ultrasound development. Starting from 1960s, the ultrasound modality was firstly used for diagnosis. At that time, the system was scanning by mechanical approach, instead of electronic method, meanwhile the focusing way is to use single TX focus and single RX focus. 2

3 The representative systems are Vidson of Siemens, and sector scan of Kretz. Coming into second stage, electronic technology was applied in ultrasound modality completely. During this period, the ultrasound system, designed with analog circuit, was to scan electronically as line by line way. And the focusing approach was changed to fixed TX focus and sectionalized RX focus. The 3 rd stage for real-time ultrasound was well famous as digital technology used in system, meanwhile digital beamformer was used to design system architecture, which was a big jump for ultrasound modality, because the focusing way has been changed further, which meant sectionalized transmission focus and continuous focus were firstly becoming reality. Undoubtedly continuous receiving focus was the most important progress at that time, improving resolution greatly. During 3 rd stage, the most famous machine was Sequoia 512, and even today, it was always thought as the best machine in ultrasound industry in the past 20 years. Why dose no one machine can surpass Sequoia since it faced out 10 years ago? 3

4 Let us disclose today s ultrasound limitations and challenges coming from digital beam formation. The first challenge is the trading off between three key parameters for ultrasound, and they are spatial resolution, temporal resolution and tissue uniformity, standardizing for assessing image quality. Unfortunately these three key factors are tightly linked and compromised with each other. To improve spatial resolution, the system is common to increase transmission lines, but it has to decrease temporal resolution. As to increase uniformity, it is regular to transmit by multi focusing, but the temporal resolution (frame rate) will also be decreased simultaneously. 4

The 2 nd challenge is referring to the bottleneck of resolution. It is well known that resolution is the most important factor affecting imaging quality, but it has had two great barriers.

5 The 2 nd challenge is referring to the bottleneck of resolution. It is well known that resolution is the most important factor affecting imaging quality, but it has had two great barriers. The first aspect is that resolution can not be improved obviously, as increasing physical channels infinitely, especially when the channel arrives at 128ch. The other aspect is referring to frequency. Due to the principle of ultrasound, the frequency and penetration are the couples for contradiction. However, regarding to a practical scanning for doctors, an enough penetration must be taken into consideration. So the biggest issue is that current system can not improve resolution further more at specific frequency when penetration is satisfied. The challenges in ultrasound industry, are the drive for innovating to break the previous architecture and design. In 2004, ZONE Sonography technology, invented by Zonare, has opened a new landscape for ultrasound industry. Historically, both continuous transmission focus and receive focus have firstly become reality. The most important contribution is to realize continuous transmission focus, totally changing the previous approach. It is definitely initiating another revolution in ultrasound industry. That is the definition of ZONE Sonography, which significantly transfers three key messages for ultrasound industry, revolutionary, software-driven, and channel data. 5

In 2011, Frost & Sullivan, one authority medical consultant company, has given a much high appraise that Sonography is the next industry standard method of generating ultrasound images, two

6 In 2011, Frost & Sullivan, one authority medical consultant company, has given a much high appraise that Sonography is the next industry standard method of generating ultrasound images, two generations ahead of traditional digital beam formation technology. In addition, two Germany customers, experienced ZONE Sonography technology, have also given much high comments for such technology, as it has greatly changed and improved doctors daily work. Based on so much high comments, let us disclose the differences for the architecture design,between traditional beamformer and ZONE Sonography. 6

storing complete original echoes, and one software-driven processer for synthesizing final images.

7 The two kinds of architecture are totally different. As to the architecture design, the traditional beamformer is based on hardware beamformer without storage memory before beam forming, while ZONE Sonography has designed one channel data memory for storing complete original echoes, and one software-driven processer for synthesizing final images. As to the processing, showed by the animation illustration, traditional beamformer has created images as line-by-line approach, meanwhile discarding more than 90% echo signal. In contrast for ZONE Sonography process, all the received signal has been stored in channel data memory completely, and then forming one image based on software-driven processing. ZONE Sonography architecture has resulted in revolutionary improvements as following 4 aspects: 1. Acquisition time: line-by-line acquisition vs ZONES, 10 times faster 2. Beamformer design: hardware-based beamformer without flexible upgrade vs software-based beamformer with flexibility 3. Focusing approach: limited focal depth and number vs full field of view focus 4. Sound speed: assumed speed 1540m/s vs sound speed compensation based on 7

8 different tissues Depend on ZONE Sonography innovative technology, combining ZONARE and Mindray scientists and engineers collaboration, a premium, innovative and evolving platform, ZST +, is born to break the ultrasound barriers. The structure of ZST + platform can be summarized as 4 core pillars and 2 cornerstones, which also refers to plus meanings. The first pillar is advance acoustic acquisition, which means to extract more information from each acquisition, by transmitting and receiving relatively smaller number of larger zones, 10 times faster than conventional line-by-line beam forming 8

$acquisition only cost a small fraction of time, as leaving much time available for advanced modes.$

9 methods. As comparison animations between conventional and advance acoustic acquisition displaying, it is obvious that conventional way has spent a lot of time for forming one frame, while advanced acoustic acquisition only cost a small fraction of time, as leaving much time available for advanced modes. It is quite important for the left time by advanced acoustic acquisition, because such time can be used for optimizing image quality like B mode IQ, well-balancing mixed mode IQ like B+C or B+C+PW/CW, and increasing frame rate, especially for 3D/4D volume rate or fetal heart imaging. As to the fast acquisition, it is easy to understand to take one example as photograph. One slow shutter speed leads to motion artifacts on waterfall, while fast shutter speed decreases such moving artifacts as much as possible. In a summary for clinical benefits: 1. Extremely fast and accurate display 2. Reduce tissue motion artifact 3. Well balance across all ultrasound modes in different types of patients 9

Coming to 2nd pillar of dynamic pixel focusing (DPF), it is related with focusing approach. The animation illustrates the method to improve tissue uniformity by focusing.

With channel data, DPF can achieve the most precise pixel focusing from skin to deepest depth, by phase alignment (time delaying) and coherent synthesis (synthesizing)

10 Coming to 2nd pillar of dynamic pixel focusing (DPF), it is related with focusing approach. The animation illustrates the method to improve tissue uniformity by focusing. The left one, conventional way, displays to realize uniform by using multi-focus, from near field to far field, but sacrificing frame rate greatly. With channel data, DPF can achieve the most precise pixel focusing from skin to deepest depth, by phase alignment (time delaying) and coherent synthesis (synthesizing) algorithms, within just one zone transmission. The below slices will take a series of photograph as an example. This picture does not use a correct focus setting, so the image is too much fuzzy. 10

With another focus in near field, more information appears in picture, but it is still difficult to achieve the

11 As increasing one focus point in far field, the clarity has been improved just in focus area, but other parts keep as fuzzy as the previous picture. With another focus in near field, more information appears in picture, but it is still difficult to achieve the whole field of view. Through Dynamic Pixel Focusing (DPF), the picture has an amazing uniformity in the whole field of view, and even another deer within tree branches displays on such photo. 11

That is the very incredible DPF, leading to the obvious improvements on image quality. How to realize focusing pixel-by-pixel? The answer is in the following slices.

First is to capture acoustic channel data by a few number of large zones, which contains the complete original acoustic information coming from each channel 2.

12 That is the very incredible DPF, leading to the obvious improvements on image quality. How to realize focusing pixel-by-pixel? The answer is in the following slices. Generally speaking, the system has followed these three steps: 1. First is to capture acoustic channel data by a few number of large zones, which contains the complete original acoustic information coming from each channel 2. Second: Phase alignment (time delay) is to make the received channel data in the same phase on every overlapping pixel, which is the precondition for coherent synthesis 3. Third step: after phase alignment on each overlapping pixels, the processor can realize synthesis and construction on each pixel by both amplitude and phase information Further more, Phase alignment (time delay) is to make received echo data in the same phase on overlapping points Coherent synthesis (synthesizing or compounding) is referring to synthesizing each pixel by overlapping points with both amplitude and phase signal Finally, every pixel from each time slots is coherently synthesized, focusing on time slots. 12

DPF has been proved by both phantom and real clinical images.

is formed with specific focus setting on 7 cm, more clutters around the pins are obvious in the far field.

Definitely, the right one has a nearly perfect uniformity from near field to far field, especially an incredible

13 DPF has been proved by both phantom and real clinical images. Comparison between the two ultrasound images scanning on the same phantom is a best answer to show: The left one image is formed with specific focus setting on 7 cm, more clutters around the pins are obvious in the far field. The right one is scanned with dynamic pixel focusing. Definitely, the right one has a nearly perfect uniformity from near field to far field, especially an incredible detailed resolution in the far field, which should be quite valuable on abdomen application. With the dynamic pixel focus of ZST +, you can experience superb tissue uniformity from near to far field. The entire image is in focus with excellent homogeneity. 13

You can clearly observe and easily distinguish a series of complicated structures on the left image, such as liver, pancreas, abdomen aorta, IVC from skin to deepest depth.

The third pillar is sound speed compensation, retrospectively processing channel data with various sound speed and acquiring the optimal tissue-specific image adaptively Conventional system has

14 You can clearly observe and easily distinguish a series of complicated structures on the left image, such as liver, pancreas, abdomen aorta, IVC from skin to deepest depth. On the right image, also for the spontaneous blood flow in IVC (Inferior vena cava). The third pillar is sound speed compensation, retrospectively processing channel data with various sound speed and acquiring the optimal tissue-specific image adaptively Conventional system has assumed one specific sound speed at 1540m/s, but in fact different tissue has different speed propagation, which means ultrasound has always used a not precise sound speed for image formation in a long history. From now on, ZST + has corrected image formation method with adaptive sound speed. There are two key steps for SSC processing 1 st step: SSC is based on the received complete channel data for forming images retrospectively at different sound speed 2 nd step: The processor will make an intelligent decision to select one best image fitting with specific tissue sound propagation instead of 1540m/s and displaying on screen Obviously, the assumed sound speed at 1540m/s forms a worse lateral resolution on the left one, while by SSC optimization at 1480m/s providing a better lateral resolution. Also on the clinical image, SSC improves the penetration, especially for fatty liver. 14

15 Spatial resolution with more detail information is clearly improved in the whole field. Both the portal vein and hepatic vein are visualized with much better clarity, and you can also see the liver capsule has been better defined with penetration improvement The forth pillar is total recall imaging, which refers to allowing system to do retrospective processing on channel data and also permits user to modify numerous imaging parameters on stored images to optimize clinical information. As mentioned before, Channel data is an entire frame of original echo data received by each transmission with each channel. Channel data stored in memory can be reprocessed multiply and retrospectively by digital processor with different algorithms In the other hand, based on channel data image formation, the final images stored in cine memory also have much capability for post-processing to eliminate the repeat scanning The clinical benefits for total recall imaging has two aspects, one is coming from channel data, and the other is stored images. For channel data, it enables system do the retrospective processing and gives the potential of off-boarding capabilities for extended research in the future. For stored images, it is also able to optimize parameters for post scanning, and also 15

aspects: One is powerful processing architecture, mainly focusing on cutting-edge design and hardware devices.

16 eliminates repeat scanning. All is the core pillars for ZST +. Besides four pillars, ZST + has also been evolved based on ZONE Sonography. One is the powerful processing architecture, the other is enhanced channel data processing In a summary, evolution of ZONE Sonography can be answered from two aspects: One is powerful processing architecture, mainly focusing on cutting-edge design and hardware devices. The other aspect is enhanced channel data processing, including latest innovative technologies such as HD Scope, coherent spatial synthesis etc., improved sound speed compensation and great progress on 3D/4D, C-Plane imaging etc.. 16

In one image, there are various kinds of tissues such as muscle, fat, blood and so on.

17 HD Scope is one of the outstanding evolved technology based on channel data. With channel data, HD Scope has reprocessed multiply and retrospectively to improve the detail information and image contrast on specific area maximally. In one image, there are various kinds of tissues such as muscle, fat, blood and so on. Some lesion and interest target is just located on a specific area, commonly quite different from the surrounding tissues. How to distinguish the target obviously is the concerning for doctors. Based on the complete channel data, HD Scope can make enhancement on such specific area with a series of algorithms on interest area like tumor or mass dedicatedly. Finally, by compounding all the enhanced results together, the image quality on ROI is to optimize maximally. Just looking at the clip, such thyroid has a small mass inside, but it is not clear and even difficult to differentiate the border and detail on the right image. With HD Scope on the left window, it is much more confident to distinguish the size, the boundary, even the structure and detail inside. 17

Coherent spatial synthesis is another innovative technology based on channel data to coherently synthesize each pixel from multiple-angle transmission to further improve image quality.

Finally every point is synthesized coherently with both amplitude and phase signal, instead of conventional way only compounding amplitude signal and the finalized images have shown much more precise

18 Coherent spatial synthesis is another innovative technology based on channel data to coherently synthesize each pixel from multiple-angle transmission to further improve image quality. By multiple transmission with different angles, the complete acoustic data is received and stored in channel memory with both amplitude and phase information. Finally every point is synthesized coherently with both amplitude and phase signal, instead of conventional way only compounding amplitude signal and the finalized images have shown much more precise information, especially on contrast resolution. It is obviously showed that the right one with coherent spatial synthesis has a much better performance on lateral and contrast resolution. As CSS has taken more 50% information than conventional compounding way, with both amplitude and phase signal from multi-angle transmission, the contrast resolution for each target, has been improved significantly. 18

19 Turning back to the challenges mentioned at the beginning. With advanced acoustic acquisition and dynamic pixel focusing, these three parameters are decoupled and increased simultaneously. As to the bottleneck of resolution, channel data and HD Scope have given almost perfect solutions. With channel data processing, receiving beam is no longer limited by transmission. To some extent, the resolution is not tightly dependent on number of physical channel, so the resolution has been improved obviously up to 38% increasing on the same physical channel machine. Meanwhile HD Scope can also realize to increase resolution on specific area as keeping the same level for frequency. That is the story for ZONE Sonography technology plus, revolutionary sonography and industrial milestone. 19

Resona 6 Premium Ultrasound System

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