EDAN Acclarix LX4 User Manual
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EDAN Acclarix LX4 User Manual

Diagnostic ultrasound system
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EDAN Agile PLM Electronic Signature Information
--Signatures related to this document and performed in EDAN Agile PLM.
文件名称(Document Name)：Acclarix LX4(新显示器臂)使用说明书基础册_英文
文件编号(Number)：01.54.458402
版本(Version)：1.0
产品型号(Product Model)：Acclarix LX4
项目编码(Project Code)：2911G003
签批信息(Signature):
作者(Originator) : 谢 菊艳 (xiejuyan)
2019-08-19 14:34:48
审核人(Reviewers) : 李 娟 (lijuan)
2019-08-19 17:35:41
审核人(Reviewers) : 鲁 应君 (luyingjun)
2019-08-20 15:01:34
审核人(Reviewers) : 陈 云飞 (chenyunfei)
2019-08-19 17:34:03
审核人(Reviewers) : 赵 云兰 (zhaoyunlan)
2019-08-22 08:56:56
批准人(Approvers) : 郭 伟娟 (guoweijuan)
2019-08-26 10:27:51
批准人(Approvers) : 冀 伟 (jiwei)
2019-08-26 15:47:35
版权©深圳市理邦精密仪器股份有限公司 (Copyright©Edan Instrument,Inc.)

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Summary of Contents for EDAN Acclarix LX4

  • Page 1 EDAN Agile PLM Electronic Signature Information --Signatures related to this document and performed in EDAN Agile PLM. 文件名称(Document Name)：Acclarix LX4(新显示器臂)使用说明书基础册_英文 文件编号(Number)：01.54.458402 版本(Version)：1.0 产品型号(Product Model)：Acclarix LX4 项目编码(Project Code)：2911G003 签批信息(Signature): 作者(Originator) : 谢 菊艳 (xiejuyan) 2019-08-19 14:34:48 审核人(Reviewers) : 李 娟 (lijuan) 2019-08-19 17:35:41 审核人(Reviewers) : 鲁...
  • Page 3 Imaging System safely for the intended purposes and approved clinical applications. This User Manual applies to all 1.0X releases. Read and understand all instructions in this manual prior to using the Acclarix LX4 ultrasound system. Disregarding instructions, particularly warnings and cautions, is considered abnormal use.
  • Page 4 Regulatory Approval Remarks  Auto OB measurement IS NOT available in the USA and its territories.

  • Page 5: Table Of Contents

    Contents Introduction ..........................1 1.1 Intended Use/ Indications for Use ..................1 1.2 Contra-indications ........................1 1.3 Device Description ......................... 1 1.4 Labeling Symbols ........................2 Safety ............................5 2.1 Warnings ..........................5 2.2 Cautions ..........................7 Getting Started ........................10 3.1 System Configuration ......................
  • Page 6 5.6.1. Anatomic M Touch Screen Controls ................55 5.6.2. Anatomic M Mode Operations ..................55 5.7 TDI Mode ..........................56 5.7.1. TDI Mode Operations ....................56 5.7.2. TDI Touch Screen Controls ..................56 5.8 3D/4D Mode ........................57 5.8.1. Pre-3D/Pre-4D......................57 5.8.2.
  • Page 7 Utilities ..........................117 9.1 Set-up ..........................117 9.1.1. General Set-up ......................118 9.1.2. Patient Set-up ......................119 9.1.3. Store/Print Set-up ....................... 120 9.1.4. Miscellaneous Set-up ....................122 9.1.5. User Set-up ......................... 123 9.2 Connectivity ........................124 9.2.1. TCP/IP ........................124 9.2.2.

  • Page 8: Introduction

    Acclarix LX4 Diagnostic Ultrasound System User Manual Introduction 1 Introduction 1.1 Intended Use/ Indications for Use The Ultrasound system is intended for use by a qualified physician or allied health professional for ultrasound evaluations. Specific clinical applications include:  Abdominal ...

  • Page 9: Labeling Symbols

    Acclarix LX4 Diagnostic Ultrasound System User Manual Introduction 1.4 Labeling Symbols The following labels are used on the system: Symbol Definition Serial Number Part Number Date of Manufacture Manufacturer Operating instructions Warning (Background: Yellow; Symbol & outline: Black ) Refer to User Manual (Background: Blue;...
  • Page 10 Acclarix LX4 Diagnostic Ultrasound System User Manual Introduction Transducer connector Transducer lock Transducer unlock Equipotential grounding Network port Trademark Video Output port USB 2.0 port USB 3.0 port Microphone input Headphones to move the control panel up or down Up/Down button, Forbid to move the system by pushing the monitor.
  • Page 11 Acclarix LX4 Diagnostic Ultrasound System User Manual Introduction Federal Communications Commission: ID:SMQLX8EDAN FCC ID:SMQLX8EDAN Non-sterile. Indicates a medical that has not been subjected to a sterilization process. The following labels are used on the wooden packaging: Symbol Definition This way up...

  • Page 12: Safety

    2.1 Warnings  Only use an Edan supplied power cord.  Only use Edan supplied transducer. Use of other transducers may result in electric shock or system malfunction.  Only use a hospital grade, grounded, power outlet and plug. Do not use with an ungrounded outlet.
  • Page 13  Install the system according the EMC guidance provided in Chapter 14  Do not stack the system on other electronic equipment.  The use of transducer and connecting cable not supplied by EDAN may result in increased emissions or decreased immunity of the equipment.

  • Page 14: Cautions

     Use only Edan supplied or recommended parts and accessories.  Verify measurement results prior to entering them into a report.  Contact your local distributor or Edan Service if there is excessive noise from the system speaker or fans.
  • Page 15  Confirm patient identification information prior to storing or printing any exam information.  If you have any questions about maintenance, technical specifications, or system functionality, please contact your local distributor or Edan Service at: support@edan.com.cn  Ultrasound images occasionally have artifacts, and should only be used as one part of an overall clinical assessment.
  • Page 16  Always ensure the privacy of patient information and data displayed/stored in the ultrasound system or exported to external storage devices.  The software upgrade can only be performed by EDAN-qualified service professionals with upgrade files of known provenance. Confirm that the system boots to imaging after an upgrade.

  • Page 17: Getting Started

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3 Getting Started 3.1 System Configuration The system is shipped with the following components:  1 main unit  1 bottle of coupling gel  1 power cord  1 potential equalization conductor ...
  • Page 18 Only the recommended printers listed above are verified by EDAN. Therefore, it is suggested to only use these printers. Use of other printers should comply with IEC 60950 or standard IEC 60601-1. Edan is not responsible for the accuracy of other printers. - 11 -...

  • Page 19: System Overview

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3.2 System Overview 3.2.1. Front View Figure 3-1 Front View - 12 -...
  • Page 20 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 1. Monitor 8. Speaker 2. Coupling gel holder/Coupling gel 9. Transducer sockets(four) warmer(optional) 3. Touch screen 10. Coupling gel holder 4. Transducer holder 11. Transducer holder 5. Control Panel 12. Up/Down button 6.

  • Page 21: Rear View

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3.2.2. Rear View Figure 3-3 Rear view of the device with Z-shaped monitor arm - 14 -...
  • Page 22 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started Figure 3-4 Rear view of the device with C-shaped monitor arm Table for placing printer Cable holders (two) Peripheral cable access panel door Heat dissipation orifice Filter Table 3-4 Rear View ports CAUTION 1.

  • Page 23: Left View

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3.2.3. Left View Figure 3-5 Left view of the device with Z-shaped monitor arm - 16 -...
  • Page 24 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started Figure 3-6 Left view of the device with C-shaped monitor arm 1. USB 2.0 Ports (two) 2. DVD drive Table 3-5 Left View ports NOTE: USB ports here can only support USB disk.

  • Page 25: Connecting And Disconnecting A Transducer

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started I/O Ports on the Rear Panel: Figure 3-7 I/O port interface 1. AC power switch 5. Network port (DICOM 3.0) 9. USB 2.0 interface 2. S-Video output port 6. Microphone port (Reserved) 10.
  • Page 26 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started There is information about Model and SN on the transducer connector. To connect a transducer: 1. Place the transducer’s carrying case on a stable surface and open the case. 2. Carefully remove the transducer and unwrap the transducer cable.
  • Page 27 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started Figure 3-10 Transducer socket number NOTE: 1. Once the transducer is connected to the main unit, please do not reinstall it frequently. This is to avoid poor contact between the transducer and the main unit.

  • Page 28: Powering On/ Off

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3.4 Powering on/ off Please review and follow the steps described in the Section 12.1.Daily Checklist prior to powering on the system.  To power on: 1. Connect the system to a hospital grade power supply, switch on the AC power switch on the rear panel.
  • Page 29 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 4. Select another user from the User Name drop-down list and then enter password to login.  To power off: 1. Press the Power on/off key on the top left of control panel for 2s~3s and the system displays a confirmation dialog box.

  • Page 30: Screen Layout

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3.5 Screen Layout ① ④ ③ ⑤ Figure 3-12 Main Screen Display ①Information Field： The top line of this field contains your hospital/institution name. Please see Section 9.1.1. General Set-up for information on customization.
  • Page 31 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started The bottom of the screen is used to display icons that provide system status. These include:  Image Store Icon. : Number of static images and clips in the current exam.
  • Page 32 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started  USB icon : Symbol in grey color: USB available  Wifi Icon :Wi-Fi available. Subject to regulatory approval. See Connectivity (Section 9.2.1) for enabling wireless if it is licensed. If Wi-Fi function is activated, clicking on this icon shows a "WiFi: Turn off"...

  • Page 33: Control Panel

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3.6 Control Panel Figure 3-13 Control Panel of the System Name Description Power on/off Press to power on/off the system switch Press this button to get the Set Up, Maintenance, Utilities Connectivity, Screen Adjust keys, etc.
  • Page 34 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started Report Press to display the report page. Press to enter exam database or image review mode. See Review section 7.4 for details. Its default function is to print image by video printers. It...
  • Page 35 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started Enters or exits the Comment function. See section 7.1 for Comment details. Enters or exits the Body Markfunction. See section 7.2 for Body Mark details. In measurement, pressing Update switches the active side of calipers.
  • Page 36 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started Press this key to switch between the frozen and real-time Freeze/Cine states. Move the trackball to change the cursor position, adjust M mark position in M mode, adjust sample line position in PW mode, etc.

  • Page 37: Touch Screen

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3.7 Touch Screen The Touch Screen contains controls that vary depending on the active imaging mode or function. There are several types of controls used by the touch screen, as illustrated below: Figure 3-14 Touch screen of the System A.

  • Page 38: Trackball

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started Customizing the touch screen The touch screen can be customized to meet your needs. Press and hold any control for about a second to put the touch screen in customization mode. Continue pressing and drag the control to a new location.

  • Page 39: Monitor Position Adjustment

    Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started 3.9 Monitor Position Adjustment 3.9.1. Adjusting the Position of Monitor with Z-shaped Support Arm Before adjusting the position of the monitor, you need to unlock the upper support arm. To unlock the upper support arm, press the release button(see the figure below).
  • Page 40 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started  Rotating the monitor The monitor can be rotated leftwards or rightwards along with the support arm. The upper support arm and lower support arm can be rotated leftwards or rightwards separately. Or, the monitor can be rotated alone without rotating the support arm.
  • Page 41 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started CAUTION Ensure enough spaces are available before rotating the monitor. Please mind your hands when adjusting the position of the monitor. 3.9.2. Adjusting the Position of Monitor with Z-shaped Support Arm ...
  • Page 42 Acclarix LX4 Diagnostic Ultrasound System User Manual Getting Started CAUTION Ensure enough spaces are available before rotating the monitor. Please mind your hands when adjusting the position of the monitor. - 35 -...

  • Page 43: Exam Operation

    Acclarix LX4 Diagnostic Ultrasound System User Manual Exam Operation 4 Exam Operation 4.1 How to Start an Exam To start a new exam, press the Patient key and enter in patient information, or select a scheduled patient from the modality worklist.

  • Page 44: How To Restart An Exam

    Acclarix LX4 Diagnostic Ultrasound System User Manual Exam Operation 4.3 How to Restart an Exam Select an exam from the Exam Database within the time limit selected in Patient Set-up menu. For the setting of time limit, refer to section 9.1.2 Patient Set-up.
  • Page 45 Acclarix LX4 Diagnostic Ultrasound System User Manual Exam Operation The next line shows the current transducer and the preset that will be used for the current exam. See section8.3.1.2 for information on presets. The preset can be changed by clicking the drop-down menu and selecting another preset associated with the current transducer.

  • Page 46: Modality Worklist

    Acclarix LX4 Diagnostic Ultrasound System User Manual Exam Operation Figure 4-3 Patient Information Touch Screen Press Start Exam to exit the Patient Page function and return to B-mode imaging with the newly entered demographic data for the active exam. Press Cancel to exit the Patient Information Page without storing any of the entered data.
  • Page 47 Acclarix LX4 Diagnostic Ultrasound System User Manual Exam Operation Figure 4-4 Modality Worklist Display The worklist is displayed at the left side of the Patient Information Page in two columns labeled patient name and patient ID. Clicking on the header of each column will sort the list for the corresponding column.

  • Page 48: Imaging

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging 5 Imaging The imaging modes are entered and exited via dedicated hard keys or knobs on the control panel. Key/Knob Description The B-mode knob behaves differently than the other mode keys/knobs. B-mode imaging is the baseline state of the system.
  • Page 49 The Left/Right invert control is indicated by a backward R and is used to toggle the left/right orientation of the image. The Edan E Left/Right orientation marker at the top of the image switches with the left/right invert to match the orientation marker on the transducer.
  • Page 50 Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging The Up/Down invert control is indicated by an upside-down R and is used to toggle the up/down orientation of the image. The TGC curve Up/Down is also re-oriented with Invert On, so that the top of the TGC curve corresponds to the top of the image on the screen.

  • Page 51: Dual Imaging

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Press to activate 3D/4D imaging mode. Refer to section 5.8 3D/4D 3D/4D mode for details. Press to invoke the touch screen for Needle Enhancement Needle Visualization and Needle Biopsy Guide functions. See section 7.5 and 7.6 for more information.

  • Page 52: Panorama

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Quad Exit Quad is exited by any of the following:  Pressing the B, M, PW, CW hard key.  Pressing the Dual button or dual hard key.  Pressing the 3D, 4D button.

  • Page 53: Zoom

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging 5.1.5. Zoom Zoom is available in live or frozen B-mode and Color imaging. Rotate the physical Zoom knob on console to zoom an image.  Zoom Knob o Turn the Zoom knob rightwards to make the image bigger.
  • Page 54 Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging The Filter control removes excessive noise from movement of Filter vessel walls. Options of Low, Med and High are available. Switches between grayscale and colorized (pseudo-color) Colorize postprocessing maps. Gray Map Adjusts the current postprocessing, either grayscale or tinted...

  • Page 55: Hprf

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Spectral Doppler supports image presets for Low Flow, Medium Image Type Flow and High Flow. This control is only available for linear transducers and steers the Steer Doppler cursor angle left or right.

  • Page 56: Update

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging If HPRF is active, you will see multiple Doppler gates on the reference image. If you do not want to be in HPRF, decrease the scale or move the primary PW gate to a shallower location until only one gate is displayed.
  • Page 57 Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Quick-Angle Adjusts the angle correct quickly to one of 60/0/-60. The Filter control removes excessive noise from movement of Filter vessel walls. Options of Low, Med and High are available. Switches between...

  • Page 58: Color-Mode

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging 5.4 Color-mode 5.4.1. Color Touch Screen Controls The following touch screen controls impact the color image. The location of the touchscreen controls can be customized (see section 3.7 for details). Name Control...
  • Page 59 Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Persistence determines the number of frames that are averaged Persist together for display. Levels of Off, Low, Med and High are available. The smoothness filter determines the spatial filtering that is applied Smooth to the Color image.

  • Page 60: Color Mode Variants

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging The Dynamic Range, or log compression, adjusts how echo intensities are converted to brightness. A high dynamic range Dynamic presents a flatter, less contrasty color display, while a low dynamic Range range presents a more contrasty color display. Only available in PDI/DPDI mode.
  • Page 61 Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging The Dynamic Range, or log compression, adjusts how echo intensities are converted to brightness. A high dynamic range Dynamic will display more shades of gray, while a low dynamic range will Range display fewer shades of gray and a more contrasty M-mode display.

  • Page 62: Anatomic M Mode

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging 5.6 Anatomic M Mode Anatomic M mode allows you to manipulate the position and angle of M sample line and displays real-time M strip image. Only phased transducer support Anatomic M mode.

  • Page 63: Tdi Mode

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging 5.7 TDI Mode Tissue Doppler Imaging (TDI) mode shows information about low-velocity and high-amplitude tissue motion, usually used to evaluate cardiac tissue motion. Only Phased transducer supports TDI mode. There are two types of TDI modes available on this system: ...

  • Page 64: 4D Mode

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging 5.8 3D/4D Mode Depending on the system configuration and regulatory approval, 3D/4D may be available on the C5-2MD transducer. The first step in using 3D or 4D is to activate pre-3D or Pre-4D mode. There are three ways to activate pre-3D or Pre-4D mode: Press the 3D or 4D button on the touch screen in B-mode.

  • Page 65: Volume Sweeping

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging The touch screen controls in Pre-3D and Pre-4D: Name Control Description Adjusts the trade-off between speed and image quality of the Image Quality acquisition. Settings include High (quality), Middle, and Fast. Adjusts the angle of the volume acquisition. Upward presses Angle increment the angle.

  • Page 66: Image Review

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Figure 5-3 3D Image Scanning While scanning, the sector in the right bottom is filled gradually, and no buttons on the control panel and touch screen can be activated. 5.8.3. 3D Image Review The system will enter to the 3D review status after finishing one sweep.
  • Page 67 Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging  Quadrant C is orthogonal to A and B, showing a slice that is parallel to the transducer face. The icon at the bottom-right shows the position of each slice with respect to the full 3D data set.
  • Page 68 Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Undo All Return to the condition before cutting Adjust the threshold of surface render mode, Upward Threshold presses increase threshold. Downward presses decrease threshold. Brightness Adjust the brightness of 3D image Contrast Adjust the contrast of 3D image.
  • Page 69 Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Select MPR tint. Options of Gold, Sepia, Blue, Ice and Clear MPR Tint are available. Press to show the baby face automatically. Only available in eFace Surface render mode. Table 5-8 Volume imaging Mode Touch Screen...

  • Page 70: Volume Acquisition

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Control Name Description These three radio buttons determine which slice is the required A/B/C parallel slice. These three choices are the same as on the Volume display in quad mode. 3*3, 2*2, These three radio buttons determine the layout of the display.

  • Page 71: Live Volume

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging 5.8.5. 4D Live Volume 4D Live volume continuously sweeps and displays successive 3D volumes. During live 4D imaging the following controls are available: activate any window of A/B/C/3D, Single/Dual/Quad, VOI, Threshold, Brightness, Contrast, 3D Smooth/ MPR Smooth, 3D Tint/ MPR Tint, Quick angle rotation, , Zoom and Gain.

  • Page 72: 4D Dataset

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging Touch screen controls are the same as that of static 3D except for Cine button. Name Control Description cine Switch between 3D and 4D review state Table 5-10 4D Touch Screen 5.8.7. 3D/4D Dataset This system supports storing 3D and 4D datasets for reviewing and re-editing.

  • Page 73: Knobs And Buttons On Control Panel

    Acclarix LX4 Diagnostic Ultrasound System User Manual Imaging 5.8.8. Knobs and Buttons on Control Panel Knobs and buttons on control panel can also be used to make operation more convenient in 3D/4D mode. Name Control Description store 3D and 4D...

  • Page 74: Transducers

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 6 Transducers 6.1 Transducer Model Model Type Application Abdominal Fetal / Obstetrics C5-2D Convex Urology Gynecology Musculoskeletal Fetal / Obstetrics Gyncecology E8-4D Endocavity Trans-vaginal Trans-rectal Urology Small parts L12-5D Linear Peripheral Vascular...

  • Page 75: Name And Function Of Each Part Of The Transducer

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 6.2 Name and Function of Each Part of the Transducer Figure 6-1 shows an example of a transducer. Transducer head Transducer cable Transducer connector Figure 6-1 Typical transducer Name Function Converts electrical signals to sound waves, and then converts received echoes Transducer head back to electrical signals.

  • Page 76: Disinfection

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features To clean the transducers: 1. Disconnect the transducer from the system. 2. Wear sterile protective gloves to prevent infection. 3. Remove all residual foreign matters from the transducer using sterile cloth or paper towel immediately after examination.
  • Page 77 Acclarix LX4 Diagnostic Ultrasound System User Manual Features WARNING 1. Unplug the transducer from the system prior to cleaning or disinfecting. 2. To avoid infection, always use protective gloves when performing cleaning and disinfecting procedures. 3. To avoid infection, ensure that expiration date of the disinfecting solution has not passed.
  • Page 78 Acclarix LX4 Diagnostic Ultrasound System User Manual Features 8. Inspect the transducer to ensure that there is no damage. L17-7SD E8-4D Disinfectant Figure 6-2 Depth of the Transducer Immerged into Disinfectant WARNING 1. Do not immerse the transducer connector. If the cable connector is immersed, do not plug the connector into the system.

  • Page 79: Sterilization

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 6.3.3. Sterilization Intra-operative transducers must be sterilized after each exam. Sterilizing the transducers: 1. Disconnect the transducer from the system. 2. Wear protective gloves to prevent infection. 3. Clean and dry the transducer according to the methods in section 6.3.1 Cleaning.

  • Page 80: Using Transducers

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 6.3.5. Using Transducers Proper Use of Transducers To extend the service life and maintain optimum transducer performance, please operate as follows: Inspect AC plug, socket and acoustical window of the transducer periodically.
  • Page 81 Acclarix LX4 Diagnostic Ultrasound System User Manual Features To install transducer sheath: 1. Place an adequate amount of sterile coupling gel on the acoustic window of the transducer; 2. Insert the transducer into the sheath; 3. Pull the sheath over the transducer and cable until the sheath is fully extended;...

  • Page 82: Features

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 7 Features 7.1 Comments The Comments function allows you add annotation to an image(including an image in review status). The Comment function is invoked by pressing the Comment hard key on the console.
  • Page 83 Acclarix LX4 Diagnostic Ultrasound System User Manual Features Adding comments You can add either pre-defined comments or use a keyboard. Adding comments using the keyboard 1. Invoke the Comment function. 2. Use the keyboard of the system or press the “Keyboard...” touch screen key to display a keyboard on the touch screen.

  • Page 84: Body Mark

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 7.2 Body Mark Body Mark allows you add a bodymarker graphic to an image (including an image in review status) and indicate the location of the transducer using a transducer icon on that graphic. The Body Mark function is invoked by pressing the Body Mark hard key on the console.

  • Page 85: Measurements

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features Deleting a body mark: There are two ways of deleting a bodymarker graphic:  Press Delete on the touch screen to delete the graphics on the image area.  Press the Clear hard key to delete all bodymarkers, comments, and measurements.
  • Page 86 Acclarix LX4 Diagnostic Ultrasound System User Manual Features Figure 7-4 Tool Options Touch Screen Moving the measurement result window The measurement result window is displayed on the top left corner of the image field by default, the system supports changing the display position of the result window by dragging it.

  • Page 87: Generic Measurements

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 7.3.1. Generic Measurements A default generic measurement is automatically started when Measure is invoked. Each imaging mode supports several types of measurements, as described below. You can switch between these types using the touch screen buttons along the bottom of the touch screen. Some generic measurements have options, for the method used to perform the measurement.
  • Page 88 Acclarix LX4 Diagnostic Ultrasound System User Manual Features To measure Area or Circumference with a Trace: 1. Invoke the measure function on a B-mode image. 2. If Area or Circumference is not the default measurement, select Circ/Area from the touch screen.
  • Page 89 Acclarix LX4 Diagnostic Ultrasound System User Manual Features 4. Presses of the Update key toggle which side of the caliper can be moved. Pressing the Set key completes the first caliper pair and creates the second caliper pair. 5. Repeat step 3~5 to complete the second caliper pair and create the third caliper pair.
  • Page 90 Acclarix LX4 Diagnostic Ultrasound System User Manual Features To measure Stenosis with a Spline: 1. Invoke the measure function on a B-mode image. 2. If Stenosis is not the default measurement, select Stenosis from the touchscreen. If Spline is not the default tool, press Tool Options to switch to Spline. Spline can be created by placing several calipers.
  • Page 91 Acclarix LX4 Diagnostic Ultrasound System User Manual Features  PG2  PHT Presses of the Update key toggle which side of the caliper can be moved. Pressing the Set key completes the caliper and allows you to begin another measurement.
  • Page 92 Acclarix LX4 Diagnostic Ultrasound System User Manual Features 6. Moving the caliper backwards to previous ones will erase the points and curve line connecting them. Or, you can press Undo button to remove one point and its connecting curve line. Each press of Undo button removes one point.
  • Page 93 Acclarix LX4 Diagnostic Ultrasound System User Manual Features  DT  HR NOTE: Measure Auto trace can only be activated on a frozen Doppler strip. Live Auto Trace is available as a separate feature on the Doppler touch screen. HR：The HR measurement tool can provide the heart rate calculation.

  • Page 94: Application Measurements And Calculations

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 3. Press the Set key to place that caliper and add the second half of the caliper pair. Presses of the Update key toggle which side of the caliper can be moved. Pressing the Set key completes the measurement and allows you to begin another measurement.
  • Page 95 Acclarix LX4 Diagnostic Ultrasound System User Manual Features 7.3.2.1. Auto IMT Intima-media thickness (IMT) is a measurement of the thickness of tunica intima and tunica media. The system provides an automatic measurement of the Carotid IMT. Figure 7-6 IMT Touch Screen To measure IMT: 1.
  • Page 96 Acclarix LX4 Diagnostic Ultrasound System User Manual Features Figure 7-7 ROI Box of Auto IMT Figure 7-8 Measure Result of Auto IMT 7.3.2.2. Simpson’s Method of Disks (MOD) Simpson’s MOD is a method used to calculate LV diastolic and systolic volumes and ejection fraction.
  • Page 97 Acclarix LX4 Diagnostic Ultrasound System User Manual Features 4. Draw the trace along the endocardium of the left ventricular. 5. Press Set key to fix the end point B and complete the trace. A new caliper positions automatically at the apex (Point D) of the trace, connecting the Point C (Midpoint of point A and B).
  • Page 98 Acclarix LX4 Diagnostic Ultrasound System User Manual Features 7.3.2.4. Auto OB Measurement Auto OB is a method designed to measure BPD, HC, HUM and FL automatically. To use Auto OB measurement: 1. Invoke B mode. 2. Freeze the image when a standard fetal image is got.

  • Page 99: Patient Information Management

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features  Line A (Baseline) connects the osseous acetabular convexity to the point where the joint capsule and the perichondrium unite with the iliac bone;  Line B(Inclination Line) connects the osseous acetabular convexity to the labrum acetabulare;...

  • Page 100: Reviewing Images

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features clip or until the clip store is interrupted. The following events can cause the clip store to stop:  A second press of the button  Display of a GUI screen or dialog ...
  • Page 101 Acclarix LX4 Diagnostic Ultrasound System User Manual Features R.Margin Change the right margin of a highlighted clip Frame Scroll the paused clip frame by frame Plays/Stops the highlighted clip. This can also be done with the Set key on Play the control panel.

  • Page 102: Patient Database

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features Reviewing Clips: By default stored clips playback at half speed. You can adjust the playback rate by using the Speed button. Review will show Static and Clip images intermixed in the order they were stored.
  • Page 103 Acclarix LX4 Diagnostic Ultrasound System User Manual Features Filter: The database filter field at the top-left of the screen provides a powerful tool to find the study of interest. It filters the list based on whatever text is typed in this field. The filter applies to all fields.

  • Page 104: Archiving Studies

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features Working with multiple studies: Multiple studies can be selected by clicking the small box at the left of each listed study. Multiple studies can be stored to a DICOM server, saved to a USB device or DVD drive, or deleted. Only one study can be reviewed at a time.

  • Page 105: Needle Biopsy Guide

    If previous use has shown some drift of the needle from the center of the guidelines. 3. The displayed needle guide pathway on the EDAN video monitor is intended for reference during biopsy procedures. A variety of factors outside EDAN’s control, such as changing tissue density, bending of the needle, off-axis pressure by the person holding the transducer, etc., may cause deflection of a needle outside of the...
  • Page 106 Acclarix LX4 Diagnostic Ultrasound System User Manual Features WARNING The needle guide bracket kits are not disinfected or sterilized before delivery. Disinfect the needle guide kit before the first use and after each subsequent use For detailed operations, see 12.3.3.
  • Page 107 Acclarix LX4 Diagnostic Ultrasound System User Manual Features Figure 7-15 Attaching Bracket Kit to Probe Figure 7-16 Turning Knob 2 Clockwise Step 4: Insert the needle into the rectangular hole, as shown in Figure 7-17. Rectangular Hole 矩形孔 Figure 7-17 Inserting Needle into Rectangular Hole Installing needle guide bracket of endocavity probe: Step 1: Take the needle guide bracket kit out of the package.
  • Page 108 Acclarix LX4 Diagnostic Ultrasound System User Manual Features Knob Fixing claws Figure 7-18 Structure of Needle Guide Bracket Kit Step 2: Attach the needle guide bracket kit to the transducer by placing the bracket over the head of the probe, ensure that the three fixing claws of the bracket catch in the notches at the probe tip, turn the lock clockwise as the arrow direction shown in Figure 7-21, and then turn knob 1 clockwise until it locks in place, as shown in Figure 7-22.

  • Page 109: Activating Needle Guide Function

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features Figure 7-21 Turning the Knob 1 Clockwise Step 3: Insert the needle into the round hole, as shown in Figure 7-22. Round hole Figure 7-22 Insert the Needle into the Round Hole 7.5.2.

  • Page 110: To Adjust The Needle Guide Line

    Acclarix LX4 Diagnostic Ultrasound System User Manual Features 7.5.3. To Adjust the Needle Guide Line The needle guide bracket was calibrated during manufacture. However, certain events may cause the bracket alignment to shift, and new calibration required. WARNING 1. Calibrate the needle guide under any of the following conditions: a) The first time a needle guide is used with a given transducer.
  • Page 111 Acclarix LX4 Diagnostic Ultrasound System User Manual Features Angle Line Needle Enhancement Visualization Figure 7-25 Needle Visualization is invoked by pressing the Needle button on B-mode touch screen, and then the Enable button in the Needle Visualization section of the Needle touch screen. The following parameters can be adjusted when it is active.

  • Page 112: Presets

    Acclarix LX4 Diagnostic Ultrasound System User Manual Presets 8 Presets 8.1 Preset Organization The system Presets are divided into two levels: the Exam Presets and Application Presets. Exam Preset: Each transducer has its own set of Exam Presets. Each Exam Preset contains: ...

  • Page 113: Storing A Preset

    Acclarix LX4 Diagnostic Ultrasound System User Manual Presets active transducer is shown at the top of the touch screen. Below it are all the presets associated with that transducer. Pressing any preset button selects that preset, recalling its parameters for system use.

  • Page 114: Presets

    Acclarix LX4 Diagnostic Ultrasound System User Manual Presets  Press Body Mark to configure which body marker graphics appear with each bodymarker preset.  Press Measure to configure measurement options of each measure preset. Figure 8-3 Top level Touch Screen for the Setup Function 8.3.1.
  • Page 115 Acclarix LX4 Diagnostic Ultrasound System User Manual Presets Figure 8-5 Example Set-up Screen for Imaging Parameters Transducer and Exam Preset: There are drop-downs at the top of the screen for selecting the transducer and Exam Preset you want to edit. Each transducer has its own set of exam presets, and these two drop-downs let you select which exam preset, on which transducer, you want to edit.
  • Page 116 Acclarix LX4 Diagnostic Ultrasound System User Manual Presets Figure 8-6 Example Patient Information Configuration Page To change the demographic fields shown with any preset:  Select the preset you want to configure. This can either be done at the Preset Definition level before invoking the Patient Information Configuration page, or it can be done directly on this page.

  • Page 117: Comments Presets

    Acclarix LX4 Diagnostic Ultrasound System User Manual Presets 8.3.2. Comments Presets Figure 8-7 Comments Preset Adding a new Comment: 1. Move the cursor to a blank field in the comments area and press Right Set. 2. Enter a new comment through keyboard and press Left Set to finish editing.

  • Page 118: Bodymarker Presets

    Acclarix LX4 Diagnostic Ultrasound System User Manual Presets General Settings:  Auto-erase comments when the image is unfrozen: If this option is enabled, the comments will be erased when the image is unfrozen, otherwise the comments will only be erased on demand or at the start of a new exam.
  • Page 119 Acclarix LX4 Diagnostic Ultrasound System User Manual Presets Enabling/Disabling a Bodymarker to a Preset: Press a bodymarker on touch screen to switch it as checked or not, the bodymarker is enabled or disabled to current preset. Pre-defined graphics area Figure 8-10 Bodymarker Preset...

  • Page 120: Measure Presets

    Acclarix LX4 Diagnostic Ultrasound System User Manual Presets  Suppress Body Mark on Unfreeze: If this option is enabled the bodymarkers function goes away when the system is unfrozen, and comes back again with the next freeze. Manually exiting the function causes it to remain inactive until manually activated.
  • Page 121 Acclarix LX4 Diagnostic Ultrasound System User Manual Presets Adding a new Measure Preset A new measure preset can be added by copying an existing preset. The new measure preset contains the same measurements as the copied preset. Select a preset from the list along the left, and then press the Copy As button.
  • Page 122 Acclarix LX4 Diagnostic Ultrasound System User Manual Presets Figure 8-14 Measurement Option 8.3.4.1. General Settings Figure 8-15 Measurement General Settings - 115 -...
  • Page 123 Acclarix LX4 Diagnostic Ultrasound System User Manual Presets  Report Logo The system supports a user-defined report header by importing a logo and setting the logo’s position and size. Report logo settings are as follows:  Import: import a bmp format logo from USB disk.

  • Page 124: Utilities

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities 9 Utilities The Utilities hard key provides access to setup, screen adjust, connectivity and maintenance software. Each of these is described in separate sections below. 9.1 Set-up The Set-up function is divided into several sections, accessed by separate touch screen buttons ...

  • Page 125: General Set-Up

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities 9.1.1. General Set-up Figure 9-1 General Set-up Screen Item Options Description Input freely Set hospital name displayed on the top left of Hospital the screen and diagnosis report Chinese, English, German, Set the system language(new language is...

  • Page 126: Patient Set-Up

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Color, PDI, DPDI, Needle, 3D, Define the F1/F2 keys, select one of the 4D, Store 3D data set, Store pull-down options. The options that are Button F1/F2 4D data set. available will depend on what functions are enabled on the system.

  • Page 127: Store/Print Set-Up

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Item Options Description Weight Unit kg, lbs Set the weight unit of patients Height Unit cm, ft/in Set the height unit of patients Title of custom You can define two additional fields for data entry on the...
  • Page 128 Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Item Options Description Store Image Store static image to internal hard disk Store Clip Store clip to internal hard disk SONY-UP-D25MD, Connect the corresponding printer to print the SONY-UP-D898MD_X898MD current image. Store 3D data set to internal hard disk in 3D Store1/Store2/ mode.

  • Page 129: Miscellaneous Set-Up

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities 9.1.4. Miscellaneous Set-up Figure 9-4 Miscellaneous Set-up Screen Item Options Description Default review layout 4*4, 2*2, 1*1, 2*3 Set the default review layout √/× Overlay Show or hide overlay icons on thumbnail images Optimize Gain or not when press Auto button on √/×...

  • Page 130: User Set-Up

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities 9.1.5. User Set-up Figure 9-5 User Set-up Screen Item Options Description Enable Password Show or hide the login dialog when booting up the system. √/× Protection Password is required to enable password protection function.

  • Page 131: Connectivity

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Caution 1. For security consideration, a password with high secure intensity is suggested for each user account, and the password should be changed periodically. 2. Please keep your user name and password safe.
  • Page 132 Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Figure 9-6 TCP/IP Set-up Screen Wired Settings: The following settings apply when connecting a system to a wired network via the network port on the side of the system. Get Local IP: Either Manually entered (Static) or DHCP. The correct setting will depend on how your DICOM network is administrated.

  • Page 133: Dicom

    Local AE Title: Any 16 characters that uniquely identify this system on your DICOM network. The default “EDAN_STR_SCU” will work unless you have multiple Edan systems on your network. Time Out, Transfer Syntax: These determine how the DICOM messages are configured.
  • Page 134 Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Ping works, but Verify does not, you may need to review the conformance statement of your server to determine the proper settings for these. DICOM Store: Determines when DICOM images and clips are sent to the server. The options are: ...

  • Page 135: Network Store

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Testing the server: There are two tests to ensure that the server information is entered correctly. Click on any field for a given server to make that server selected, then:  Ping: A successful Ping means that the system can communicate with the server at a low-level;...
  • Page 136 Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Figure 9-8 Network Store Set-up Screen FTP Server list: The main interaction in this section is a list of configured servers and directories. It starts off as an empty list, and grows as servers are added. Most sites will only use one, but if the system is moved between locations then multiple entries may be useful.

  • Page 137: Maintenance

    The Version screen shows the current version of software, firmware, and selected hardware for the system. This information is only needed if requested by an Edan service engineer. This page also includes an Upgrade, Import Config and Show Config button. Any released upgrade will include instructions regarding use of this button.

  • Page 138: Demo

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities 9.3.3. Demo A Demo exam is a special exam with a patient name of “Demo”. It allows you to collect any set of images from multiple exams. To create a Demo exam: 1.

  • Page 139: Export/Import

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities 9.3.4. Export/Import The system supports export/import of user-configured presets and settings to an external storage device. This same UI supports the export of system log files. To export user data: 1. Press Utilities hard key, select Maintenance Export/ImportExport.

  • Page 140: Screen Adjust

    Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities To import user data: 1. Press Utilities hard key, select Maintenance Export/ImportImport. 2. Select an external USB storage device. All the presets on it will be loaded and displayed. The Presets must have been previously exported from a system.
  • Page 141 Acclarix LX4 Diagnostic Ultrasound System User Manual Utilities Figure 9-13 Screen Adjust Screen - 134 -...

  • Page 142: In Between Exams

    After unpacking the device, you should follow the packing list to check the product carefully and to make sure that no damage has occurred during transportation. For installation, please contact your local distributor or the EDAN service department at: support@edan.com.cn.

  • Page 143: Order List

    The following accessories are recommended for use on the system. WARNING Only accessories supplied or recommended by EDAN can be used, the transducers of EDAN can be only used on EDAN’s systems. Otherwise, the performance and electric shock protection cannot be guaranteed. If electrical or mechanical equipment from other companies need to be connected to the device, please contact EDAN or authorized representatives before connection.

  • Page 144: Troubleshooting And Maintenance

    Check before the system is switched on, if any system malfunction is experienced, eliminate the malfunction before use, or contact EDAN or authorized representatives for service if needed.  Visually inspect all the transducers. Do not use any damaged transducer.

  • Page 145: Cleaning The System

    2. Clean the button 12.3 Cleaning the System Use only the EDAN-approved substances and methods listed in this chapter to clean the system. The warranty does not cover damage caused by using unapproved substances or methods. Edan Instruments has validated the cleaning and disinfection instructions included in this User Manual.

  • Page 146: Cleaning The System Surface

    Acclarix LX4 Diagnostic Ultrasound System User Manual Troubleshooting and Maintenance 12.3.1. Cleaning the System Surface The validated disinfecting agents for cleaning the system are:  Ethanol (75%)  Isopropanol (70%) To clean the system surface: Switch off the system and unplug it.

  • Page 147: Needle Guide Bracket Cleaning And Sterilization

    2. Inspect the bracket for damage such as cracks or breakage. If damage is evident, discontinue use of bracket and contact your Edan representative for disposal guidance. 3. Sterilize the bracket before disposal or sending back to manufacturer for repair.

  • Page 148: Maintenance

    Acclarix LX4 Diagnostic Ultrasound System User Manual Troubleshooting and Maintenance properly when any damage is found. 12.3.3.2. Sterilization 1. Wear sterile protective gloves to prevent infection. 2. Disconnect the bracket from the transducer, and remove all visible residues from the bracket using sterile cloth.

  • Page 149: Specifications

    Acclarix LX4 Diagnostic Ultrasound System User Manual Specifications 13 Specifications 13.1 Electrical Safety Classifications According to the type of protection Class I equipment against electric shock According to the degree of protection Type BF against electric shock Whole device: IPX0 According to the degree of protection Transducer (not including the transducer connector): IPX7;...

  • Page 150: General Technical Specifications

    Acclarix LX4 Diagnostic Ultrasound System User Manual Specifications 13.5 General Technical Specifications B Mode: Single, Dual, Quad C Mode: B/C(Single, Dual, Quad); B+B/C(Dual Live); B/C/PW(Triplex mode) PDI/DPDI Mode: B/PDI(DPDI) (Single, Dual, Quad); B+B/PDI(DPDI) (Dual Live); B/PDI(DPDI)/PW (Triplex mode) PW Mode: B/PW;(Update)

  • Page 151: Operating, Storage And Transportation Environment

    Acclarix LX4 Diagnostic Ultrasound System User Manual Specifications B/Color mode Distance, Circ/Area, Angle, Volume, Stenosis ratio, Dist Stenosis, Area Stenosis Generic measurement M mode Distance, Slope, Time, HR generic measurement D mode Velocity, RI, Time, PI, Heart Rate, Auto Trace, PG1, PG2, S/D, ΔV,...

  • Page 152: Emc Information

    Acclarix LX4 Diagnostic Ultrasound System User Manual Ultrasound Gel Warmer 14 EMC Information Electromagnetic Emissions Guidance and manufacture’s declaration – electromagnetic emission The system is intended for use in the electromagnetic environment specified below. The customer or the user of the system should assure that they are used in such an environment.
  • Page 153 Acclarix LX4 Diagnostic Ultrasound System User Manual Ultrasound Gel Warmer Electromagnetic Immunity Guidance and manufacture’s declaration – electromagnetic immunity The system is intended for use in the electromagnetic environment specified below. The customer or the user of the system should assure that they are used in such an environment.
  • Page 154 Acclarix LX4 Diagnostic Ultrasound System User Manual Ultrasound Gel Warmer Electromagnetic Immunity Guidance and manufacture’s declaration – electromagnetic immunity The system is intended for use in the electromagnetic environment specified below. The customer or the user of the system should assure that they are used in such an environment.
  • Page 155 Acclarix LX4 Diagnostic Ultrasound System User Manual Ultrasound Gel Warmer NOTE 1 At 80 MHz and 800 MHz, the higher frequency range applies. NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.
  • Page 156 Acclarix LX4 Diagnostic Ultrasound System User Manual Ultrasound Gel Warmer Table 1 Test specifications for ENCLOSURE PORT IMMUNITY to RF wireless communications equipment Test Band Service Modulation Maximum Distance Immunit frequency (MHz) power (W) y test (MHz) level (V/m) 380-390...
  • Page 157 Acclarix LX4 Diagnostic Ultrasound System User Manual Ultrasound Gel Warmer Recommended Separation Distances Recommended separation distances between portable and mobile RF communications equipment and the system The system is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled.

  • Page 158: Ultrasound Gel Warmer

    Ultrasound gel warmer is an optional component. It is installed before delivery if you purchase this function. Installation and replacement of gel warmer can only be performed by EDAN authorized service personnel. Please refer to the service manual for the procedure of removing gel warmer.
  • Page 159 Acclarix LX4 Diagnostic Ultrasound System User Manual Ultrasound Gel Warmer To Clean gel warmer Switch off the system and unplug it. Remove the gel warmer bottom cover. Use a soft cloth dampened with disinfecting agent to gently wipe the entire exterior surface(including the bottom cover) and inner surface of the warmer thoroughly until no visible contaminants remain.
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