ALBERTA SONO
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Standard acquisiton sequence

Standard acquisition sequence

Technicians in the echo lab follow a prescriptive sequence in obtaining echo clips/images and making measurements. Here we provide a gross outline of the imaging sequence for the purposes of critical care and other sub-specialty trainees.
​

Enter data

​
STEP 1- Enter demographic info for image capture and storage: Pt name, ULI, and your user ID

STEP 2- Select low-frequency, phased-array transducer. Ensure cardiac setting is selected (marker to screen right).

​STEP 3- Connect ECG leads to patient




Parasternal views

Step 1: Parasternal views

Start at 2nd ICS with parasternal long axis view, depth of field ~12-15cm.
  • Angle probe marker toward patient's right shoulder, slight inferior tilt (over the rib).
  • Slide probe down chest until cardiac structures come into view. Capture this image.
  • Deep initial view will prevent missing a pericardial/pleural effusion

Parasternal long axis

Decrease depth so that the heart fills as much of the screen as possible without cutting off structures.
  • Capture 1-2 loops in B-mode to assess wall motion
  • Visually inspect mitral/aortic valve appearance and opening
  • Place M-mode cursor just past MV leaflets to assess fractional shortening of LV cavity
Picture
Picture

STep 3: PLAX valves

Capture loops with color doppler over MV/AV
  • Adjust sector width (medium) to optimize frame rate if needed
  • Place color box over individual valve (aortic/mitral)
  • Zoom in on valves if any abnormality suspected

Step 4: RV inflow

Tilt transducer over rib to bring right-sided (anterior) structures into view
  • Color doppler through tricuspid valve
Measure: CW Doppler through TR jet, TR Vmax to estimate RVSP

Step 5: PsSax valves

Keep probe on same "footprint": rotate transducer so that marker now points toward left shoulder
  • Tilt transducer toward sternum so that AV comes into view end-on
  • Assess valve structure and opening
  • Capture a loop of best possible view
  • Color doppler over AV
  • Color doppler over TV
Measure- CW Doppler through TR jet, TR Vmax to estimate RVSP: Color doppler over PV

Step 6: PSSAX function

Tilt transducer toward cardiac apex to bring LV/RV cavities into view
  • Optimize image to make LV as round as possible (rotate and tilt)
  • Capture loop at the level of the LV pap muscles
  • Tilt transducer further toward cardiac apex and capture a loop of the apex
Picture

Apical views

Step 7: Apical 4-chamber

​Place transducer over cardiac apex- roughly 4-5th ICS, just lateral to mid-clavicular line. Probe marker toward the ground in a supine patient
  • Center the septum and rock probe to get septum as vertical as possible
  • Rotate and tilt probe to bring cardiac chambers into best possible view. Capture loop
  • Color doppler over MV
  • Color doppler over TV
  • Place M-mode cursor over lateral tricuspid annulus
Measure- TAPSE (>1.6cm normal): CW through TR jet, TR Vmax to estimate RVSP

Diastology

In an apical 4-chamber view place the PW Doppler sample volume box at the tips of the leaflets in diastole--as shown here.
Picture

Step 8: apical 5-chamber

Slight fan (tilt) upward of transducer will bring LVOT and AV into view
  • Color doppler over LVOT
Measure: PW sample box into LVOT just proximal to AV leaflets. Trace out LVOT VTI (18-22cm normal)

PUlse wave Doppler in the left ventricular outflow tract

Place the PW Doppler sample volume box roughly within 1 cm of the aortic valve. Trace the spectral waveform below the baseline in systole to measure the LVOT VTI.

Measurement of RV function

M-mode should be used to assess the lateral tricuspid annulus.  A normal RV moves >1.6 cm from base to apex.
Picture
Picture
Tissue Doppler imaging can also be used to assess tissue velocity of lateral tricuspid annulus. A normal R function has a velocity of over 10 cm/s (RV "S' labelled "1").

subcostal views

Step 9: subcostal 4-chamber

Slide probe upwards toward xiphoid from just above umbilicus. Rock probe to bring entirety of heart including apex into view
  • Capture loop of best possible view
  • Fan (or tilt) transducer antero-posterior to 'sweep' through pericardial space looking for effusion

Step 10: subcostal short axis

Rotate transducer 90 degrees so that probe marker is pointed toward the ceiling
  • Tilt transducer to bring LV in short axis into view. Rotate probe to make LV cavity as circular as possible
  • Capture loop at level of pap muscles
Picture

Inferior vena cava

Step 11: inferior vena cava

Place transducer directed posteriorly just to the right of the xiphoid with probe marker toward patient's head.
  • Bring IVC into view, imaging at the level that the hepatic vein merges with the IVC
  • Rock probe so that the IVC is imaged at the widest possible point (avoid cylinfer effect)
  • Capture loop of IVC for 1-2 resp cycles
  • M-mode cursor over IVC ~1cm distal to hepatic vein
Measure IVCd and compressibility
Picture
  • Home
  • About
    • The Team
    • Social Media
    • Research >
      • COVID Shunt Study
      • Echo-AKI
      • Curriculum design & implementation
    • Events >
      • ABSono Rounds >
        • ABSono Rounds Recordings
      • Joint Rounds
      • CRUS 2021
    • Training >
      • CCUS Rotation
      • Clinical CCUS Fellowship
      • eCLass Ultrasound
  • Sonology
    • Physics of ultrasound
    • Transducer manipulation
    • Image optimization
    • Machines >
      • X-Porte
      • EDGE
    • Quality >
      • Essentials QPath E
      • Submitting for QA
    • Critical Thinking
  • Echo
    • Standard echo views >
      • Echo in shock VR
    • LV Function Assessment >
      • Regional cardiac anatomy
    • Pitfalls in LV assessment
    • Pericardial space
    • RV function assessment
    • Inferior vena cava
    • Cardiac Output
    • Echo in VTE
    • The Echo Lab >
      • Standard acquisition
      • Key references
    • TEE >
      • Focused 4-view
      • Shunts and Bubble Studies
  • Lung US
    • Overview
    • Pneumothorax detection
    • Interstitial diseases
    • LUS in respiratory failure
    • Pleural Effusion Assessment
    • LUS in Covid-19
  • Whole-body Ultrasound
    • RUSH exam
  • Procedural US
    • VR in HALO
    • Central line (IJ)
    • Central line (Subclavian)
    • Central line (Femoral)
    • Thoracentesis
    • Paracentesis
    • U/S-guided PIV
  • Trauma US
    • eFAST fundamentals
    • eFAST Core Knowledge
    • The Thorax
    • The Heart
    • The Abdomen
  • Neuro
    • Optic nerve sheath diameter
    • Transcranial Doppler
  • GIMUS
    • GIMUS Rounds
    • Rules of GIMUS
  • References and links
    • References
    • Helpful links