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
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 viewsStart at 2nd ICS with parasternal long axis view, depth of field ~12-15cm.
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Parasternal long axis
Decrease depth so that the heart fills as much of the screen as possible without cutting off structures.
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STep 3: PLAX valvesCapture loops with color doppler over MV/AV
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Step 4: RV inflow |
Tilt transducer over rib to bring right-sided (anterior) structures into view
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Step 5: PsSax valvesKeep probe on same "footprint": rotate transducer so that marker now points toward left shoulder
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Apical views
Step 7: Apical 4-chamberPlace transducer over cardiac apex- roughly 4-5th ICS, just lateral to mid-clavicular line. Probe marker toward the ground in a supine patient
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Step 8: apical 5-chamberSlight fan (tilt) upward of transducer will bring LVOT and AV into view
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PUlse wave Doppler in the left ventricular outflow tractPlace 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.
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Measurement of RV function
subcostal views
Step 9: subcostal 4-chamberSlide probe upwards toward xiphoid from just above umbilicus. Rock probe to bring entirety of heart including apex into view
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Inferior vena cava
Step 11: inferior vena cavaPlace transducer directed posteriorly just to the right of the xiphoid with probe marker toward patient's head.
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