ASE Guideline Webinar Series: Part 1

Comprehensive Transthoracic Echocardiographic Examination in Adults

Introduction

• Presenter: Christina LaFuria
• Speaker: Dr. Carol Mitchell, University of Wisconsin-Madison

Webinar Focus

• Nomenclature and instrumentation related to ASE guidelines for transthoracic echocardiograms
• Acknowledgments to the writing group, sonographers, and ASE members for their contributions

Learning Objectives

1. Describe scanning maneuvers: tilting, rotating, sliding, rocking, angling
2. Instrumentation controls: grayscale map, dynamic range, overall gain, time gain compensation
3. Color Doppler settings for low flow states
4. Optimize spectral Doppler settings
5. Advantages and limitations of pulse wave and continuous wave spectral Doppler

Scanning Planes and Maneuvers

• Planes: Long axis, short axis, apical plane
• Maneuvers:
  • Tilting: Fixed base, anterior/posterior image acquisition
  • Rotating: Long axis to parasternal short axis view
  • Sliding: Movement of transducer, especially in short axis plane
  • Rocking: Centering structure in parasternal long axis view
  • Angling: Directing sound beam towards structure of interest

Image Acquisition Windows

• Parasternal Views: Long axis and short axis
• Apical Window: Four-chamber view
• Subcostal Window: Four-chamber view
• Right Parasternal Window: Ascending aorta imaging
• Suprasternal Notch: Aortic arch imaging

2D B-mode Instrumentation Settings

• Grayscale Maps: Adjusts brightness levels
• Dynamic Range: Ratio of echo amplitudes; influences number of gray shades
• Overall Gain: Brightness setting
• Time Gain Compensation: Amplification for even image brightness

Automatic Ultrasound Optimization

• Feature for quick TGC adjustments

Frame Rate Considerations

• Importance of high frame rates for temporal resolution

Color Doppler Imaging

• Region of Interest/Color Box: Influence on frame rate
• Color Gain: Optimizes color fill
• Velocity Scale: Influence on laminar vs. turbulent flow

Spectral Doppler Settings

• Velocity Scale: Optimize for aliasing
• Sample Volume Size: Impacts on noise and flow appearance
• Wall Filters: Remove low amplitude noise
• Spectral Doppler Gain: Adjusts brightness of Doppler signal

Pulse Wave Doppler

• Aliasing and Nyquist limit considerations

Continuous Wave Doppler

• High velocity measurement with range ambiguity

Doppler Tissue Imaging

• Measures myocardial and valve annuli movements

M-mode Settings

• Sweep Speed: Adjusts timing of events
• Color M-mode: Integrates color Doppler with M-mode

Key Adjustments

• Gain, Dynamic Range, Grayscale Maps differences

Questions Addressed

• Differences between scanning maneuvers and instrumentation settings
• Recommendations for setup and optimization

Conclusion

• Importance of accurate settings and application specialist consultation

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These notes cover the main points and details from the ASE guideline webinar on performing comprehensive transthoracic echocardiograms. Adjustments in scanning techniques and instrument settings are crucial to ensuring accurate imaging and measurements. Working with application specialists is recommended for optimal settings.