ASE Guideline Webinar Series: Part 1

Introduction

• Speaker: Dr. Carol Mitchell, Assistant Professor, University of Wisconsin-Madison
• Topic: Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults - Instrumentation and Nomenclature.
• Part 1 of a 2-part series.

Acknowledgments

• Writing group and expert sonographers.
• ASE Guidelines and Standards Committee.

Learning Objectives

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

Scanning Planes and Maneuvers

• Scanning Planes:

  • Long axis: Parasternal long axis images.
  • Short axis: Cross-section of the left ventricle.
  • Apical plane: Apical four-chamber view.

• Scanning Maneuvers:

  • Tilting: Fixed transducer base, tilt anterior/posterior.
  • Rotating: Change orientation index, e.g., long to short axis.
  • Sliding: Move transducer physically, especially in the short axis.
  • Rocking: Small maneuver to center a structure.
  • Angling: Direct the sound beam towards the structure of interest.

Image Acquisition Windows

• Parasternal Views: Long and short axis views.
• Apical Window: Series of views, starting with the apical four-chamber.
• Subcostal Window: Supine position, view the four chambers.
• Right Parasternal and Suprasternal Notch: Ascending aorta and aortic arch imaging.

2D B-Mode Instrumentation Settings

• Grayscale Maps: Adjust how shades of gray are displayed.
• Dynamic Range: Ratio between highest and lowest echo amplitudes.
• Overall Gain: Brightness of the image.
• Time Gain Compensation (TGC): Amplify image portions for equal brightness.

Color Doppler Imaging Instrumentation

• Region of Interest: Defines size and position for color interrogation.
• Color Doppler Gain: Optimize color fill in structures.
• Velocity Scale: Optimize for laminar vs. turbulent flow.

Spectral Doppler

• Velocity Scale: Avoid aliasing.
• Sweep Speed: Adjust for the heart rate, typically 100 mm/s.
• Sample Volume: Determines flow display in pulse wave Doppler.
• Wall Filters: Remove low-velocity signals.

Doppler Techniques

• Pulse Wave Doppler: Specific depth, prone to aliasing.
• High Pulse Repetition: Increases maximum velocity detected.
• Continuous Wave Doppler: No Nyquist limit, range ambiguity.
• Doppler Tissue Imaging: Measures moving myocardium.

M-Mode

• Sweep Speed: Optimize timing of events.
• Color M-Mode: Integrate color Doppler with M-mode.

Review and Q&A Highlights

• Main changes to the document: Focus on how-tos, meeting with application specialists.
• Differentiating maneuvers: Standardize terms across disciplines.
• Equipment settings: Work with application specialists to optimize system settings.

Thank you for attending the session.