The #1 Priorities while Performing and Echocardiogram
By Walter Rasmussen, R.D.C.S.
The main imaging goals are to craft a two-dimensional image with the highest detail, adjust Color Doppler for a moderate to high frame rate and obtain spectral Doppler tracings that are large enough to measure accurately.
#1. Start the two-dimensional exam at the highest available transducer frequency, and then lower it as necessary when beam penetration is not sufficient to clearly demonstrate targeted anatomy. During the course of the exam, experiment with the frequency and re-adjust to higher frequencies whenever possible.
#1. Keep the Color Doppler Frame Rate as high as possible (22-to 30 Hz is ideal), and no lower than 17 Hz by Selecting a Medium Flow Optimization/medium FR setting and by adjusting the color box and two-dimensional image widths. Exceptions can be made when tracking venous blood flow or in patients withlow cardiac output state.
#1. Just as is done with two-dimensional imaging, adjust Color Doppler Gain and frequency for each transducer position to assure that jet areas will not be underestimated. With each transducer position increase Color Doppler Gain until random colored pixels indicating noise are seen and then back-off until most of the noise is eliminated without diminishing the visualization of flow jets.
#1. Adjust the spectral Doppler scale so that the tracing fills the graph, thus allowing for more accurate measurements.
#1. Be alert for unexpected anatomical and blood flow abnormalities. Follow-up with enough images to support or eliminate a diagnosis.