The #1 Priorities while Performing and Echocardiogram
By Walter Rasmussen, R.D.C.S.
Imaging Goals: Crafting a two-dimensional image with the highest detail for the conditions, adjusting Color Doppler for a moderate to high frame rate and obtaining spectral Doppler tracings that are clear, consistent and 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 higher resolution will aid in making diagnostic decisions (i.e.: artificial heart valves).
#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 narrowing the color box and two-dimensional image widths. Exceptions can be made when tracking venous blood flow or in patients with low cardiac output state.
#1. Just as is done with two-dimensional imaging, re-adjust color Doppler Gain and frequency for each transducer position to assure that there will be good beam penetration so that jet area will not be underestimated. With each transducer position, experience will guide you to recognize insufficient Gain however, whenever there is doubt, increase the color Doppler Gain until random colored pixels (indicating noise), are observed and then back-off until most of the noise is eliminated without diminishing the visualization of important blood flow jets.
#1. Adjust the spectral Doppler scale and baseline so that the spectral envelope fills the graph, thus allowing for more accurate measurements.
#1. Be alert for unexpected anatomy and blood flow anomalies. Follow-up with further investigation until the anomaly is identified.