PSAX Doppler Protocol

Gain, scale, box size, centering

What do we adjust when optimizing for colour Doppler

Alignment, baseline, scale, gain, sweep speed

What do we adjust to optimize for spectral Doppler

AV colour, TV colour, TV CW, PV colour, MV level

What Doppler images do we take in PSAX

Zoom

What also do we do to the AV colour image besides add colour to it

False, should see a bit around the AV too

T/F: the zoom on the AV should be tightly around the valve without any space around the valve so you can see it really well

True

T/F: sometimes aliasing in the AV is normal because of the high velocity flow through the valve

Diastole

When does AR occur

Systole

When does AS occur

Make sure to see the valve opening and don't center over the rib

What are some tips for the PSAX RV inflow image

TR

What are we assessing for when sweeping through the TV

Annulus

The colour box over the TV should be just as wide as the _________

More medial

Does TR usually show up more medially closer to the Av or more laterally closer to the edge of the image in the PSAX TV colour image

TR jet

What should the CW cursor be lined up to

2.4m/s

What should the scale be at for the TV CW

Parabolic jet

In the TV CW image, you will measure if a ____________ ____ is seen

No

Would you measure this TR jet

No

Would you measure TR jet 2

Because there difference in jets is just from the heart moving in and out of alignment

Why would you still measure jet 1 if the other jets are not measurable

Yes

Would you measure TR jet 1

80%

Up to ____% of us have some TR

Just wide enough

The colour box for the PV should be _______ ________ _________ because the PV is a narrow valve

Red flame on the RVOT side of the PV

How is pulmonary regurgitation visualized on ultrasound in terms of colour Doppler

True

T/F: you may need to take 2 images at the PV, one showing the PV and one showing the birfurcation

Inferior and lateral

How does the MPA bifurcation usually sit compared to the PV

Little bit of aliasing and narrow jet

How would normal PR look like

Lot of aliasing, goes farther back into RV, and wide jet

What would abnormal PR look like

CW

What kind of spectral Doppler do we use on PR and PS

PW

What kind of spectral Doppler do we use on the RVOT

PR is higher velocities and RVOT are slower velocities

Why do we use different spectral Doppler on PR and RVOT

Within 5mm of that PV in the RV

Where should the sample volume be placed for the RVOT PW

Higher than mid

How should the baseline be placed for the RVOT PW

Closing click

What aspect of the PW waveform would suggest you are aligned correctly in the RVOT for the RVOT PW

Peak velocity or trace VTI

What do you measure in the RVOT PW image

True

T/F: you ignore any PR that shows up in the RVOT PW image

RV outflow velocity

What does the RVOT PW image assess

Forward

Optimization on the RVOT PW spectral should be done for _________ flow

Congenital abnormalities

What can suggest high velocity in the RVOT suggest

RV stroke volume calculation

What else can the RVOT PW peak velocity be used for

Peak velocity

What does you measure in the PV CW

Pulmonary regurg

What is flow 1 from in this CW PV

Pulmonary outflow

What is flow 1 from in this CW PV

Near the top

Where should the baseline be for the PV CW

Below the base line

Where is normal flow from the PV found

Pulmonary stenosis and regurgitation

What are we assessing for in CW PV

No

Should you have any flow through the MV when the valve is closed

True

T/F: if you see regurge in PLAX, you should also see it in PSAX

Eccentric

What is the nature of MR flow usually

Abnormal flow across the IVS

What are you looking for in colour IVS sweep

VSD

What does this flow through the IVS indicate

Ventricular septal defect

What does abnormal flow across the IVS indicate

Base to apex

How do you sweep the IVS