DSAE 1415 Exam 1 Study Materials with Key Terms and Definitions

Anaechoic

These areas appear black on ultrasound because they do not send back any sound waves.

Hypoechoic

structure appears darker than surrounding structures.

Hyperechoic

These areas bounce back many sound waves. They appear as light gray on the ultrasound.

focus

Adjusts shape and width of the ultrasound.

Narrower width results in better lateral resolution

Automatic and manual settings

Total gain/TGC

adjusts brightness of the image equally through out the Frame of view

zoom provides:

better resolution

Frame rate

changes sector size.

makes the image more narrow, the more narrow the better the details

Decrease depth, decrease sector size, decrease number of focal zones, use preprocessing zoom.

Medical ultrasound frequency:

2 MHz to 20 MHz

Adult transthorasic echo (TTE) transducer frequency range:

2 - 5 MHz

transducer frequency range for TTE

2-12 MHz

Pediatric TTE

3.5 to 5.0 MHz

Neonates TTE

7.0 MHz or higher

Motion mode echocardiography (M-mode)

one dimensional view.

curser lines passes through and displays on a graph

Acoustic Windows

transduce placement on special positions on the chest to image the heart through the chest wall

what are the Main acoustic windows:

Parasternal (right & Left)

Apical

Subcostal

Suprasternal

Three imaging planes:

Long axis plane (LAX) divides the heart into left and right

Short axis plane (SAX) divides the heart into inferior and superior portion (perpendicular to above plane)

Apical or 4 chamber plane -runs parallel to anterior andposterior surfaces and divides the heart into four chambers

Parasternal Long Axis (PLAX) shows:

RV-right ventricle

LV-left ventricle

LA-left atrium

AV -aortic valve

MV-mitral valve

LVOT-left ventricular outflow tract

AO -aorta

IVS-interventricular septum

PW-posterior wall

DAO - Descending aorta

CS- Coronary sinus

PLAX optimized: Arties that can be seen

DA, CS and LCX

mostly the DA is seen

PLAX: Anterior structures are seen..

top of the image

ex: RA and chest wall

PLAX: posterior structures are seen..

seen at the bottom of the image

EX: posterior LV wall

PLAX: superior structures are seen..

seen to the right of the image

EX: aorta and LA

PLAX: inferior structures are seen..

seen to the left of the image

EX: apex

PLAX: If the LV apex is seen, the probe is rotated too far clockwise or the probe is too low on the chest wall

right ventricular outflow tract (RVOT)

PV-pulmonary valve (right and left leaflets)

PA-pulmonary artery.

*tilt face superior

RVOT: inferior structure are seen..

towards the top left

EX: RVOT

RVOT: superior structures are seen..

towards the bottom right

EX: MPA

RVOT: right sides structures are seen..

top right

RVOT: left sides structures are seen...

bottom left

EX: LV

Right Ventricular Inflow Tract (RVIT)

TV- tricuspid valve (leaflets: ATVL & PTVL)

RV -right ventricle

MB-moderator band

RA-right atrium

CS-coronary sinus

IVC-inferior vena cava

ER- eustation ridge

*Tilt face inferior

RVIT: inferior structure are seen..

top left of the image

Ex: RV

RVIT: anterior structures are seen..

top right of the image

RVIT: superior structures are seen..

bottom right of the image

Ex: RA

RVIT: posterior structures are seen..

bottom left of the image

LAX views

views of the heart obtained from the parasternal and apical windows

decides the heart into left and right

SAX views

views of the heart obtained from the parasternal and subcostal windows

divides heart into inferior (lower) and superior (upper) sections

views of the heart obtained from the apical and subcostal windows:

4-chamber views of the heart

angulation: is:

side to side swinging of the probe on the chest

High Parasternal Window (high PLAX):

used To assess ascending aorta

Probe is positioned one or two intercostal space higher than the standard PLAX position

Aim is to demonstrate the aortic root and long axis of ascending aorta

Pericardial effusion

when excess fluid builds up in the pericardial sac around the heart

Pleural effusion

A buildup of fluid between the tissues that line the lungs and the chest.

RVIT

TV (anterior and Posterior leaflets)

*NO LV

Deep PLAX

optimized PLAX

Zoomed AOV

be able to see AO root and arch

Zoom MV and AV

RVIT

RVIT

TV (anterior and Posterior leaflets)

*NO LV view should be in image

Why does echo not use a higher frequency when scanning?

a higher frequency = lower penetration

-produces a good resolution but cannot go through the body very well

When is high frequency used during echo?

a high frequency is used when scanning babies because of their small size

the sound waves do not have to penetrate through much (babies have small bodies)

low frequency transducer produces:

decreased resolution but improves depth

high frequency transducer produces:

increased resolution but decreases depth

low frequency yields

high penetration & bad resolution

newborns are scanned with

7 MHz transducer

sweep

Multiple movements are used to record a long video clip or showmultiple anatomic structures

modalities of echocardiogram

1. 2D echo

2. M-mode (motion mode) echo

3. Doppler echo (color flow and spectral)

4. 3D

5. 4D

depth

maximum distance into the body that an ultrasound system is imaging

TTE

transthoracic echocardiogram

two dimensional echo (2D echo):

real time

black and white

cardiac vessel and anatomy functions and dimensions

frame rate:

number of images per second

temporal resolution

systems ability to detect a structure has moved over time of distinguish between rapidly moving structures

harmonic imaging

the creation of an image from sound reflections at twice the frequency of the transmitted sound

helpful with obese patients

Parasternal Long Axis - Systole

AOV opens, blood flows LV-> AO

Parasternal Long Axis - Diastole

MV opens, blood flows LA -> LV

RVIT: chiari network

thin web-like fenestrated membrane off the IVC

ONLY view to see posterior leaflet of TV

RVIT

the index marker is pointing towards the patients left, subclavicular fossa (at 1 o clock)

PSAX orientation

5 PSAX images

1. PA

2. PSAX AV, LA

3. PSAX LV, MV

4. LV papillary muscles

5. PSAX LV apex

PSAX PA level

PSAX: aorta level structures

Aortic leaflets

Pulmonary leaflets

Main pulmonary artery

Tricuspid leaflets

IVC, coronary sinus

LA, LAA

Pulmonary veins

IAS (dropout artifact)

Descending aorta

PSAX at AV level

PSAX LV at mitral level

Portion of RV-crescent shaped

LV-identify the walls

Diastole and systole

AMVL, PMVL (fish mouth appearance, Commissures seen)

PSAX LV at mitral level

PSAX Papillary Muscle level

Middle segments of LV-IVS, anterior, lateral and inferior walls

PM- posterior medial

AL- anterior medial

* remember AL and PAM are a couple

PSAX LV papillary muscles 1

PM- posterior medial

PSAX LV papillary muscles 2

AL- Anterior lateral

PSAX LV at apical (apex view)

PSAX LV at apical (apex view)

PSAX PA

PSAX AV level

PSAX AOV level

PSAX AV level

PSAX PA

PSAX LV at mitral level

PSAX LV papillary muscles level

PSAX-Apex Level

Landmark to tell if the image has a pericardial or pleural effusion

Descending aorta

PLAX optimized: If you see the MV leaflets, going backwards into the LA

You went to high

MVP (mitral valve prolapse)

condition in which the leaflets of the mitral valve prolapse into the left atrium during systole, resulting in incomplete closure and backflow of blood

RVIT

PSAX LV mitral valve level

PSAX LV aortic valve level

PSAX Left ventricular papillary muscle level

PSAX Pulmonary artery bifurcation level

Tall thin patients PLAX window usually is

vertical and low

Short obese patients PLAX window usually is

vertical and high

PSAX ML level: LV wall 8

inferoseptal wall

PSAX ML level: LV wall 3

anteroseptal wall

PSAX ML level: LV wall 4

anterior wall

PSAX ML level: LV wall 5

anterolateral wall

PSAX ML level: LV wall 6

inferolateral wall