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EACVI Echocardiography Textbook - sample

Discover the EACVI Textbook of Echocardiography 2nd edition

14 Chapter 1 general

14 Chapter 1 general principles of echocardiography Heating depends on tissue density and heat loss with blood flow. The soft tissue TI is the output power divided by the power producing more than a 1°C temperature rise. TI is higher for Doppler imaging. Cavitation is tissue gas bubble volume oscillation with pressure variation, similar to the oscillation of contrast microbubbles. It can induce disruption at very high MI. Performance is tested on tissue-equivalent phantoms and test objects. Axial, lateral, and contrast resolution, penetration, and calibration are assessed (see % Fig. 1.15). Safety is tested with hydrophones, measuring acoustic output. Pressure amplitude, period, and pulse duration are determined. Frequency, PRF, power, and intensity are derived. The transducers and other parts of the machine should be cleaned regularly. Quality assurance and ultrasound instruments A programme of instrument performance and safety testing every 6 months is recommended, for early identification of alterations (e.g. transducer elements breakdown) and maintenance planning. Further reading Education Committee of the European Association of Cardiovascular Imaging 2012-2014. EACVI Echocardiography Core Syllabus. A learning framework for continuous medical education in echocardiography. 2013. Available at: http://www.escardio.org/communities/EACVI/ education/Documents/EACVI-core-syllabus.pdf

Chapter 2 Transthoracic echocardiography/ two-dimensional and M-mode echocardiography Miguel Ángel García Fernández and José Juan Gómez de Diego Contents Principles of imaging 15 Patient position 15 Transducer position: the echocardiographic windows 15 Two-dimensional echocardiography 16 Parasternal long-axis view 17 Parasternal right ventricle views 17 Parasternal short-axis views 18 Apical views 19 Subcostal views 21 Suprasternal view 21 M-mode echocardiography 22 Aortic root, aortic valve, and left atrium 23 Mitral valve 23 Left and right ventricle 24 Pulmonic and tricuspid valves 24 The echocardiographic examination 25 Further reading 25 References 26 Principles of imaging Patient position To perform an echocardiographic examination the sonographer can be seated on the left or on the right side of the patient depending on standards of practice or personal preference. However, it is useful to develop skills to work from both sides of the patient in order to be prepared in the case the patient situation or room does not permit a choice. Echocardiographic examination is usually performed with the patient in the left lateral decubitus position, with the left hand under the head (% Fig. 2.1). By tilting the patient to the left, the heart comes nearer to the chest wall and by rising the left arm the space between the ribs widens. Both measures allow an easier positioning of the transducer and improve the ultrasound beam access. To obtain specific views, additional positioning of the patient will be required [1]. Subcostal images are obtained by placing the patient in the supine position. Asking the patient to flex their knees in order to relax abdominal muscles will give more room to manoeuvre the transducer. For suprasternal views the transducer should be placed in the suprasternal notch, with the patient in the supine position. Placing a pillow under the patient’s shoulders may be necessary to hyperextend the neck and to provide more room for the transducer. In some special cases the right lateral decubitus position will be required as well. Transducer position: the echocardiographic windows Ultrasound cannot pass through air or bone. This is the reason why there are in fact only a few points that can be used to scan the heart with an ultrasound beam. These points are called windows (% Fig. 2.2). A specific orientation of the transducer in a specific access point gives a specific imaging pattern called echocardiographic view. The standard transducer locations useful to scan the heart are the suprasternal, the apical, the suprasternal, and the subcostal windows. Two-dimensional (2D), M-mode and Doppler imaging from different windows should be obtained to obtain data about cardiac structures from different points of view (% Fig. 2.3). This information will be integrated by the sonographer in a coherent model of the patient’s heart anatomy and function. Usually parasternal and apical windows are the most useful windows in adults because

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