Checklist for 2D Echo/M-Mode/Doppler/TDI image acquisition in sequence

Image optimization – able to visualize endocardial border
Depth and focus
Framerate if 2D strain
Colour doppler scale/ aliasing velocity ≥ 60cm/s
Colour doppler gain (optimize by overgain then decrease untill no more background “speckling”)
Allow 3 – 5 beats for each looping


PLAX (1) with Desc Thoracic Ao
PLAX (2) without Thoracic Desc Ao
PSLAX(3) M-Mode Ao/LA
PSLAX (4) M-Mode Mitral Valve Tip (Colour M-Mode if SAM)
PSLAX (5) M-Mode LV at chordae level 

ASE guideline
Note: If heart orientation is distorted then direct 2D measurement to replace M-mode measurement
PSLAX (6) Zoom Aov and Mv
PSLAX (7) Colour Aov and Mv
Parasternal RV inflow (1)
Parasternal RVinflow (2) with colour
Parasternal RVinflow (3) CW for TR
Parasternal RVoutflow (1)
Parasternal RVoutflow (2) with colour
Parasternal RVoutflow (3) CW for PR (PW followed by CW if infundibular or valvular PS
Parasternal SAX (1) AO/MPA
Parasternal SAX (2) Colour PA
Parasternal SAX (3) PW RVOT
Parasternal SAX (4) CW PV
Parasternal SAX (5) Zoom Aov
Parasternal SAX (6) Colour Aov
Parasternal SAX (7) TV
Parasternal SAX (8) Colour TV for TR
Parasternal SAX (9) IAS with colour
Parasternal SAX (10) Basal LV (Zoom MV if MS )
Parasternal SAX (11) Colour MV if MR
Parasternal SAX (12) LV mid
Parasternal SAX (13) LV Apex
Parasternal SAX (13) LV Apex
Apical 4Ch (1) – All 4 Chambers in
Apical 4Ch (2) – LA and RA volume
Apical 4Ch (3) – Zoom LV
Apical 4Ch (4) – Zoom LV, measure EF (Single plane simpson’s)
Apical 4Ch (5) – Rotate to apical 2Ch
Apical 4Ch (5) –Measure EF (biplane simpson’s)
Apical 4Ch (6) – Assess RV
Apical 4Ch (7) – measure TAPSE and TDI s wave
Apical 4Ch (8) – Colour and CW MV - quantitate MR of MS if present
Apical 4Ch (9) – Colour and CW TV - quantitate TR of TS if present
LV diastolic function
Sample volume (1 – 2 mm) at tip of MV
(guide by colour to align the cursor parallel to flow – angle < 20°
E vel, A vel, Decel time

Sample Volume at MV annulus level
Mitral A duration

Source : Anderson, B., (2002), The Normal Examination and Echocardiographic Measurements.


LV Diastolic Function (1) Mitral Inflow
LV Diastolic Function (2)Mitral A duration
LV Diastolic FunctionIVRT and Pul Vein
3. Sample volume 2 – 3 mm in-between MV and AoV
IVRT

4. Sample volume 3 – 5 mm at pulmonary vein 1-2cm into pulm vein (preferably RUPV)
PVs vel, PVd vel, PVar peak vel, PVar duration

Source : Anderson, B., (2002), The Normal Examination and Echocardiographic Measurements.

LV Diastolic Function (3) IVRT
LV Diastolic Function (4)Pulmonary Vein
LV Diastolic FunctionPW TDI
5.Sample Volume 3 mm at MV septal annulus
TDI E’ Vel, A’ Vel, S’ Vel

6.Sample Volume 5 mm at MV lateral annulus
TDI E’ Vel, A’ Vel, S’ Vel

TDI sensitive to angle – align cursor parallel to annulus motion


Source :Hill, J.C, and Palma, R. A.“Doppler Tissue Imaging for the Assessment of Left Ventricular Diastolic Function: A Systematic Approach for the Sonographer”, JASE 2005, Vol 18, No 1, pp80 - 88

LV Diastolic Function (5)TDI Septal Annulus , Use PW TDI
LV Diastolic Function (6)TDI Lateral Annulus , Use PW TDI

Apical 4Ch
Assess MV and TV with colour doppler

Apical 5Ch
2D followed by colour

Apical 2Ch
2D followed by colour

Apical 3Ch
2D followed by colour

Apical 5 Chamber (1) – 2D loop
Apical 5 Chamber (2) – Colour AovZoom Aov if AS or AR and Quantitate severity
Apical 5 Chamber (3) – PW LVOT
Apical 5 Chamber (4) – CW AoV
Apical 2 Chamber (1) – 2D Loop
Apical 2 Chamber (2) – Colour MVQuantitate MR
Apical 3 Chamber (1) – 2D loop
Apical 3 Chamber (2) – Colour MVQuantitate MR, Zoom MV if necessary
Great Vessels
If aortic root dilated in PSLAX, then go one ICS up to visualize the entire aortic root and ascending aorta
Ao annulus, trans-sinus of valsalva, Sino- tubular junction and ascending aorta

Finally IVC dimension and collapsibility to estimate RAP.

Pulmonary Artery Systolic Pressure = TR peak PG + RA pressure
Pulmonary Artery Diastolic Pressure = PR end diastolic peak PG + RA pressure

Other additional views/measurements depend on pathology
Other additional views (1) High parasternal view to visualize entire Ao root
Subcostal View (1) – 2D IVC and M-Mode IVC
Other additional views
Depend on abnormalities detected eg. if Ao root dilated, high parasternal view to visualize the entire Ao root; Suprasternal view for significant AR, Modified 4Ch for ASD, Subcostal view for pericardial effusion ….. etc
Other additional views (2) Suprasternal View if significant AR
Other additional views (2) Modified 4Ch for ASD
Other additional views (3) Subcostal 4Ch for Pericardial eff
RV diastolic function
Sample volume 3-5 mm at tip of TV (RV inflow or apical 4C )
Guide by colour so that angle< 20°
E vel, A Vel, Decel time

Sample volume 2 mm in Hepatic vein(HV)
HV systolic forward flow vel, Diastolic forward flow vel, A reversal vel
TV inflow
PW hepatic vein
Summary
Do the same measurement at the same location as this will lead to consistency in measurement and able to detect any changes especially in serial echo.

Always remember that different category of people see things in different depth when interpreting echo, if you are not sure of what you are scanning do not panic, record (standard views) before you call the expert to review.

At the end of the study you should have an answer or at least an explanation for the doctor who requested that particular echo.