Echo basics: Tips and Tricks

Echocardiography tips and tricks on optimising your image, making measurements, recognising artefacts and controlling infection

Preparing to scan

Before you begin your scan, remember to ask yourself the following questions:

Optimising your image

Here are some tips you can use to obtain an optimal image:

Probe Frequency Adjustment

• Large patients: Use a lower scanning frequency to improve penetration.
• Small patients: Use a higher scanning frequency to enhance resolution.

Sector Width and Depth

• Adjust sector width and depth to visualise only relevant structures.
• Always readjust these parameters when changing the imaging window (e.g., from parasternal to apical, or apical to suprasternal views).

Gain Settings

• Avoid over-gaining the image, especially in well-lit environments.
• Use Time Gain Compensation (TGC) to enhance deeper structures:
  • If your machine does not adjust automatically, ramp down the top 2–3 TGC sliders to reduce near-field echoes.

Focus and Zoom

• Align the focus with structures of particular interest.
• Use high-resolution zoom to improve visualisation of key anatomical areas.

Image Review Tools

• Use freeze and trackball functions to scroll slowly through image loops, allowing detailed examination.

Doppler Optimisation

• Adjust velocity scale and sweep speed:
  • Display 2–3 waveforms per image.
  • Ensure waveforms occupy at least two-thirds of the y-axis for clarity.

Archiving and Image Capture

• Archive high-quality clips using ECG triggering for timing.
• Use cycle select to ensure the best cardiac cycle is stored.

Making measurements

To help you make your measurements, here are some things to keep in mind:

Departmental Conventions

• Always use the same measurement conventions as the rest of your department to ensure consistency and reproducibility.

Reference Ranges

• Ensure the normal ranges you reference are:
  • Appropriate for your patient population, and
  • Based on the same measurement conventions (e.g. inner-edge vs leading-edge) as when the reference values were established.

Measurement Techniques

Parasternal Views

• Use a leading edge-to-leading edge convention by default.
• Left Ventricular Outflow Tract (LVOT):
  • Typically measured inner edge-to-inner edge.
• Aortic Root:
  • Historically measured leading edge-to-leading edge in systole.
  • Increasingly measured inner edge-to-inner edge in diastole, depending on local protocols.

Doppler Velocities

• Avoid overestimating Doppler velocities:
  • Trace the main body of the waveform.
  • Ignore artifacts, particularly at the tips of the waveform.

Ejection Fraction (Simpson’s Method)

• Do not attempt Simpson’s EF if the endocardium is not clearly visualised.
  • Poor visibility leads to unreliable measurements and should prompt alternative methods or views.

Recognising artefacts

An artefact can make it look like there is something present that isn’t there, or it may hide structures from being seen. If you suspect an artefact, try one of the following:

• Image from other views.
• Alter the machine settings.
• Observe whether it looks and moves physiologically.

Artefacts are particularly likely when there is material within the scanning zone which is unlike normal cardiac tissues, such as a pacing lead, replacement valve, air, or calcium. Typically, returning echoes are interpreted incorrectly because the normal assumptions about the behaviour of ultrasound in the body do not apply.

Controlling infection

This is an important component of performing an echo and will be informed by your institution’s policies and practice guidelines.

As a general rule, anything that touches the patient should be cleaned carefully after every scan. Some cleaning agents can damage ultrasound probes, so make sure you use a method the manufacturer supports and it’s good practice to routinely check the probe for damage before you use it.

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Radiology Library: Echocardiography basics

• Rimington H. Echo basics: Machines and probes. LITFL
• Rimington H. Echo basics: Tips and Tricks. LITFL
• Rimington H. Echo basics: Key concepts and Doppler modalities. LITFL
• Rimington H. Echo basics: Parasternal Views. LITFL
• Rimington H. Echo basics: Apical and Subcostal Views. LITFL