1. 2D/M mode (+/- zoom) 2. colour 3. spectral (PW or CW)

Echo Doppler Basics Flashcards by Kate Grimeau

6 things Doppler asses in echo

flow through valves
pulmonary venous flow into LA
hepatic venous flow
SVC/IVC flow
aortic flow
differentiate tissue from blood

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normal valve velocities:
TV ≤ ____
PV ≤ ____
MV ≤ ____
AV ≤ ____

1
1
1.3
2

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valvular stenosis results in ____ flow velocities

increased

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colour (qual/quantitative, give us what)

qualitative
gives us a good idea about regurg, stenosis, etc.

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pulsed wave spectral (PW) (qual/quantitative, give us what)

quantitative
give us spectral signal from a specific sample volume (spot)

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continuous wave spectral (CW) (qual/quantitative, give us what)

quantitative
gives us a spectral signal from an entire line of scan

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CW spectral is used for _____ velocities

very high

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order of images

2D/M mode (+/- zoom)
colour
spectral (PW or CW)

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do we ever invert colour for echo

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colour doppler is a ____ wave technique and ____ subject to aliasing

pulsed
is

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where is aliasing normal

where higher velocities are (ex. LVOT/AV)

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antegrade = _____ flow

normal

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normal flow in echo has a normal flow _____ and flow ___

direction
velocity

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colour doppler is a ____ doppler technique with many tiny sample volumes placed in the colour box = _____ FR

PW
lower

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3 advantages to colour doppler

sensitivity: can detect small amounts of blood flow
ROI: anatomic + hemodynamic info in one image
laminar vs turbulent

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PFO

patent foramen ovale
hole in interatrial septum

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2 disadvantages to colour

aliasing: at high velocities
directional ambiguity: perpendicular = flow is many colours

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does stenosis show aliasing

yes

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does regurg show aliasing

will show a bit right at the valve and beyond

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do shunts show aliasing

yes for the most part due to a large difference in pressures = high velocity

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colour imaging adjustments (4)

gain
scale
box size
centering

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what is a shunt

connection that doesn’t normally belong there

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colour
overgaining will cause:
undergaining will cause:

bleeding
missed data

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gain is adjusted with each new patient or when ____ has been majorly adjusted

scale

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does a large atrial septal defect show aliasing

gain for colour doppler should be

just below speckle

do most patients need scale changed

scale should match ___

flow

if flow is average velocity, scale should be ___

not changed

if flow is a high velocity, scale should be ____ (ex of where)

increased AC, PV, Ao

if flow is low velocity, scale should be ___ (ex of where)

decreased pulmonary veins, IVC, IAS, hepatic veins)

box size for echo colour should be ____ and ____

long and lean

the ____ of the colour box has a large effect on the frame rate

width

frame rate for echo must be ____

20 or more Hz

box should be wide enough to:

cover width of entire valve

box should be narrow enough to:

narrow enough to maintain FR

why is centering colour box important

moves with cardiac cycle so make sure it is always over ROI, ensure some room around ROI

spectral doppler adjustments (5) (PW or CW)

alignment (want 0 degrees) baseline scale gain sweep speed

the ideal doppler angle for echo is ___

0 degrees (or 180 if flow is going away)

we must try to line up our flow to be ____ with our beam to achieve accurate doppler imaging

parallel

baseline should sit _____ from either the top or bottom, leaving room for the _____ flow pattern

1/4-1/3 dominant

scale should be low enough that there is no ____

wasted space

doppler signal should be displayed as _____ as possible without _____ in either direction (scale)

large aliasing

scale should be ___ enough to leave a little room around the signal

high

spectral gain should ______ noise from behind signal (background = ____, PW has ______)

eliminate black black envelope

sweep speed should be set to show _____ full beats

_____ the sweep speed for higher HR

increase

_____ sweep speed for a low HR

decrease

faster sweep speed = _____ waveform

stretches

sweep speed is represented in ____

mm/sec

spectral for TR should have a TV scale _____ baseline set to ______

below 240cm/sec

why don't we focus above the baseline for TV

because TV stenosis is very rare in adult population

PW vs CW (2)

PW has pulses from a specific site and is used for lower velocity signals vs CW samples entire scan line and is used for high velocity signals

CW often has ______ due to the many different velocities seen along the scan line

spectral broadening

PW doppler 4 advantages

range specificity adjustment of sample volume size/position able to map velocities at any point in the heart 2D display guidance

PW 2 disadvantages

inability to measure high velocities due to aliasing limited by the speed of sound in tissue and PRF

PW can't measure velocities above ___

2.0-2.5 m/s

nyquist limit = ____ PRF

1/2

4 ways to overcome aliasing (Nyquist limit)

adjust baseline decrease sample depth = increase PRF switch to high PRF switch to CW doppler

what is high PRF setting

increased PRF by increasing the number of sample volumes 2nd pulse emitted before 1st returns

high PRF setting leads to

range ambiguity

high PRF setting is used to sample ______ velocities at _____

high specific sites

HOCM

hypertrophic obstructive cardiomyopathy

main advantage to CW

high velocity range

main disadvantage to CW

no range resolution (unable to be sure that a velocity is coming from a specific location)

TDI stands for

tissue doppler imaging

TDI assesses the ______

movement of myocardial tissue

TDI signal is of greater ______ (____)

intensity bright

TDI had a _____ velocity compared to blood flow velocities

lower

TDI should resemble a mirror image of ____ velocity profile and on a ____ scale

MV Lower

TDI consists of ____ upward wave(s) and ___ downwards wave(s)

one two

in TDI, the machine is able to change settings automatically to optimize tissue doppler waveforms (T/F)

4 advantages to TDI

easily reproducible provides systolic and diastolic info in one waveform can be performed on every patient including TDS patients less volume dependant than MV inflow (preload)

4 disadvantages to TDI

angle dependant filter settings can vary widely between machines gain settings can be too low on phillips not helpful when patient has: prosthetic valves, MAC, mitral annular ring

MAC

mitral annular calcification

how to do TDI

place cursor at annulus click TDI button on touch screen

2 doppler measurements

peak velocity (caliper) velocity time integral (VTI) (tracing)

VTI is a representation of how far the blood flow would have ____ in that time (represented in ___)

travelled cm

peak velocity measures (2)

peak velocity maximum (peak) instantaneous pressure gradient

do not include ____ on peak velocity measurements

feathering

VTI measures what 5 things

peak velocity (m/s) mean velocity (m/s) VTI (cm) max PG (mmHg) mean PG (mmHg)

minimize the "beard" by ____ the reject and ____ the compression

increasing decreasing