Echocardiography: Tools to Increase Clinical Confidence

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  Displacement Imaging on the Toshiba Aplio XG graphically displays correct timing sequence with pacemaker optimization. At right, the graph depicts quantification of wall displacement.

In 50 years, echocardiography has gone from a single dimensional view of the heart to a 3D and even 4D real-time technique. Adding to echo’s sophistication are quantitative analysis, greater portability, better workflow and efficient information management.

Three things are converging to make echocardiography better: Image quality keeps improving, applications are faster and networked systems are smaller and more portable. Portable machines provide echo, email, and a workstation in one laptop so tests can be done anywhere, stored, and then communicated back to the department. State-of-the art ultrasound systems no longer live in just large boxes. And in the next couple of years, the size of echo systems will shrink even further to be a bit larger than an iPod and offer excellent image quality.

Building clinical confidence is a major piece of the echocardiography puzzle. Labs around the country are utilizing the latest technologies, ultimately allowing physicians to make a more confident diagnosis.

Better efficiency


Dennis Atherton is the director of non-invasive cardiology at Maine Medical Center in Portland. He and his team perform adult and pediatric echocardiography on premature infants under 1 kilogram to adults over 600 pounds—presenting a variety of challenges. Last year, the hospital performed approximately 10,000 echo exams.

To get the most accurate read, Atherton obtains 3D data and strain data on every patient using the IE33 from Philips Medical Systems. He finds that Tissue Doppler Imaging (TDI) Quantification allows clinicians to better diagnose coronary artery disease, and assess cardiovascular anatomy and LV function with more accuracy. Strain imaging assists in detecting wall motion abnormalities and contrast improves imaging, enabling perfusion data to be obtained. Atherton says the new digital capabilities have greatly improved their efficiency: Pathology can be quickly identified and interrogated, and when speed and accuracy are essential—such as in a trauma room setting—his team is able to provide it.

“If you cannot see it, you cannot make the diagnosis,” says Atherton. “The single crystal in the system provides the best image with the broadest imaging frequency that I have seen in my 25 years of scanning.” That PureWave crystal technology provides greater sensitivity in harmonic imaging, improving penetration in difficult patients. Now sonographers and clinicians can quickly obtain the required images and then analyze the raw data later. The user also can change settings and measurements on the images to verify or correct the work that has been prepared.

Quantify, quantify, quantify


Quantification of traditionally difficult tasks such as ejection fraction and wall motion give the skilled reader more data, making the overall study more accurate and reproducible. With a higher degree of clinical confidence, the physician has more time to focus on diagnosis and patient management.

Randolph Martin, MD, is a cardiologist at Emory University Hospital in Atlanta—where he scans both complex adult patients and those with congenital heart disease. Emory is a 587-bed facility specializing in the care of acutely ill adults. Martin says quantitative analysis is one of the best improvements in echo to date.

“Until now, echo has mostly been qualitative—through the experienced eye of the reader—but to be quantitative, we’re adding a level of tremendous sophistication to our diagnoses,” says Martin. “The ability to use automated 3D volumes and automated ejection fractions and to quantitate global and regional strain has been extremely useful.”

Using the Vivid 7 from GE Healthcare, Martin measures patients with heart failure, patients who have had myocardial infarct and complications of that, and patients with very complex congenital abnormalities. “Echo provides amazing diagnostic information across the gamut of disease states,” he says. “And because it is three-dimensional, we think it aids us greatly in making a better diagnosis.” Martin believes that there will be further quantification of not only the function of the heart, but early detection of disease states before they clinically manifest.

Image is everything


Storing images digitally allows users to move them around, manipulate them, and then send them to specialists such