Comprehensive Echocardiogram Protocol and Best Practices

Pre-Examination Preparation

Patient Preparation

• Verify patient identity and order appropriateness
• Obtain relevant clinical history and indications
• Position patient in left lateral decubitus position
• Ensure ECG leads are properly placed

Equipment Setup

• Initialize ultrasound system
• Select appropriate transducer (2-4 MHz)
• Enter patient demographics
• Optimize machine settings

Standard Views and Measurements

Parasternal Long Axis (PLAX)

1. Obtain view at 3rd-4th intercostal space
2. Measure:
   • LV dimensions
   • Septal and posterior wall thickness
   • LVOT diameter
   • Aortic root dimensions

Parasternal Short Axis (PSAX)

1. Rotate transducer 90° clockwise from PLAX
2. Obtain images at multiple levels:
   • Aortic valve level
   • Mitral valve level
   • Papillary muscle level
   • Apex level

Apical Views

1. Four Chamber View

   • LV and RV size/function
   • Mitral and tricuspid valve assessment
   • Tissue Doppler imaging

2. Five Chamber View

   • LVOT and aortic valve assessment
   • CW/PW Doppler measurements

3. Two Chamber View

   • LV wall motion
   • Mitral valve assessment

Subcostal Views

• IVC dimensions and respiratory variation
• Pericardial assessment
• RV size and function

Doppler Assessment

Color Doppler

• All valves from multiple views
• Septal defect screening
• Great vessels

Spectral Doppler

1. Pulse Wave Doppler

   • Mitral inflow
   • Pulmonary venous flow
   • LVOT velocity

2. Continuous Wave Doppler

   • Aortic valve gradients
   • Tricuspid regurgitation velocity

Image Optimization and Documentation

Required Documentation

• Complete set of standard views
• M-mode measurements
• Doppler recordings
• Calculations of key parameters

Quality Assurance

• Review for image quality
• Ensure all measurements are accurate
• Document any technical limitations

Post-Examination

Data Management

• Save all images and measurements
• Complete preliminary report
• Archive study appropriately

Patient Care

• Clean equipment
• Provide post-exam instructions
• Schedule follow-up if needed