In this video the anatomical structures are indicated on the beating heart

Observe: Liver, apex of the heart, basis of the heart, right atrium, right ventricle, left atrium, left ventricle, inter-ventricular septum, inter-atrial septum

The probe is placed on the skin of the thorax, the yellow fan-like sector (scanning plane) diverges from the probe and intersects the heart

The orientation marker (OM – green arrow) of the probe is pointing towards the left side of the patient. The OM corresponds to the orientation indicator (OI) on the right side of the screen

To understand how the sector is presented on the screen, imagine that the upper border of the screen is the skin, and the sector diverges from the probe placed on the skin

The blue radius of the sector on the screen corresponds to the blue border of the yellow fan

The red radius of the sector on the screen corresponds to the red border of the yellow fan

The apex of the heart is displayed on the right side of the screen, when the OM is correctly pointing towards the patient’s left shoulder (the right side of the screen)

The target view is a 4-chamber image showing the structures of the target image, corresponding to the scanning plane illustrated on the torso of the picture

As the RA and RV are placed anteriorly they will appear in the near field and LA and LV appear in the far field

The key to successful imaging for beginners is to use a systematic approach

Always have the FATE card in front of you or use the posters available during the workshops

Ask yourself – and during the workshop also the rest of the group:
1. Which position – 1, 2, 3 or 4?
2. How should I hold the probe?
3. Whereto should the orientation marker (OM) be pointed?
4. What should appear on the screen?

By convention the orientation indicator on the screen is placed at the right side of the screen by the cardiologists, but on the left side of the screen by radiologists and emergency physicians

Since the orientation marker on the transducer should point in the cranial direction, the diaphragm is seen on the right side of a cardiologist’s screen (when cardiac transducer in chosen) and on the left side of a radiologist’s / emergency physician’s screen (when non-cardiac transducers are employed)

This can be a bit confusing, but is easily adapted when the convention is understood

The pleural views are suitable for evaluation of:
– Pleural effusion
– Atelectasis/lung parenchyma
– Pneumothorax
– Pulmonary edema
– Correct intubation confirmed by bi-lateral lung sliding

The FATE position 1 is called the subcostal or subxiphoid view

The subcostal view is a 4 chamber view, imaging all 4 chambers of the heart

The position obtained in position 1 is indicated on page 1 of the FATE-card

The subcostal 4-chamber view is suitable for a quick qualitative evaluation of:
– pathology (pericardial effusion, pulmonary embolus)
– wall thickness
– chamber dimensions
– bi-ventricular function

You will now be taken through the positions in detail, focusing on how to obtain and interpret the right 2D ultrasound image

Recall the content of the scanning guide on the previous pages

Holding the probe in your right hand:
1. apply gel without touching the footprint of the probe with the gel dispenser
2. place the transducer on the chest wall where you expect to get the desired image
3. move your hand in small circles until you recognise any anatomical structures on the screen
4. then stop circling and optimise the image in only one plane at the time by means of:
– rotating
– tilting
– sliding
the transducer

Never move the probe in more than direction at the time
When you are familiar with this scanning procedure proceed to the next page

Page 1 on the FATE card is used for this part of the FATE examination

Position 1 is indicated on the FATE torso in the lower right corner of the card

The image in the upper left corner of page 1 of the FATE card is the target image to be obtained in position 1

Study the FATE card, and memorize position 1 and the target image before beginning the examination

The parasternal short axis view (PSAX) is obtained from position 3 by aiming the orientation marker on the transducer at the patient’s left shoulder

In this view two cardiac chambers can be visualized:
– Left ventricle (LV)
– Right ventricle (RV)

The parasternal short axis view (PSAX) on the right shows how the image should appear by convention on the screen

This view is suitable for a quick evaluation of:
– Pathology
– Dimensions of cavities: Left and right ventricle
– Myocardium: Left and right ventricle
– Left ventricular function:
– Global
– Regional (Myocardium with blood supply from all three coronary arteries represented)