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 apical 4-chamber view is obtained from position 2

In this view these cardiac chambers can be visualised:
– Left atrium (LA)
– Right atrium (RA)
– Left ventricle (LV)
– Right ventricle (RV)

The apical 4 chamber view below shows how the image by convention should appear on the screen

This view is suitable for a quick qualitative evaluation of:
– Pathology
– Wall thickness
– Chamber dimensions
– Bi-ventricular function

At the left parasternal position – FATE position 3 – two different views are obtained

1) The parasternal long axis view (PLAX)

2) The parasternal short axis view (PSAX)

The parasternal long axis view (PLAX) is obtained from position 3 by aiming the orientation marker of the transducer at the patient’s right shoulder

In this view these cardiac structures can be visualised:
– Left atrium (LA)
– Left ventricle (LV)
– Right ventricle (RV)
– The aortic root (AO)
– The mitral valve

The FATE card is made to assist your memory

The FATE card shows you:
– Where to place the transducer on the thorax for each of the four positions
– The direction of the transducer orientation marker (OM)
– The rotation of the transducer
– The expected sonographic image

Standard cardiac abbreviations used throughout the course:
LA = left atrium
RA = right atrium
LV = left ventricle
RV = right ventricle
AO = aorta
IVS = interventricular septum
IAS = interatrial septum

You can download the FATE card from: usabcd.org/FATE-card

Recall the content of the scanning guide on the previous page

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 recognize any anatomical structures on the screen
4. Then stop circling and optimize the image in only one plane at a time by means of:
– rotating
– tilting
– sliding
the transducer

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

A systematic approach is a prerequisite to successful imaging performed by a novice

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. Where should the orientation marker (OM) be pointing to?
4. What should appear on the screen?

The subcostal 4-chamber view is obtained from position 1

In this view these cardiac structures can be visualised:
– Left atrium (LA)
– Right atrium (RA)
– Left ventricle (LV)
– Right ventricle (RV)

The subcostal 4 chamber view shows how the image by convention should appear on the screen

Observe the liver lying “above” the heart, and the base of the heart at the left side of the screen, and the apex of the heart at the right side of the screen

The subcostal 4-chamber view is suitable for a quick qualitative evaluation of:
– Pathology
– Wall thickness
– Chamber dimensions
– Bi-ventricular function