Echocardiography Protocol: Step-by-Step Execution, Measurements, and Conclusion

Preparation for the Study

Before starting, familiarize yourself with the referral, indications, and diagnosis, review medical records and previous echo reports for comparison. Prepare the equipment: electrodes, ultrasound gel, clean bedding, transducer (Blagodir, 2024).

Enter the patient's data into the device, verify the name, date of birth, and medical record number. Position the patient on the couch, connect 3 ECG electrodes, and adjust the couch height. The ECG channel is mandatory: the study is synchronized with the electrocardiogram, and modern modalities (speckle tracking, automatic volume analysis, and LVEF) do not work without an installed ECG module.

Position and Scanning Technique

Scanning is performed with the left or right hand depending on the echolab features and personal preference — it is optimal to be proficient with both hands. When scanning with the right hand, the patient lies with their back to the operator, the hand wraps around the patient's body, relieving tension. This position may be suboptimal in the operating room, in case of injury, and with hygiene issues in the patient.

Synchronization with the Cardiac Cycle

The end of diastole corresponds to the R wave, and the end of systole to the end of the T wave on the synchronously recorded ECG. It is to these phases that linear measurements are tied.

Linear Measurements in LAX LV (End of Diastole)

When measuring septal thickness, the measurement is typically taken at the level of the leaflet tips; it is actually permissible slightly above or below, as this part of the LV is rectangular. The main thing is not to include the moderator band in the measurement, which sometimes extends along the septum: it significantly differs in echogenicity. This is where significant skew is most often allowed (2025).

Study Modes

Step-by-step TTE includes 2D mode, M-mode, and all types of Doppler studies. M-mode is not recommended for assessing heart chambers.

Color Flow Doppler (CFD)

The specialist selects the color map (velocity or variance). In most labs, flow towards the transducer is colored red, away from the transducer is blue (BART scheme, Blue Away Red Toward). The higher the flow velocity, the more turbulent it is — this manifests as a mosaic pattern (yellow, light blue, green shades). The optimal Doppler angle is parallel to the flow (0° or 180°); it is necessary to set the optimal CFD gain.

Doppler Measurements: Common Errors

For CW Doppler, measure the densest primary edge of the signal (“chin”), not the weakly expressed areas (“beard”), optimizing gain and brightness from several planes. Position the ultrasound beam parallel to the blood flow, ideally at an angle <20° to minimize velocity measurement error. In pronounced TR, the CW Doppler signal shape helps assess the accuracy of RVSP calculation (Mukherjee, Rudski et al., 2025).

Indexing Parameters and Conclusion

When assessing patients with overweight and obesity, it is advisable to index quantitative echo parameters to the ideal body surface area: it remains unchanged throughout the observation period, allowing tracking of cavity size and LV wall thickness dynamics with changes in body weight. When indexing to the actual body surface area, it is not possible to track dynamics, as the area itself changes. In routine studies, it is possible to embed the Mosteller formula in the device, specifying boundary values by calculation (2025).