1) Cardiac

•  general criteria for all clips:
• indicator mark on screen right for all clips
• all files should be clips rather than still images

 

Parasternal long-axis

• axis:
• following structures visible: LV, LA, RV, LVOT, aortic valve, mitral valve
• functional finding: 
• aortic & mitral valve both seen opening @ appropriate part of the cardiac cycle
• gain:
• blood is either grossly anechoic (black) or mostly anechoic with just a few specks of grey
• depth:
• able to see at least descending thoracic aorta

 

Parasternal short-axis

• axis:
• following structures visible: LV @ mid-ventricular level, RV
• gain:
• blood is either grossly anechoic (black) or mostly anechoic with just a few specks of grey
• depth:
• able to see deep enough to visualize parietal pericardium

 

Apical 4-chamber

• axis:
• following structures visible: LV, RV, RA, LA, mitral, tricuspid
• functional finding: 
• tricuspid & mitral valves both seen opening in diastole
• gain:
• blood is either grossly anechoic (black) or mostly anechoic with just a few specks of grey
• depth:
• able to see deep enough to see just posterior to the atria

 

Subcostal 4-chamber

• axis:
• following structures visible: LV, RV, RA, LA, tricuspid, (optional = mitral)
• functional finding: 
• tricuspid valve seen opening in diastole
• gain:
• blood is either grossly anechoic (black) or mostly anechoic with just a few specks of grey
• depth:
• able to see deep enough to just posterior to parietal pericardium deep to the LV

 

IVC long-axis

• axis:
•  following structures visible: IVC (NOT aorta or hepatic vein) in long-axis, liver
• gain: 
• blood is either grossly anechoic (black) or mostly anechoic with just a few specks of grey
• depth: 
• able to see deep enough to see behind the IVC to see if there is liver tissue or spine there (i.e., if liver posterior to IVC, this supports the identification structure as IVC whereas if spine is posterior, supports identification of this structure as aorta)

 

2) Lung

• general criteria for all clips:
• indicator mark on screen left for all clips
• all files should be clips rather than still images

 

anterior or antero-lateral lung view

• axis:
• cranial & caudal ribs/rib shadows visible
• should be able to visualize whether lung sliding is present or absent
• depth:
• if B-lines are visible, screen depth should be enough to see the B-lines obliterate at least 2 A-lines (typically at least 10cm)
• if only A-lines are visible, one only needs enough screen depth to visualize the first A­ line
• gain:
• gain should be low enough to see pleural line distinct from surrounding structures

 

postero-lateral lung view

• axis:
• should be able to see the following structures: diaphragm, spine caudal to the diaphragm, supradiaphragmatic space
• depth:
• should be set deep enough to see the spine
• gain:
• gain should be high enough to see liver/diaphragm as having medium (tissue-like) echogenicity (i.e., liver/spleen should NOT be completely anechoic)

 

3) Gastric

• general criteria for all clips:
• indicator mark on screen left for all clips
• video clips are preferred but still images will be considered if they are of high-quality
• need to include both a supine and a RLD clip for purposes of the supervised portion of the portfolio (note: in routine clinical practice, the RLD view can be skipped if the supine shows either solids or a grossly distended antrum)
• axis:
• should be able to see the following structures: liver, antrum in full circumference, aorta (exception when there is recent solid intake in which case the aorta may be obscured by air artifact in the antrum)
• depth:
• should be set deep enough to see the aorta, or where it aorta expected to be
• gain:
• should be set so that the liver appears of medium echogenicity (grey) and the content of aorta appears anechoic