How the Future of Ultrasound hinges on Election…..

Ultrasound in hands of BossJust a quick thought today about healthcare in general and Ultrasound’s and Sonography’s future in specific.  This will effect all modalities including Echocardiography (Cardiac Ultrasound), Vascular Sonography and General (OB/GYN)  Ultrasound.

As many of you are already aware the Obamacare law has slashed the reimbursements for Echocardiography, Vascular Ultrasound, and General Ultrasound.  This has had, in my opinion, a great influence on the number of Echocardiographers, Vascular Techs and Ultrasound Techs being hired.  Many facilities have gone to PRN sonographers in leu of full time positions.  Thus the final symposis is their are very few jobs being offered right now, at a time when graduate numbers are increasing.  Also added to this is that when fully implemented, Obamacare, will greatly increase the number of patients requiring Echo, Vascular, and Ultrasound studies.  So while lowering reimbursements, causing fewer techs, raising the number of studies requested.  Sound like a formula for wait lists, shortages, etc?  We at the Academy are already noticing many imaging centers and Dr. offices no longer offering inhouse studies. (More Echo, Vascular, and Ultrasound techs without employment)  This will greatly influence Echocardiography Training and Vascular Training and Ultrasound Training.  It is more important than ever to attend a program that has passing the ARDMS or CCI registry as part of their curriculum.

So back to the thought for today. I came across this article dealing with the future of Healthcare after the Election.  It discusses both alternatives, considering the election outcome.

A short excerpt:

“the future of ObamaCare is at stake in next week’s elections. If President Obama wins and Democrats hold the Senate, the Affordable Care Act will survive. If Mitt Romney wins and Republicans take the Senate, the law is dead. It is the starkest of differences”

You can find the remainder of the article at:

No matter how your political views swing, I feel that the Healthcare law and its future will have a dramatic impact of the future of Echocardiography, Vascular and General Ultrasound jobs going forward.

As always if this info was interested like it and share it with your social networks.

By John Sheldon

Virtual Echocardiography Training

Vita Echo Echocardiography Virtual TrainingJust announced last night is a new breakthrough in the world of Ultrasound, specifically Echocardiography Training.

As you know the Academy of Ultrasound, LLC, has an established Echocardiography program offering online training for new Echo Techs.  One of the greatest challenges is providing online students with practice and visual aids, on the performance of the actual Echocardiogram.  The distance format makes this an even greater concern.  To date, the Academy of Ultrasound, LLC is offering visual aids in the form of pictures, videos of Echocardiograms both performed and being performed.  This has been the standard, in Online Echocardiography training since its start.

Now the good news.  A company named Vita Systems has created a Virtual Echocardiography Training software to solve these concerns.  This product, dubbed VitaEcho was announced on 10/24/12 at a conference in Miami, Fl.  They describe the product as,

“a software platform designed to teach the mechanics of echocardiography, before a practitioner ever encounters a live patient”

The official description is,

“The VidaEcho system features a simulated 3D anatomy of the heart, and the corresponding echo image.  By moving a virtual echo probe handle with a mouse, users learn how the device will interact with cardiac anatomy.  The application features an intuitive user interface and highly realistic depictions of the heart’s anatomy and ultrasound, with both transesophageal (TEE) and transthoracic (TTE) modes available.  The system offers preset views but can also be customized.  Features also include the ability to overlay the echo image onto the 3D anatomy, so that the practitioner can internalize the translation of 3D anatomy to 2D images, a common hurdle for mastering echocardiography learning.”

So now we are beginning to get training products that can help Online Echocardiography Training programs to give thier students a visual and hands on way of developing hands on skills and begin to visualize the cardiac anatomy in 3D.  This will help immensely in the Echo Students comfort before they begin the clinical portion of their Echocardiography Training.

Although the announcement of the VitaEcho system has happened, the product hasn’t become officially available just yet.  Since this product is in the cloud, and software based, we at the Academy of Ultrasound, LLC are hoping the pricing will allow us to take advantage of this breakthrough in Online Echocardiography Training.  Check back and we will continue to update this story as Vita Echo becomes available for use.

As always, if you found this info interesting, like us and share this article with your social networks.

By John Sheldon




Echocardiography used as Henry Doorly Zoo gorillas screened for heart disease

Gorilla Echocardiography

I was browsing ultrasound articles this morning and came across an interesting piece.

Apparently gorillas in captivity suffer from Heart Disease, as one of the major killers.  This is surprising since they don’t engage in any of the destructive behaviors that are thought to be contributors to human heart disease.

With the increasing use and image quality of portable echocardiography machines, Drs are not able to perform ultrasounds on the gorillas while awake.  This is amazing, the gorillas are trained to allow the echocardiogram to be performed while the stay calm and relaxed.  Wish we could train some of our ultrasound patients to do the same.

Just shows us that the future of Ultrasound and Echocardiography is always expanding into uncharted territory.  Check out the full story at the link below.

Henry Doorly Zoo gorillas screened for heart disease –

If you liked this article be sure to share with your internet friends on facebook, twitter, etc.

Good luck with your future scanning.

By John Sheldon


Explaining Echocardiography and the Transthoracic Echocardiogram

Transthorasic EchocadiogramSince starting the Echocardiography program at the Academy of Ultrasound, LLC, we are constantly looking for new and improved reference materials.  The hope is to better explain, to our students and patients, what we as sonographers do and what the ultrasound test is.

One of the spots we frequent is the Family Practice Notebook (  Recently we found a new outline formatted description of an Echocardiogram.  Its a great synopsis, complete with references to common terms and images. 

Below is their description.  Review it and leave any comments you might have.  We feel it will help with your understanding of the basic Echocardiography exam.

If you like it be sure to share this with your friends.



 Transthoracic Echocardiogram

See Also

    1. Transesophageal Echocardiogram
    2. Echocardiogram in Congestive Heart Failure
    3. Stress Echocardiogram
  • Background
    1. Use Phased-Array transducer (1-5 MHz)
      1. Faster frame rate to catch dynamic images throughout cardiac cycle
      2. Use cardiac preset
        1. Transducer marker corresponds to screen right (contrast with other presets where marker is on screen left)
    2. Most patients will have one adequate view to visualize heart function
      1. Quality of view is inversely proportional to body habitus (i.e. Obesity degrades the view)
      2. However, technique for a single view can be modified to visualize most structures
    3. Emergency Echocardiography (or Focused UltrasoundExamination) does not replace a complete Echocardiogram
      1. Emergency Echocardiogram is done to answer specific emergency related questions
  • Precautions
    1. Pericardial Effusion
      1. Features
        1. Pericardial Effusion will surround the heart and should be seen in multiple views
        2. Pericardial fluid moves in opposite direction as heart wall
        3. Cardiac Tamponade
          1. Right heart wall movement will be paradoxical rocking motion
            1. Right atrium collapse in systole (also occurs with hypovolemic shock)
            2. Right ventricular collapse in diastole
      2. Differential diagnosis (look-alikes on Echocardiogram, confirm in multiple views)
        1. Pericardial fat pad (moves with heart wall)
        2. Descending aorta
  • Indications: Emergency Echocardiogram
    1. Cardiac Arrest
      1. Cardiac standstill
        1. Distinguish from Ventricular Fibrillation appearance (shimmering appearance of ventricular wall)
        2. Distinguish from lung excursion with Positive Pressure Ventilation (stop PPV to visualize heart activity)
        3. Prolonged cardiac standstill may demonstrate congealed blood in ventricle
        4. Associated with little to no chance of survival (helps direct cessation of code)
          1. Blaivas (2001) Acad Emerg Med 8:616
      2. Identify reversible causes of PEA
        1. Cardiac Tamponade (Pericardial Effusion and right ventricular collapse in diastole)
        2. Hypovolemic shock (hyperdynamic heart with with small ventricular chamber)
        3. Pulmonary Embolism (new dilated right ventricular chamber)
        4. Myocardial Infarction (new wall motion abnormality, decreased contractility or EF)
    2. Shock or Hypotension
    3. Acute Dyspnea
    4. Trauma
      1. See FAST Exam
    5. Myocardial Infarction
    6. Ultrasound-Guided Pericardiocentesis
  • Views: General
    1. Parasternal Echocardiogram View
      1. Parasternal Long-Axis Echocardiogram View
      2. Parasternal Short-Axis Echocardiogram View
    2. Apical Echocardiogram View
    3. Subcostal Echocardiogram View
    4. Suprasternal Echocardiogram View
  • Views: Parasternal Long-Axis Echocardiogram View
    1. Improved window (bring heart closer to transducer and reduce rib shadowing)
      1. Patient positioned in left lateral decubitus position
      2. Start along sternal border near the 3rd interspace and check several interspaces inferiorly and laterally
    2. Transducer orientation
      1. Transducer 3-5 cm to the left of the left sternal border at the 3rd to 5th intercostal space
      2. Transducer indicator pointed towards patient’s right Shoulder (10:00 position)
    3. Images
      1. UltrasoundHeartPLAXAndPSAX.jpg
    4. Landmarks
      1. Right ventricle or right ventricular outflow tract
      2. Left ventricle, aortic valve and proximal aorta
      3. Mitral valve and left atrium
      4. Descending Aorta
    5. Conditions
      1. Visualizes the positions of the parasternal short axis cross sections (see below)
      2. Wall motion abnormalities (especially apex and septum)
      3. Valvular insufficiency (Mitral Regurgitation or Aortic Insufficiency) with color doppler
      4. Aortic root dilation (best imaged with same probe orientation but at the 3rd intercostal space)
      5. Left ventricular Systolic Dysfunction(CHF)
        1. Decreased contractility of left ventricle
          1. Normal
          2. Depressed or severely depressed
          3. Hyperdynamic
        2. Decreased ejection fraction
          1. Gross Estimate
            1. Estimate visually what percentage difference is seen between the left ventricle volume in systole and diastole
            2. M-mode compare end-systolic (ESD) and end-diastolic (EDD) diameters
          2. Linear calculation: Ultrasoundcalc package
            1. In M-Mode, measure end-diastolic (EDD) and end systolic (ESD) diameters
            2. Ejection fraction = 100 * (EDD^3 – ESD^3) / EDD^3
        3. Dilated left ventricle (end diastolic diameter >56 mm)
          1. Measure across widest point between septum and posterior wall
          2. Chordae tendinae may obscure true posterior wall
        4. E-point septal separation (EPSS) on M-Mode or cine
          1. Distance between the septum and the mitral valve leaflet when maximally open
          2. Normal is <8-10 mm (>20 mm is correlated with an EF<30%)
  • Views: Parasternal Short-Axis Echocardiogram View
    1. Transducer orientation (start)
      1. Transducer Rotated 90 degrees clockwise from Parasternal Long Axis View
      2. Transducer 3-5 cm to the left of the left sternal border at 3rd to 5th intercostal space
      3. Transducer indicator pointed towards patient’s left Shoulder (1:00 position)
    2. Transducer gradually tilted down heart axis to obtain 4 heart cross-sectional slices
      1. Aortic valve level
      2. Mitral valve level
      3. Mid-ventricle level
      4. Heart apex
    3. Images
      1. UltrasoundHeartPLAXAndPSAX.jpg
    4. Landmarks: Aortic valve level
      1. Right ventricular outflow tract
      2. Tricuspid valve, aortic valve (peace or mercedes sign when tri-leaflet) and pulmonic valve
      3. Right atrium, left atrium and pulmonary artery
    5. Landmarks: Mitral valve level
      1. Right ventricle
      2. Mitral valve (anterior and posterior leaflets appear as a fish mouth opening and closing)
    6. Landmarks: Mid-ventricle level
      1. Right ventricle
      2. Left ventricle (with trabeculations representing papillary muscles)
    7. Landmarks: Apical level
      1. Right ventricle (much smaller in size than left ventricle unless right ventricle dilated)
      2. Left ventricle
    8. Conditions
      1. Bicuspid aortic valve (Aortic valve level)
      2. Left ventricle wall motion abnormality (mid-ventricle level)
        1. Best view to see all left ventricle walls
  • Views: Apical Four Chamber Echocardiogram View
    1. Transducer orientation
      1. Transducer placed at PMI or approximately xiphoid level (6th intercostal space) in mid-clavicular line or nipple line
      2. Transducer indicator pointed towards patient’s left (3:00 position)
      3. Align energy toward right Shoulder along heart’s long axis
      4. Hand holding transducer is pushed with knuckles into the bed to get best angle through heart
    2. Landmarks: Four chamber heart view
      1. Right ventricle and left ventricle
      2. Tricuspid valve and mitral valve
      3. Right atrium, left atrium and descending aorta
    3. Conditions
      1. Pericardial Effusion
      2. Apical thrombus (decrease depth to see, apex is closest to probe in this location)
      3. Systolic Dysfunction
      4. Wall motion abnormalities
  • Views: Subcostal Echocardiogram View (or subxiphoid view)
    1. See FAST Exam
    2. Pearls to improve view window
      1. Consider starting this view longitudinally with indicator at 12:00 to identify left lobe of liver and angle through heart
      2. View improves with the patient taking a deep inspiration
    3. Transducer orientation
      1. Hold transducer over the top (more at the base of probe) to allow for a more shallow angle
      2. Push the transducer down (posteriorly) to drop below (deep) to the xiphoid process
      3. Transducer placed sub-xiphoid (by 1-2 cm) in superior epigastrium
      4. Transducer indicator pointed towards patient’s right (9-10:00 position) with energy toward left Shoulder
    4. Landmarks
      1. Four chamber heart view
      2. Increase angle of approach (aiming more posterior) if aorta is seen in the four chamber view
    5. Conditions
      1. Pericardial Effusion
      2. Systolic Dysfunction
      3. Wall motion abnormalities
  • Views: Subcostal Longitudinal (volume status view)
    1. Pearls to improve view window
      1. View improves with the patient taking a deep inspiration
    2. Transducer orientation
      1. Transducer placed right lateral to sub-xiphoid
      2. Transducer indicator pointed towards 12:00 with energy toward left atrium
    3. Landmarks
      1. Inferior vena cava
      2. Right atrium
    4. Conditions
      1. Volume depleted (e.g. Hemorrhagic Shock, dehydration)
      2. Volume overload (e.g. Congestive Heart Failure)
    5. Interpretation: Volume status based on IVC alone
      1. Inferior vena cava (IVC) is normally 1.5 to 2.5 cm in diameter (measured 3 cm from atrium)
        1. IVC <1.5 cm suggests volume depletion
        2. IVC >2.5 cm suggests volume overload
      2. Inferior vena cava (IVC) normally collapses more than 50% with inspiration or sniffing
        1. Total collapse suggests volume depletion
        2. Collapse <50% suggests volume overload
      3. Correlation between RA pressure (CVP) and IVC appearance
        1. CVP 0-5 cm: IVC totally collapses on inspiration and is <1.5 cm in diameter
        2. CVP 5-10 cm: IVC collapses >50% on inspiration and is 1.5 to 2.5 cm in diameter
        3. CVP 11-15 cm: IVC collapses <50% on inspiration and is 1.5 to 2.5 cm in diameter
        4. CVP 16-20 cm: IVC collapses <50% on inspiration and is >2.5 cm in diameter
        5. CVP >20 cm: No change in IVC on inspiration and is >2.5 cm in diameter
    6. Interpretation: Volume status by Caval Aorta Index
      1. Step 1: Measure maximal internal IVC anteroposterior diameter (in M Mode)
        1. Subxiphoid level in longitudinal axis
        2. Measure just caudal to confluence of hepatic veins
      2. Step 2: Measure maximal internal aorta anteroposterior diameter (in M Mode)
        1. Subxiphoid region in longitudinal axis
        2. Measure just to the left of the IVC
      3. Step 3: Calculate the Caval Aorta Index as IVC/Ao
        1. CVP <7 cm H2O: Caval Aorta Index of 0.72 (+/- 0.09)
        2. CVP 8-12 cm H2O: Caval Aorta Index of 1.23 (+/- 0.12)
        3. CVP >13 cm H2O: Caval Aorta Index of 1.59 (+/- 0.05)
      4. Reference
        1. Sridhar (2012) ISRN Emergency
  • Views: Suprasternal Echocardiogram View
    1. Transducer orientation
      1. Transducer placed in suprasternal notch
      2. Transducer indicator pointed towards 9:00
      3. Align energy inferiorly (towards feet) until arch comes into view
      4. Rotate transducer clockwise until arch is in full view
    2. Landmarks
      1. Brachiocephalic artery, Left Carotid Artery, Left subclavian artery
      2. Aortic arch
      3. Right pulmonary artery
      4. Left atrium
    3. Conditions
      1. Aortic Dissection
      2. Aortic aneurysm
  • Resources
    1. Sub-xiphoid View Video (SonoSite)
    2. Apical 4-Chamber View Video (SonoSite)
    3. Parasternal Long Axis View Video (Sonosite)
    4. Parasternal Short Axis View Video (SonoSite)
    5. Suprasternal Notch View Video (Sonosite)
    6. Inferior Vena Cava UltrasoundVideo (SonoSite)
    7. Echocardiographer
  • References
    1. Mateer and Jorgensen (2012) Introduction and Advanced Emergency Medicine Ultrasound Conference, GulfCoast Ultrasound, St. Pete’s Beach
    2. Noble (2011) Emergency and Critical Care Ultrasound, Cambridge University Press, New York, p. 61-88
    3. Reardon (2011) Pocket Atlas Emergency Ultrasound, McGraw Hill, New York, p. 61-106

By John Sheldon

What is an Echocardiogram?

Echocardiography HeartToday I was searching the web for interesting topics in the field of Echocardiography and Ultrasound in general.  This process started me thinking; We speak about echocardiograms and other Ultrasound studies all the time, but do our readers always know what the exams are?

One of the articles I found, does a pretty good job of explaining exactly what an Echocardiogram is.  I have decided to share this with my readers.

Here is an excerpt from the article:

What is an echocardiogram?
An echocardiogram is a non-invasive diagnostic test performed to evaluate the heart’s function. While the echocardiogram is being done, both you and your doctor will be able to watch your heart, as it beats, on a small monitor. It is often performed on pediatric cardiac patients.
What kinds of things can an echocardiogram find?
An echocardiogram is able to monitor the performance of the valves. It can help to diagnose structural abnormalities in the heart wall, valves, and blood vessels. It can detect tumors, clots or pericardial effusions (abnormal fluid collection around the heart). It is sometimes used after a heart attack to evaluate the cardiac wall motion and function. The most frequent use of an echocardiogram is for diagnosing or monitoring congenital heart disease, cardiomyopathies or aneurysms.

 The link to the full article is  This is worth reading.

If you enjoy this post consider sharing with your favorite sites.



Echocardiographers, cardiac sonographers: info on Tetralogy of Fallot

Hello, everyone.  It has been a while since our last post.  However, I wanted to share some information I thought to be interesting.  While completing my weekly reading and research, I came across an interesting article and thought I might share it with our readers;


By all  means, post comments on your opinions of the article.  I believe sharing various experiences in the field of sonography;  with today’s emphasis on echocardiography, can only make a better sonographer.  So, feel free to share your experiences and other material you may find in your research that may be helpful to your colleagues.


Have a Great day!

PH:  (866) 867-2824

Echocardiography, Vascular, and General/Vascular Cross-training: Become dual-certified as a Sonographer


Sonography/Ultrasound Cross-Training 
Training for an additional ultrasound modality can only make you more valuable as a Sonographer.  In today’s completitive job-market, it is not always enough to be certified in one ultrasound specialty. By becoming dual-certified, you are not only adding to your value as a technician; but also the quality of care you offer to your patients.   In most cases, being a dual-registered ultrasound technician can lead to an increase in pay.



Echocardiography, Vascular, and General/Vascular
The additional modalities of ultrasound training are: Echocardiography, Vascualr, and General/Vascular sonography.  If you are already registered in one modality, you qualify for the shorter-term crossover program at the Academy of Ultrasound.  With the increased popularity of this program, we have added additional spots to online course.  So, contact us – NOW- to reserve your space.  You may be eligible for the special discount being offered.

Contact the Academy of Ultrasound to reserve your spot before availability is closed.  You can email: or call PH# 1-866-867-2824

Current Positions Available in: Sonography; Echocardiography, Vascular, and General Ultrasound



Since employment opportunities in ALL industries are hard to come by, even in the best of economic conditions, I am including some of the postings for ultrasound positions I have found while researching other sonography-related topics.  I am providing links to positions across the U.S. in Echocardiography, Vascular, and General Ultrasound.  These are just a few suggestions.  Feel free to add to the list and even post other possibilities that you have encountered; but, may not be the position for you.

I have compiled this information in one place in an attempt to save time for the reader in their job search.  I do hope this information is useful.

1)  Echocardiography Lab; per diem  –

2)  Cardiac Sonographer –

3)  Diagnostic Medical Sonographer Instructor/Clinical Director –

4)  Cardiac Sonographer –

5) Sonographer –

6)  Cardiac Sonographer; per diem –

7)  Cardiac sonographer; PRN, near Pensacola, FL. –

8)  Sonography Jobs; Redondo Beach –,%2520CA/&ct=ga&cad=CAcQARgBIAEoBDAAOABAj4TE8QRIAlgAYgVlbi1VUw&cd=OH0zqwMp_Pk&usg=AFQjCNGW69pih_owsemqDcNrG-4UXe4TEA

9)  Echo-Sonographer for La Crosse in WI –

10)  Cardiovascular Sonographer; Portland, OR –

** You can also go to “” and search the job postings for ultrasound, sonography, Echocardiography, Vascular,  and General ultrasound jobs available.


                                                      We invite you to follow us on FaceBook and subscribe to this blog.  Thanks, again, to the Academy of Ultrasound.









Traveler Sonography Series: Endocarditis; results of echocardiography study




Good afternoon to all of you sonographers; Echocardiographers, General ultrasound technicians, Vascular technicians, and/or our valued blog followers who are interested in various case studies. 

Today’s study involves a patient who has been in hospital for a while and has had to be incubated.  A couple of weeks ago, an echocardiogram was performed that resulted in no unusual findings.   However, new study was completed that detected a large growth.  Listen to the video for the details. 


Feel free to express and share your thoughts and experiences.  Again, thanks to the Academy of Ultrasound AND THANK YOU for following our blog.  We appreciate and look forward to your input into the discussion.   If there are specific topics/studies that you would like to discuss or receive more information on, again, do not hesitate to request.  We have many resources and would welcome the opportunity to share with you.





New Sonography Series on Interesting Ultrasound Case Studies: Echocardiography, Vascular, and General Ultrasound

Good afternoon to all of you!  As a follower of our SoundWaves ultrasound blog, you are already aware that we have recently started a songraphy series.  This series includes video information on interesting, as well as unusual, case studies experienced by our sonographers in echocardiography, vascular and general ultrasound.  These are submitted while completing travel assignments across the United States.  This is a helpful teaching tool for students and veteran techinicians in the ultrasound field.

We would like for YOU to share your interesting and unusual case studies with us and our followers.  These experiences can be in any of the ultrasound modalities: Echocardiography/Cardiac, Vascular, or General sonography.  Also, your submission can be in written form and/or video.  However, if video, we ask that the maximum length not exceed 5 minutes.  Please incude details of case study scenario; but, of course, do NOT use any names.  We want to share these studies on the Academy of Ultrasound’s facebook page and our blog.

Again, thank you for your support and following.