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Transducer Placement
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Education>Expert TTE>Image Orientation>Transducer Placement>1
 
Introduction
 
Unlike TEE, where the plane of imaging is changed using mechanical manipulation of the piezoelectric crystals, TEE imaging planes are changed with movement of the operator’s hand. Each probe has a "notch” or index mark on the transducer tip, that allows for proper image orientation and description of movement. When describing maneuvering of the TTE probe, certain nomenclature should be reviewed.  Motion of the transducer is described as such:
 
  • Angle:  sliding the transducer tip side to side, to image in parallel planes
  • Rotate: twisting the transducer tip in a set position to image bisecting planes
  • Tilt:  rocking of the transducer tip within the same plane
 
To obtain different views from the same acoustic window, the probe can be angled from the same location. Different views of adjacent structures can be interrogated.
 
Figure 4a. Transducer movements and maneuvers. Image source: Echocardiography Pocket Guide: The Transthoracic Examination. Bulwer BE,   Jones and Bartlett Publishers,2011.
The probe can also be rotated upon its axis to obtain different views of the heart. From the same acoustic window, rotation of the probe can obtain different views of the heart.
 
Figure 4b. Transducer movements and maneuvers. Image source: Echocardiography Pocket Guide: The Transthoracic Examination. Bulwer BE,   Jones and Bartlett Publishers,2011.
 
Lastly, tilting the probe from its acoustic window will obtain different views of the heart.
 
Figure 4c. Transducer movements and maneuvers. Image source: Echocardiography Pocket Guide: The Transthoracic Examination. Bulwer BE,   Jones and Bartlett Publishers,2011.
 
Because the heart may be rotated, displaced, or abnormal, fine adjustments of the location of the acoustic window such as the probe angle, rotation, and tilt may be required to bring in the standard views on different patients. Manipulation of the probe requires knowledge of the spatial anatomy of the heart and the patient being interrogated.
 
 
 
Probe Placement/Position
Probe Position
Image 4.3.1
 
The scan plane is a pie-shaped scan sector or image display representing the anatomical scan plane (Figure 8). By convention, the transducer index mark, which appears as a palpable ridge or sign, indicates the part of the image plane that appears on the right side of the image display (Figures 5 and 6).
 
Figure 5. Anatomical scan planes, transducer index mark, and image display (scan sector) convention. Image source: Echocardiography Pocket Guide: The Transthoracic Examination. Bulwer BE,   Jones and Bartlett Publishers, 2011
Figure 6. Transducer index mark, anatomical scan plane, and orientation of image display. Image source: Echocardiography Pocket Guide: The Transthoracic Examination. Bulwer BE,   Jones and Bartlett Publishers, 2011.
 
From the four TTE windows used to image the heart (Parasternal, Apical, Subcostal, and Suprasternal), the table below shows the TTE window, the position of the probe, the direction of the notch, the location of the probe, and structures that are imaged:
Figure 7. Panoramic anatomical displays of the standard transducer ASE-recommended transducer positions or echocardiographic windows. Image source: Echocardiography Pocket Guide: The Transthoracic Examination. Bulwer BE, Jones and Bartlett Publishers, 2011.
Figure 8. Anatomical display of the standard transducer American Society of Echocardiography (ASE)-recommended transducer positions or echocardiographic windows showing standard transducer maneuvers conducted during the normal transthoracic examination.  Image source: Echocardiography Pocket Guide: The Transthoracic Examination. Bulwer BE, Jones and Bartlett Publishers, 2011.
 
Window Patient Position Anatomic Probe Placement Transducer Tip Position to Start
Parasternal Left Lateral Decubitus 3rd or 4th left intercostal space Transducer notch pointing toward right shoulder
Apical Steep Left Lateral Decubitus Mid-axillary line (palpate apex) Transducer notch pointing toward floor
Subcostal Supine, Knees Bent Subcostal slightly right of midline Transducer notch pointing toward patient’s left
Suprasternal Supine, chin pointing to ceiling Sternal notch Transducer notch at 12 o’clock (toward patient chin)
 
Show an image of the view of the pt position and probe and notch direction
 
 
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