Image
Optimization

DEFINITY® Delivers High-Quality Images¹

Image optimization is important when performing a DEFINITY® echo where the image always dictates the appropriate settings.²

Are You Optimizing the Use of Contrast
Echocardiography? A Case-Based Discussion

Anita M. Kelsey, MD, and Steven Walling, RDCS, explore 2 cases to illustrate the importance of teamwork, operational efficiency, and the appropriate use of DEFINITY® in achieving quality echocardiographic imaging.

Image Optimization Guide

Ultrasound System Control Adjustments Vary by Patient and Ultrasound System³

Key Controls to Optimize Image Quality

Mechanical Index/Power: Strength of Ultrasound Beam³

Adjust power to adequately visualize cardiac anatomy

Frequency: Affects the Penetration of the Ultrasound Beam and Image Resolution⁴

Choose a frequency for optimal image resolution

Focus: Narrowest Area of the
Ultrasound Beam With the
Greatest Ultrasound Intensity^3,4

Place focus at the mitral valve level for optimal visualization of the left ventricle

Position focus at area of interest when evaluating pathologies, regional wall motion

High frequencies provide less depth of penetration with greater image resolution.⁴
Low frequencies provide greater depth of penetration with lower image resolution.⁴

Power/Mechanical Index Can Have the Greatest Impact on Overall Image Quality³

Power adjustments vary by patient and ultrasound system

Power too low

Power optimized

Secondary Controls to Optimize Image Quality

Gain: boosts the amplification of received echos^2,4

When gain is set too high, the image may appear too bright

When gain is set too low, the image may appear too dark

Dynamic range/compression: adjusts the range of shades of gray displayed in 2D images^2,3

When setting is too high, the image may appear washed out

When setting is too low, the image may appear dark

Speed of administration and system settings contribute to optimal image quality³

Optimal Opacification³

An ideal administration rate enables a homogeneous fill of the left ventricular cavity

Fast Injection — Attenuation^2,5

Creates a high concentration of microbubbles in the apex
Can be manipulated using the “flash” method to enhance or decrease opacity and evaluate abnormalities

Swirling²

Insufficient opacification that inhibits the adequate assessment of structural abnormalities, wall motion, and left ventricular function.

Injection rate too slow or insufficient dose
Inadequate system settings
Poor LV function

Left ventricular function plays an important role in the rate at which DEFINITY® should be injected^2,3

Poor LV function or low heart rate may require a more rapid speed of injection to allow DEFINITY® to completely fill the entire LV
High heart rate may require a slower administration rate

INDICATION

DEFINITY® is indicated, after activation, for use in adult and pediatric patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border.

IMPORTANT SAFETY INFORMATION

BOXED WARNING: SERIOUS CARDIOPULMONARY REACTIONS

Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or following perflutren-containing microsphere administration. Most serious reactions occur within 30 minutes of administration.

Assess all patients for the presence of any condition that precludes DEFINITY^® administration.
Always have resuscitation equipment and trained personnel readily available.

INDICATION AND IMPORTANT SAFETY INFORMATION

INDICATION

IMPORTANT SAFETY INFORMATION

BOXED WARNING: SERIOUS CARDIOPULMONARY REACTIONS

Assess all patients for the presence of any condition that precludes DEFINITY® administration.
Always have resuscitation equipment and trained personnel readily available.

CONTRAINDICATIONS:

Contraindicated in patients with known or suspected hypersensitivity to perflutren lipid microsphere or its components, such as polyethylene glycol (PEG).

WARNINGS AND PRECAUTIONS:

Serious Cardiopulmonary Reactions have occurred during or following administration. The risk for these reactions may be increased among patients with unstable cardiopulmonary conditions (acute myocardial infarction, acute coronary artery syndromes, worsening or unstable congestive heart failure, or serious ventricular arrhythmias).

Serious Hypersensitivity Reactions have been observed during or shortly following administration including anaphylaxis, with manifestations that may include death. DEFINITY® contains PEG and may increase risk of serious reactions including death in patients with prior hypersensitivity reaction(s) to PEG. Clinically assess patients for prior hypersensitivity reactions to products containing PEG. Monitor all patients for hypersensitivity reactions.

Systemic Embolization may occur in patients with a cardiac shunt. Assess patients with shunts for embolic phenomena following administration. DEFINITY® is only for intravenous administration and must not be administered by intra-arterial injection.

There is a risk of Ventricular Arrhythmia Related to High Mechanical Index. Additionally, end-systolic triggering with high mechanical indices has been reported to cause ventricular arrhythmias. The maximum recommended mechanical index for use with DEFINITY® is 0.8 in adult patients and 0.3 in pediatric patients.

Acute Pain Episodes in Patients with Sickle Cell Disease (SCD) shortly following administration have been reported. Discontinue DEFINITY® in SCD patients experiencing new or worsening pain.

ADVERSE REACTIONS:

The most common adverse reactions (≥0.5%) are headache, back/renal pain, flushing, nausea, chest pain, injection site reactions, and dizziness.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088.

Please see accompanying full Prescribing Information and Important Safety Information, including boxed WARNING regarding serious cardiopulmonary reactions.

References:

Kurt M, Shaikh KA, Peterson L, et al. Impact of contrast echocardiography on evaluation of ventricular function and clinical management in a large prospective cohort. J Am Coll Cardiol. 2009;53(9):802-810. doi:10.1016/j.jacc.2009.01.005
Witt SA, McCulloch M, Sisk E, et al. Achieving a diagnostic contrast-enhanced echocardiogram: a series on contrast echocardiography, article 4. J Am Soc Echocardiogr. 2001;14(4):327-334. doi:10.1067/mje.2001.112242
Burgess P, Moore V, Bednarz J, et al. Performing an echocardiographic examination with a contrast agent: a series on contrast echocardiography, article 2. J Am Soc Echocardiogr. 2000;13(6):629-636. doi:10.1067/mje.2000.105089
Armstrong WF, Ryan T. Feigenbaum’s Echocardiography. 7th ed. Lippincott Williams & Wilkins; 2009.
Eskandari M, Monaghan M. Contrast echocardiography in daily clinical practice. Herz. 2017;42(3):271-278. doi:10.1007/s00059-017-4533-x

DEFINITY® Customer Service 1.800.299.3431

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Image Optimization

DEFINITY® Delivers High-Quality Images1

Ultrasound System Control Adjustments Vary by Patient and Ultrasound System3

Key Controls to Optimize Image Quality

Power/Mechanical Index Can Have the Greatest Impact on Overall Image Quality3

Power adjustments vary by patient and ultrasound system

Secondary Controls to Optimize Image Quality

Gain: boosts the amplification of received echos2,4

Dynamic range/compression: adjusts the range of shades of gray displayed in 2D images2,3

Speed of administration and system settings contribute to optimal image quality3

Left ventricular function plays an important role in the rate at which DEFINITY® should be injected2,3

INDICATION

IMPORTANT SAFETY INFORMATION

BOXED WARNING: SERIOUS CARDIOPULMONARY REACTIONS

DEFINITY® Customer Service 1.800.299.3431

DEFINITY® Customer Service 1.800.299.3431

Image
Optimization

DEFINITY® Delivers High-Quality Images¹

Ultrasound System Control Adjustments Vary by Patient and Ultrasound System³

Power/Mechanical Index Can Have the Greatest Impact on Overall Image Quality³

Gain: boosts the amplification of received echos^2,4

Dynamic range/compression: adjusts the range of shades of gray displayed in 2D images^2,3

Speed of administration and system settings contribute to optimal image quality³

Left ventricular function plays an important role in the rate at which DEFINITY® should be injected^2,3

DEFINITY® Customer Service
1.800.299.3431