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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

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 Intensity3,4


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 echos2,4

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 images2,3

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 — Attenuation2,5

  • 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 injected2,3
  • 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

References:

  1. 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.

  2. Burgess P, Moore V, Bednarz J, et al. Cardiac sonographer's communication. Performing an echocardiographic examination with a contrast agent: a series on contrast echocardiography, article 2. J Am Soc Echocardiogr. 2000;13(6):629-636.

  3. Armstrong WF, Ryan T. Feigenbaum's Echocardiography. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:9-38.

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.

References:

  1. 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
  2. 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
  3. 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
  4. Armstrong WF, Ryan T. Feigenbaum’s Echocardiography. 7th ed. Lippincott Williams & Wilkins; 2009.
  5. 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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