<s>
An	O
echocardiography	B-Application
,	O
echocardiogram	B-Application
,	O
cardiac	O
echo	O
or	O
simply	O
an	O
echo	O
,	O
is	O
an	O
ultrasound	B-Application
of	O
the	O
heart	O
.	O
</s>
<s>
It	O
is	O
a	O
type	O
of	O
medical	B-Application
imaging	I-Application
of	O
the	O
heart	O
,	O
using	O
standard	O
ultrasound	B-Application
or	O
Doppler	O
ultrasound	B-Application
.	O
</s>
<s>
Echocardiography	B-Application
has	O
become	O
routinely	O
used	O
in	O
the	O
diagnosis	O
,	O
management	O
,	O
and	O
follow-up	O
of	O
patients	O
with	O
any	O
suspected	O
or	O
known	O
heart	O
diseases	O
.	O
</s>
<s>
It	O
is	O
one	O
of	O
the	O
most	O
widely	O
used	O
diagnostic	B-Application
imaging	I-Application
modalities	O
in	O
cardiology	O
.	O
</s>
<s>
An	O
echocardiogram	B-Application
can	O
also	O
give	O
physicians	O
other	O
estimates	O
of	O
heart	O
function	O
,	O
such	O
as	O
a	O
calculation	O
of	O
the	O
cardiac	O
output	O
,	O
ejection	O
fraction	O
,	O
and	O
diastolic	O
function	O
(	O
how	O
well	O
the	O
heart	O
relaxes	O
)	O
.	O
</s>
<s>
Echocardiography	B-Application
is	O
an	O
important	O
tool	O
in	O
assessing	O
wall	O
motion	O
abnormality	O
in	O
patients	O
with	O
suspected	O
cardiac	O
disease	O
.	O
</s>
<s>
Echocardiography	B-Application
can	O
help	O
detect	O
cardiomyopathies	O
,	O
such	O
as	O
hypertrophic	O
cardiomyopathy	O
,	O
dilated	O
cardiomyopathy	O
,	O
and	O
many	O
others	O
.	O
</s>
<s>
The	O
use	O
of	O
stress	O
echocardiography	B-Application
may	O
also	O
help	O
determine	O
whether	O
any	O
chest	O
pain	O
or	O
associated	O
symptoms	O
are	O
related	O
to	O
heart	O
disease	O
.	O
</s>
<s>
The	O
biggest	O
advantage	O
of	O
echocardiography	B-Application
is	O
that	O
it	O
is	O
not	O
invasive	O
(	O
does	O
not	O
involve	O
breaking	O
the	O
skin	O
or	O
entering	O
body	O
cavities	O
)	O
and	O
has	O
no	O
known	O
risks	O
or	O
side	O
effects	O
.	O
</s>
<s>
Not	O
only	O
can	O
an	O
echocardiogram	B-Application
create	O
ultrasound	B-Application
images	O
of	O
heart	O
structures	O
,	O
but	O
it	O
can	O
also	O
produce	O
accurate	O
assessment	O
of	O
the	O
blood	O
flowing	O
through	O
the	O
heart	O
by	O
Doppler	O
echocardiography	B-Application
,	O
using	O
pulsed	O
-	O
or	O
continuous-wave	O
Doppler	O
ultrasound	B-Application
.	O
</s>
<s>
The	O
Doppler	O
technique	O
can	O
also	O
be	O
used	O
for	O
tissue	O
motion	O
and	O
velocity	O
measurement	O
,	O
by	O
tissue	O
Doppler	O
echocardiography	B-Application
.	O
</s>
<s>
Echocardiography	B-Application
was	O
also	O
the	O
first	O
ultrasound	B-Application
subspecialty	O
to	O
use	O
intravenous	O
contrast	O
.	O
</s>
<s>
Echocardiography	B-Application
is	O
performed	O
by	O
cardiac	B-Algorithm
sonographers	I-Algorithm
,	O
cardiac	O
physiologists	O
(	O
UK	O
)	O
,	O
or	O
physicians	O
trained	O
in	O
echocardiography	B-Application
.	O
</s>
<s>
Recognized	O
as	O
the	O
"	O
Father	O
of	O
Echocardiography	B-Application
"	O
,	O
the	O
Swedish	O
physician	O
Inge	O
Edler	O
(	O
1911	O
–	O
2001	O
)	O
,	O
a	O
graduate	O
of	O
Lund	O
University	O
,	O
was	O
the	O
first	O
of	O
his	O
profession	O
to	O
apply	O
ultrasonic	O
pulse	O
echo	O
imaging	O
in	O
diagnosing	O
cardiac	O
disease	O
,	O
which	O
the	O
acoustical	O
physicist	O
Floyd	O
Firestone	O
had	O
developed	O
to	O
detect	O
defects	O
in	O
metal	O
castings	O
.	O
</s>
<s>
In	O
fact	O
,	O
Edler	O
in	O
1953	O
produced	O
the	O
first	O
echocardiographs	B-Application
using	O
an	O
industrial	O
Firestone-Sperry	O
Ultrasonic	O
Reflectoscope	O
.	O
</s>
<s>
In	O
developing	O
echocardiography	B-Application
,	O
Edler	O
worked	O
with	O
the	O
physicist	O
Carl	O
Hellmuth	O
Hertz	O
,	O
the	O
son	O
of	O
the	O
Nobel	O
laureate	O
Gustav	O
Hertz	O
and	O
grandnephew	O
of	O
Heinrich	O
Rudolph	O
Hertz	O
.	O
</s>
<s>
Health	O
societies	O
recommend	O
the	O
use	O
of	O
echocardiography	B-Application
for	O
initial	O
diagnosis	O
when	O
a	O
change	O
in	O
the	O
patient	O
's	O
clinical	O
status	O
occurs	O
and	O
when	O
new	O
data	O
from	O
an	O
echocardiogram	B-Application
would	O
result	O
in	O
the	O
physician	O
changing	O
the	O
patient	O
's	O
care	O
.	O
</s>
<s>
Diagnostic	O
criteria	O
for	O
numerous	O
cardiac	O
diseases	O
are	O
based	O
on	O
echocardiography	B-Application
studies	O
.	O
</s>
<s>
A	O
common	O
example	O
of	O
overuse	O
of	O
echocardiography	B-Application
when	O
not	O
indicated	O
is	O
the	O
use	O
of	O
routine	O
testing	O
in	O
response	O
to	O
a	O
patient	O
diagnosis	O
of	O
mild	O
valvular	O
heart	O
disease	O
.	O
</s>
<s>
In	O
this	O
case	O
,	O
patients	O
are	O
often	O
asymptomatic	O
for	O
years	O
before	O
the	O
onset	O
of	O
deterioration	O
and	O
the	O
results	O
of	O
the	O
echocardiogram	B-Application
would	O
not	O
result	O
in	O
a	O
change	O
in	O
care	O
without	O
other	O
change	O
in	O
clinical	O
status	O
.	O
</s>
<s>
Echocardiography	B-Application
now	O
has	O
a	O
vast	O
role	O
in	O
pediatrics	O
,	O
diagnosing	O
patients	O
with	O
valvular	O
heart	O
disease	O
and	O
other	O
congenital	O
abnormalities	O
.	O
</s>
<s>
An	O
emerging	O
branch	O
is	O
fetal	B-Algorithm
echocardiography	I-Algorithm
,	O
which	O
involves	O
echocardiography	B-Application
of	O
an	O
unborn	O
fetus	O
.	O
</s>
<s>
There	O
are	O
three	O
primary	O
types	O
of	O
echocardiography	B-Application
:	O
transthoracic	O
,	O
transesophageal	O
,	O
and	O
intracardic	O
.	O
</s>
<s>
Intravascular	O
ultrasound	B-Application
is	O
included	O
below	O
,	O
but	O
is	O
as	O
the	O
name	O
indicates	O
more	O
"	O
ultrasound	B-Application
"	O
than	O
"	O
echocardiography	B-Application
"	O
as	O
it	O
is	O
imaging	O
the	O
walls	O
of	O
a	O
vessel	O
rather	O
than	O
the	O
heart	O
.	O
</s>
<s>
A	O
standard	O
echocardiogram	B-Application
is	O
also	O
known	O
as	O
a	O
transthoracic	O
echocardiogram	B-Application
(	O
TTE	O
)	O
or	O
cardiac	B-Application
ultrasound	I-Application
;	O
and	O
it	O
is	O
used	O
for	O
rapid	O
evaluation	O
of	O
a	O
patient	O
at	O
their	O
bedside	O
.	O
</s>
<s>
In	O
this	O
case	O
,	O
the	O
echocardiography	B-Application
transducer	O
(	O
or	O
probe	O
)	O
is	O
placed	O
on	O
the	O
chest	O
wall	O
(	O
or	O
thorax	O
)	O
of	O
the	O
subject	O
,	O
and	O
images	O
are	O
taken	O
through	O
the	O
chest	O
wall	O
.	O
</s>
<s>
TTE	O
utilizes	O
one	O
-	O
(	O
"	O
M	O
mode	O
"	O
)	O
,	O
two-	O
,	O
and	O
three-dimensional	O
ultrasound	B-Application
(	O
time	O
is	O
implicit	O
and	O
not	O
included	O
)	O
from	O
the	O
different	O
windows	O
.	O
</s>
<s>
Images	O
can	O
be	O
enhanced	O
with	O
"	O
contrast	O
"	O
that	O
are	O
typically	O
some	O
sort	O
of	O
micro	O
bubble	O
suspension	O
that	O
reflect	O
the	O
ultrasound	B-Application
waves	O
.	O
</s>
<s>
A	O
transesophageal	O
echocardiogram	B-Application
is	O
an	O
alternative	O
way	O
to	O
perform	O
an	O
echocardiogram	B-Application
.	O
</s>
<s>
A	O
specialized	O
probe	O
containing	O
an	O
ultrasound	B-Application
transducer	O
at	O
its	O
tip	O
is	O
passed	O
into	O
the	O
patient	O
's	O
esophagus	O
via	O
the	O
mouth	O
,	O
allowing	O
image	O
and	O
Doppler	O
evaluation	O
from	O
a	O
location	O
directly	O
behind	O
the	O
heart	O
.	O
</s>
<s>
This	O
test	O
is	O
performed	O
in	O
the	O
presence	O
of	O
a	O
cardiologist	O
,	O
anesthesiologist	O
,	O
registered	O
nurse	O
,	O
and	O
ultrasound	B-Application
technologist	O
.	O
</s>
<s>
Additionally	O
,	O
the	O
ultrasound	B-Application
crystal	O
is	O
often	O
a	O
two-dimension	O
crystal	O
and	O
the	O
ultrasound	B-Application
plane	O
being	O
used	O
can	O
be	O
rotated	O
electronically	O
to	O
permit	O
an	O
additional	O
dimension	O
to	O
optimize	O
views	O
of	O
the	O
heart	O
structures	O
.	O
</s>
<s>
A	O
stress	O
echocardiogram	B-Application
,	O
also	O
known	O
as	O
a	O
stress	O
echo	O
,	O
uses	O
ultrasound	B-Application
imaging	I-Application
of	O
the	O
heart	O
to	O
assess	O
the	O
wall	O
motion	O
in	O
response	O
to	O
physical	O
stress	O
.	O
</s>
<s>
A	O
stress	O
echo	O
is	O
not	O
invasive	O
and	O
is	O
performed	O
in	O
the	O
presence	O
of	O
a	O
licensed	O
medical	O
professional	O
,	O
such	O
as	O
a	O
cardiologist	O
,	O
and	O
a	O
cardiac	B-Algorithm
sonographer	I-Algorithm
.	O
</s>
<s>
Intracardiac	O
echocardiography	B-Application
(	O
ICE	O
)	O
is	O
specialized	O
form	O
of	O
echocardiography	B-Application
that	O
uses	O
catheters	O
to	O
insert	O
the	O
ultrasound	B-Application
probe	O
inside	O
the	O
heart	O
to	O
view	O
structures	O
from	O
within	O
the	O
heart	O
.	O
</s>
<s>
ICE	O
has	O
the	O
benefit	O
over	O
transthoracic	B-Application
echocardiography	I-Application
in	O
that	O
an	O
operator	O
who	O
is	O
performing	O
a	O
sterile	O
procedure	O
can	O
also	O
operate	O
the	O
ICE	O
catheter	O
and	O
it	O
is	O
not	O
limited	O
to	O
visibility	O
problems	O
that	O
can	O
arise	O
with	O
transthoracic	O
or	O
transesophageal	O
echo	O
.	O
</s>
<s>
Intravascular	O
ultrasound	B-Application
(	O
IVUS	O
)	O
is	O
a	O
specialized	O
form	O
of	O
echocardiography	B-Application
that	O
uses	O
a	O
catheter	O
to	O
insert	O
the	O
ultrasound	B-Application
probe	O
inside	O
blood	O
vessels	O
.	O
</s>
<s>
The	O
various	O
modes	O
listed	O
below	O
essentially	O
describe	O
how	O
the	O
ultrasound	B-Application
crystals	O
are	O
used	O
to	O
obtain	O
information	O
.	O
</s>
<s>
These	O
modes	O
are	O
common	O
to	O
all	O
types	O
of	O
echocardiography	B-Application
.	O
</s>
<s>
Amplitude	O
mode	O
is	O
not	O
a	O
mode	O
used	O
in	O
modern	O
echocardiography	B-Application
.	O
</s>
<s>
Brightness	O
mode	O
is	O
often	O
synonymous	O
with	O
"	O
2D	O
"	O
and	O
is	O
very	O
commonly	O
used	O
in	O
echocardiography	B-Application
.	O
</s>
<s>
Motion	O
mode	O
is	O
infrequently	O
used	O
in	O
modern	O
echocardiography	B-Application
.	O
</s>
<s>
Strain	O
rate	O
imaging	O
is	O
an	O
ultrasound	B-Application
method	O
for	O
imaging	O
regional	O
differences	O
in	O
contraction	O
(	O
dyssynergy	O
)	O
in	O
for	O
instance	O
ischemic	O
heart	O
disease	O
or	O
dyssynchrony	O
due	O
to	O
Bundle	B-Algorithm
branch	I-Algorithm
block	I-Algorithm
.	O
</s>
<s>
The	O
methods	O
used	O
are	O
either	O
tissue	O
Doppler	O
or	O
Speckle	B-Algorithm
tracking	I-Algorithm
echocardiography	I-Algorithm
.	O
</s>
<s>
Three-dimensional	B-Application
echocardiography	I-Application
(	O
also	O
known	O
as	O
four-dimensional	O
echocardiography	B-Application
when	O
the	O
picture	O
is	O
moving	O
)	O
is	O
now	O
possible	O
,	O
using	O
a	O
matrix	O
array	O
ultrasound	B-Application
probe	O
and	O
an	O
appropriate	O
processing	O
system	O
.	O
</s>
<s>
Real-time	O
three-dimensional	B-Application
echocardiography	I-Application
can	O
be	O
used	O
to	O
guide	O
the	O
location	O
of	O
bioptomes	O
during	O
right	O
ventricular	O
endomyocardial	O
biopsies	O
,	O
placement	O
of	O
catheter-delivered	O
valvular	O
devices	O
,	O
and	O
in	O
many	O
other	O
intraoperative	O
assessments	O
.	O
</s>
<s>
Three-dimensional	B-Application
echocardiography	I-Application
technology	O
may	O
feature	O
anatomical	O
intelligence	O
,	O
or	O
the	O
use	O
of	O
organ-modeling	O
technology	O
,	O
to	O
automatically	O
identify	O
anatomy	O
based	O
on	O
generic	O
models	O
.	O
</s>
<s>
Contrast	O
echocardiography	B-Application
or	O
contrast-enhanced	O
ultrasound	B-Application
is	O
the	O
addition	O
of	O
an	O
ultrasound	B-Application
contrast	O
medium	O
,	O
or	O
imaging	O
agent	O
,	O
to	O
traditional	O
ultrasonography	O
.	O
</s>
<s>
The	O
ultrasound	B-Application
contrast	O
is	O
made	O
up	O
of	O
tiny	O
microbubbles	O
filled	O
with	O
a	O
gas	O
core	O
and	O
protein	O
shell	O
.	O
</s>
<s>
This	O
allows	O
the	O
microbubbles	O
to	O
circulate	O
through	O
the	O
cardiovascular	O
system	O
and	O
return	O
the	O
ultrasound	B-Application
waves	O
,	O
creating	O
a	O
highly	O
reflective	O
image	O
.	O
</s>
<s>
There	O
are	O
multiple	O
applications	O
in	O
which	O
contrast-enhanced	O
ultrasound	B-Application
can	O
be	O
useful	O
.	O
</s>
<s>
Contrast	O
may	O
also	O
be	O
used	O
to	O
enhance	O
visualization	O
of	O
wall	O
thickening	O
during	O
stress	O
echocardiography	B-Application
,	O
for	O
the	O
assessment	O
of	O
LV	O
thrombus	O
,	O
or	O
for	O
the	O
assessment	O
of	O
other	O
masses	O
in	O
the	O
heart	O
.	O
</s>
<s>
Contrast	O
echocardiography	B-Application
has	O
also	O
been	O
used	O
to	O
assess	O
blood	O
perfusion	O
throughout	O
myocardium	O
in	O
the	O
case	O
of	O
coronary	O
artery	O
disease	O
.	O
</s>
<s>
Echocardiography	B-Application
can	O
at	O
many	O
times	O
be	O
subjective	O
,	O
meaning	O
that	O
the	O
person	O
reading	O
the	O
echo	O
may	O
have	O
personal	O
input	O
that	O
affects	O
the	O
interpretation	O
of	O
the	O
findings	O
,	O
leading	O
to	O
so-called	O
"	O
inter-observer	O
variability	O
"	O
,	O
where	O
different	O
echocardiographers	B-Algorithm
might	O
produce	O
different	O
reports	O
when	O
examining	O
the	O
same	O
images	O
.	O
</s>
<s>
The	O
aim	O
of	O
such	O
programs	O
is	O
to	O
standardize	O
the	O
practice	O
of	O
echocardiography	B-Application
and	O
to	O
ensure	O
that	O
practitioners	O
have	O
the	O
proper	O
training	O
prior	O
to	O
practicing	O
echocardiography	B-Application
which	O
will	O
eventually	O
limit	O
inter-observer	O
variability	O
.	O
</s>
<s>
At	O
the	O
European	O
level	O
individual	O
and	O
laboratory	O
accreditation	O
is	O
provided	O
by	O
the	O
European	O
Association	O
of	O
Echocardiography	B-Application
(	O
EAE	O
)	O
.	O
</s>
<s>
There	O
are	O
three	O
subspecialties	O
for	O
individual	O
accreditation	O
:	O
Adult	O
Transthoracic	B-Application
Echocardiography	I-Application
(	O
TTE	O
)	O
,	O
Adult	O
Transesophageal	O
Echocardiography	B-Application
(	O
TEE	O
)	O
and	O
Congenital	O
Heart	O
Disease	O
Echocardiography	B-Application
(	O
CHD	O
)	O
.	O
</s>
<s>
In	O
the	O
UK	O
,	O
accreditation	O
is	O
regulated	O
by	O
the	O
British	O
Society	O
of	O
Echocardiography	B-Application
.	O
</s>
<s>
The	O
"	O
Intersocietal	O
Accreditation	O
Commission	O
for	O
Echocardiography	B-Application
”	O
(	O
IAC	O
)	O
sets	O
standards	O
for	O
echo	O
labs	O
across	O
the	O
US	O
.	O
</s>
<s>
The	O
purpose	O
of	O
accreditation	O
is	O
to	O
maintain	O
quality	O
and	O
consistency	O
across	O
echocardiography	B-Application
labs	O
in	O
the	O
United	O
States	O
.	O
</s>
<s>
Accreditation	O
is	O
offered	O
in	O
adult	O
and	O
pediatric	O
transthoracic	O
and	O
transesophageal	O
echocardiography	B-Application
,	O
as	O
well	O
as	O
adult	O
stress	O
and	O
fetal	O
echo	O
.	O
</s>
<s>
There	O
are	O
several	O
states	O
in	O
which	O
Medicare	O
and/or	O
private	O
insurance	O
carriers	O
require	O
accreditation	O
(	O
credentials	O
)	O
of	O
the	O
laboratory	O
and/or	O
sonographer	O
for	O
reimbursement	O
of	O
echocardiograms	B-Application
.	O
</s>
<s>
There	O
are	O
two	O
credentialing	O
bodies	O
in	O
the	O
United	O
States	O
for	O
sonographers	O
,	O
the	O
Cardiovascular	O
Credentialing	O
International	O
(	O
CCI	O
)	O
,	O
established	O
in	O
1968	O
,	O
and	O
the	O
American	O
Registry	O
for	O
Diagnostic	O
Medical	B-Application
Sonography	I-Application
(	O
ARDMS	O
)	O
,	O
established	O
in	O
1975	O
.	O
</s>
<s>
Under	O
both	O
credentialing	O
bodies	O
,	O
sonographers	O
must	O
first	O
document	O
completion	O
of	O
prerequisite	O
requirements	O
,	O
which	O
contain	O
both	O
didactic	O
and	O
hands-on	O
experience	O
in	O
the	O
field	O
of	O
ultrasound	B-Application
.	O
</s>
<s>
Applicants	O
must	O
then	O
take	O
a	O
comprehensive	O
exam	O
demonstrating	O
knowledge	O
in	O
both	O
the	O
physics	O
of	O
ultrasound	B-Application
and	O
the	O
clinical	O
competency	O
related	O
to	O
their	O
specialty	O
.	O
</s>
<s>
The	O
American	O
Society	O
of	O
Echocardiography	B-Application
(	O
ASE	O
)	O
is	O
a	O
professional	O
organization	O
made	O
up	O
of	O
physicians	O
,	O
sonographers	O
,	O
nurses	O
,	O
and	O
scientists	O
involved	O
in	O
the	O
field	O
of	O
echocardiography	B-Application
.	O
</s>
<s>
There	O
have	O
been	O
various	O
institutes	O
who	O
are	O
working	O
on	O
use	O
of	O
Artificial	B-Application
intelligence	I-Application
in	O
Echo	O
but	O
they	O
are	O
at	O
a	O
very	O
early	O
stage	O
and	O
still	O
needs	O
full	O
development	O
.	O
</s>
<s>
The	O
most	O
commonly	O
used	O
terminology	O
in	O
echocardiography	B-Application
diagnostics	O
are	O
:	O
</s>
