Clues For Coronary Artery Imaging
Quick Reference for Image Optimization and Acquisition
Purpose
Use this guide as a quick reference to improve coronary artery visualization through patient positioning, 2D optimization, color Doppler adjustments and consistent probe maneuvers.
Technical Tips
Patient Positioning
Begin with the patient in a steep left lateral position when practical.
2D Optimization
- Use a higher frequency probe when practical and available.
- Consider removing harmonics for infants and toddlers.
- Adjust dynamic range or compression to approximately 45 decibels.
Color Doppler Optimization
- Decrease the color Doppler scale.
- Target a Nyquist limit of approximately 20–40 cm/sec.
- Increase color frequency to approximately 5 MHz or to the highest available setting for the probe.
- Increase persistence if the infant is tachycardic.
Imaging Tips
Parasternal Short Axis
Key Requirement
Must visualize the coronary connection to the aorta by both 2D imaging and color flow Doppler.
Right Coronary Artery Imaging Tips (Figure 1)
- Image slightly higher than the level of the aortic valve en face view.
- Rotate counterclockwise.
- Tip the probe toward the patient’s right shoulder.
- May supplement with parasternal long-axis imaging to visualize the right coronary artery (RCA) for a high take-off RCA.
Left Coronary Artery
Rotate clockwise
Tip toward patient's left side
Left Coronary Artery Imaging Tips (Figure 2)
- Rotate clockwise.
- Tip the probe toward the patients left side.
- Must image the left coronary artery (LCA) to the bifurcation.
Must image LCA to the bifurcation
Right Coronary Artery
Rotate counter-clockwise
Tip toward patient's right side
High Take-Off Imaging Tips
(Figure 3)
- Place the patient in a recumbent position.
- Start by the left clavicle, at the notch between 12 and 3 o'clock.
- Slide down until the coronaries are in view.
- May need to rotate clockwise for the LCA.
Parasternal Long Axis
Left Coronary System (Figure 4)
Tilting toward the pulmonary artery can help visualize the left main, circumflex and left anterior descending coronary arteries proximally and distally along the septum.
Posterior Descending Coronary Artery (Figure 5)
Tilting toward the tricuspid valve can help visualize the posterior descending coronary artery.
Apical 4-Chamber (Figure 6)
Tilting posteriorly toward the coronary sinus can help visualize the distal right coronary artery along the right atrioventricular groove.
Practice. Practice. Practice.
Consistent repetition helps build confidence, improve recognition of coronary origins, and strengthen image acquisition technique.