CET Echocardiography Imaging Techniques 3 — Questions and Answers
Question 1: During a transesophageal echocardiogram (TEE), the mid-esophageal four-chamber view is obtained at approximately which depth from the incisors?
- 15-20 cm
- 25-30 cm (Correct answer)
- 30-35 cm
- 40-45 cm
Correct answer: 25-30 cm
The mid-esophageal position is typically located 25-30 cm from the incisors, placing the probe adjacent to the left atrium.
Question 2: Which artifact appears as multiple equally spaced lines parallel to a strong reflector and is caused by the ultrasound beam bouncing between two highly reflective surfaces?
- Side lobe artifact
- Reverberation artifact (Correct answer)
- Shadowing artifact
- Enhancement artifact
Correct answer: Reverberation artifact
Reverberation artifacts occur when echoes bounce repeatedly between two reflective interfaces, creating false parallel lines at equal intervals on the image.
Question 3: In the parasternal short-axis view at the level of the mitral valve, which structure appears as a 'fish mouth' opening during diastole?
- Aortic valve
- Tricuspid valve
- Mitral valve (Correct answer)
- Pulmonic valve
Correct answer: Mitral valve
In the parasternal short-axis view at the mitral valve level, the anterior and posterior leaflets open in diastole, creating a characteristic fish-mouth or oval orifice appearance.
Question 4: What is the primary advantage of using contrast echocardiography with agitated saline for a bubble study?
- Enhances left ventricular opacification
- Detects intracardiac right-to-left shunts (Correct answer)
- Improves Doppler velocity measurements
- Evaluates coronary artery stenosis
Correct answer: Detects intracardiac right-to-left shunts
Agitated saline microbubbles are too large to pass through the pulmonary capillaries, so their appearance in the left heart indicates a right-to-left shunt such as a patent foramen ovale.
Question 5: Which parameter on the ultrasound machine controls the amplification of returning echoes from deeper structures to compensate for tissue attenuation?
- Overall gain
- Time-gain compensation (TGC) (Correct answer)
- Dynamic range
- Reject filter
Correct answer: Time-gain compensation (TGC)
Time-gain compensation (TGC) applies progressively higher amplification to echoes returning from greater depths, offsetting signal loss due to tissue attenuation.
Question 6: The right ventricular inflow view in echocardiography is best obtained from which transducer position?
- Apical window with medial angulation
- Parasternal window with rightward and inferior angulation (Correct answer)
- Subcostal window with superior angulation
- Suprasternal notch position
Correct answer: Parasternal window with rightward and inferior angulation
The RV inflow view is obtained from the parasternal position by tilting the transducer rightward and inferiorly to align with the tricuspid valve and right ventricular inflow tract.
Question 7: When performing strain imaging using speckle tracking echocardiography, what does a negative longitudinal strain value indicate?
- Myocardial lengthening during systole
- Myocardial shortening during systole (Correct answer)
- Diastolic dysfunction
- Pericardial effusion
Correct answer: Myocardial shortening during systole
By convention, longitudinal strain is negative during systole because the myocardium shortens (contracts) in the longitudinal direction; more negative values indicate better deformation.
CET Echocardiography Imaging Techniques 3
During a transesophageal echocardiogram (TEE), the mid-esophageal four-chamber view is obtained at approximately which depth from the incisors?