Cardiac ultrasound, also known as echocardiography or echocardiogram, is used to provide several different levels and types of heart testing. Cardiac ultrasound utilizes the same ultrasound principles as used for obstetric and gynecologic evaluations of pregnant women, gallbladder ultrasound and other abdominal structures.
The ultrasound is directed out of a hand held probe which can be moved to image the heart from different positions. Additionally, so that heart events can be timed, ECG leads are placed on the chest. The reflected wave is converted into an actual image of the heart and displayed in a real-time mode or M-mode ultrasound format. M-mode recordings permit measurement of cardiac dimensions and detailed analysis of complex motion patterns depending on transducer angulations. Also the time relationships with other physiological variables such as ECG, heart sounds, and pulse tracings, can be recorded simultaneously. A stress echocardiogram provides information about the cardiac performance.
Two-dimensional tomographic images of selected cardiac sections give more information than M-mode about the shape of the heart and also show the spatial relationships of its structures during the cardiac cycle (diastole to systole).

See also M-Mode Echocardiography, and Myocardial Contrast Echocardiography.

Compound B-mode imaging takes different forms and refers to different methods of creating the ultrasound image.
Real-time compound ultrasound improves the image quality of B-mode scanning by combining ultrasound information obtained from multiple angles. The used averaging process of compound B-mode reduces artifacts and improves the representation of true image data.
B-mode images and Doppler mode images (see also Duplex) can be compounded on the display to improve the visualization of the anatomical relationships between vessels and the surrounding tissues.

Doppler ultrasound is a medical imaging technique for calculating the relative velocity between two points by measuring the frequency shift of a sound wave transmitted from one point to the other, based on the Doppler effect. Continuous or pulsed Doppler is frequently used to examine cardiovascular blood flow. The combination of routine 2D-mode and Doppler ultrasound allows a complete evaluation of the heart's anatomy and function (including the fetal heart). See also Doppler Fluximetry in Pregnancy.
Doppler ultrasound depends on the fact that if a moving object reflects the ultrasound waves, the echo frequencies are changed. A higher frequency is created if the object is moving toward the probe//transducer and a lower frequency if it is moving away from it. How much the frequency is changed depends upon how fast the object is moving. Doppler ultrasound shows the different rates of blood flow in different colors on a monitor in real time.
The major Doppler parameters are the peak systolic velocity and the end-diastolic velocity. The peak systolic velocity ratio compensates the variability between different patients and instrumentations.

Different Doppler and duplex techniques:

Different stages of the drug development and approval process in the USA, lead from preclinical trials (testing in animals), first application in humans through limited and broad clinical tests, to postmarketing studies.


By Dale E. Wierenga, Ph.D. and C. Robert Eaton
Office of Research and Development
Pharmaceutical Manufacturers Association

'In reviewing this report, it is important to keep in mind the realities of the drug discovery and development process. The U.S. system of new drug approvals is perhaps the most rigorous in the world. On average, it costs a company $359 million to get one new medicine from the laboratory to the pharmacist's shelf, according to a February 1993 report by the Congressional Office of Technology Assessment.'

See also Phase 1 2 3 4 Drug Trials, Food and Drug Administration, and European Medicines Agency.

Duplex ultrasonography (duplex scan) consists of two ultrasound modalities to study blood flow and the perivascular tissue. This includes B-mode / gray scale imaging used in combination with spectral Doppler / pulsed-wave Doppler.
The real-time visualization of the vessels and tissue by the B-mode component improves the PW Doppler positioning and the direction of blood flow can be inferred. The angle between the direction of the PW Doppler signal and the estimated direction of blood flow can be measured.
Duplex techniques are available on phased array, linear array, and mechanical scanners. A phased array probe is able to create nearly simultaneous images and flow information. A linear array transducer can also do this if the Doppler probe is attached separately to one end of the scanhead. A mechanical transducer freeze the image; the crystals must be static to produce a Doppler image. The first two transducers are therefore the best choice for Duplex.

See also Compound B-Mode, and Duplex Scanner.