Digital Echo FAQ

Q: Why go digital?
A: There are several reasons a lab may want to consider converting to a digital format, they may include any or all of the following:
- Rapid comparison with prior studies
- Immediate access to images in a study
- Integration with other medical data
- Faster reading
- Higher image quality
- Stable image quality
- Easier quantification
- Enable telemedicine
- Facilitate research
- Education!!!

Q: Digital echo is great! Why aren't all labs digital?
A: Only 40% of labs have digitally capable echo machines

Q: What does a digital echocardiogram consist of?
A: Here is a sample protocol for a digital examination:
- *PLAx
- *PLAx (MV/AV zoom)
- *RV inflow
- *RV outflow
- *PSAx (AV)
- *PSAx (MV)
- PSAx (LV)
- PSAx (Apex)
- *Ap4Ch
- *Ap4Ch (MV zoom)
- *Ap4Ch (TV zoom)

Q: What are the components of a multivendor digital lab?
A: They may include:
- Standard exchange format: DICOM
- Digital echo machines with network output
- Switched high-speed network
- High throughput server with abundant local storage
- Reliable, low cost archive
- Software to manage archive
- High speed lines for telemedicine
- Network engineer!

Q: What are the technical issues my lab should consider?
A: -How to make the transition
- Putting the pieces together
- Doing it yourself (hardware/network/software separate) vs integrated (turnkey) solution
- Internet use

Q: What are storage issues my lab should consider?
- Which storage format should we use: DICOM vs non-DICOM?
- What to store: Single vs multiple cycles vs continuous recording? How many views?? What temporal and spatial resolution?? Concerns with JPEG, can we go further?
- Sonographer issues: Training for loop capture

Q: Any Advice?
A: If a short (?<500 msec) R-R interval is detected, assume it's noise and default to a 1 second capture
-Allow the option to capture either the previous or the next beats/interval
- Storage of loops shouldn't lock up system; if they must, then no more than a second……
- Easy switching between full-frame-rate storage and 30 fps storage (selected structures may deserve full storage)
- Flexible storage of DICOM and/or raw data; make sure polar data in DICOM wrapper doesn't crash a DICOM server/viewer
- Implement DHCP protocols to allow dynamic allocation of IP addresses, essential for portable operation in many environments (maybe you do this already…….)