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RE: [echocardiography] Role of M Mode in echocardiogram

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  • Liberty Cowden
    It isn t bad to measure these parameters in m-mode, provided that there is an appropriate m-line angle. If the appropriate angle can not be achieved, then the
    Message 1 of 10 , Oct 31, 2007
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      It isn't bad to measure these parameters in m-mode, provided that there is an appropriate m-line angle.  If the appropriate angle can not be achieved, then the measurement is inaccurate.  Usualy a sonographer can "heel-toe the probe" to achieve the required angle, and many of the newer machines have angle correction on m-mode.

      For the aortic valve and mitral valve, it is very important that you place the m-line perpendicular to the leaflet tips, otherwise if the measurement is on an onblique angle, the cusp seperation will be overestimated. 

      With regard to the ventricular measurement, care must be taken to ensure that an oblique cut of the ventricle is not made, essentially increasing the interal dimensions, which would in turn effect the EF.

      Actually, the same care must be taken to ensure appropriate angles and location of measurement in 2D measure.  In fact, when we input a 2D measurement into the machine, it places it into the m-mode report in order to calculate EF (as if that measurement was taken from m-mode)....at least this is true of the Sonos 5500.

      Hope that helps.


      From: "Dr. Bashir H. Samma, MD." <bsamma_1@...>
      Reply-To: echocardiography@yahoogroups.com
      To: echocardiography@yahoogroups.com
      Subject: [echocardiography] Role of M Mode in echocardiogram
      Date: Wed, 31 Oct 2007 18:28:36 -0000

      Heard that M mode is discouraged these days in measuring the
      ventricular, atrial and valvular parameters in parasternal long axis
      view.

      It is said that B mode images should be scrolled back slowly to acquire
      the systolic and diastolic phases and measure "directly"

      KINDLY COMMENT.


    • jerrysmithus
      I still use m-mode to measure the ventricle in the PLAX but I make sure that I m perpendicular to the ventricle so the measurements are accurate. In fact, if I
      Message 2 of 10 , Oct 31, 2007
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        I still use m-mode to measure the ventricle in the PLAX but I make
        sure that I'm perpendicular to the ventricle so the measurements are
        accurate. In fact, if I know for sure that I'm perpendicular to the
        ventricle I use m-mode in the PSAX sothat I know I'm right in the
        middle of the LV.

        If I'm not perpendicular to the LV then I measure off the B-mode.

        --- In echocardiography@yahoogroups.com, "Dr. Bashir H. Samma, MD."
        <bsamma_1@...> wrote:
        >
        > Heard that M mode is discouraged these days in measuring the
        > ventricular, atrial and valvular parameters in parasternal long axis
        > view.
        >
        > It is said that B mode images should be scrolled back slowly to
        acquire
        > the systolic and diastolic phases and measure "directly"
        >
        >
        > KINDLY COMMENT.
        >
      • Liberty Cowden
        One other thing with regard to measuring directly off of b-mode, (2d)...when you measure directly on 2d you should be aware at least that frame averaging is
        Message 3 of 10 , Oct 31, 2007
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          One other thing with regard to measuring directly off of b-mode, (2d)...when you measure directly on 2d you should be aware at least that frame averaging is taking place,not true of m-mode....at least this is my understanding.

          Best Regards,

          Liberty 


          From: "Dr. Bashir H. Samma, MD." <bsamma_1@...>
          Reply-To: echocardiography@yahoogroups.com
          To: echocardiography@yahoogroups.com
          Subject: [echocardiography] Role of M Mode in echocardiogram
          Date: Wed, 31 Oct 2007 18:28:36 -0000

          Heard that M mode is discouraged these days in measuring the
          ventricular, atrial and valvular parameters in parasternal long axis
          view.

          It is said that B mode images should be scrolled back slowly to acquire
          the systolic and diastolic phases and measure "directly"

          KINDLY COMMENT.


        • Richard S Jachimowicz
          The new techs these days lack the skills and patience to do an echo properly. LV is often off axis in their hands. They also miss out on all the physiologic
          Message 4 of 10 , Oct 31, 2007
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            The new techs these days lack the skills and patience to do an echo properly. LV is often off axis in their hands. They also miss out on  all the physiologic info that M Mode can provide. Also with 3D, volumes are becoming more important. I've seen lots of labs giving up on M-Mode.Too bad. 

            "Dr. Bashir H. Samma, MD." <bsamma_1@...> wrote:
            Heard that M mode is discouraged these days in measuring the
            ventricular, atrial and valvular parameters in parasternal long axis
            view.

            It is said that B mode images should be scrolled back slowly to acquire
            the systolic and diastolic phases and measure "directly"

            KINDLY COMMENT.


          • Brown, Chris
            I use both If I can get a good M-mode I will measure off that but commonly with elderly patients and the angle of their septum I use 2D. There is one anomaly
            Message 5 of 10 , Nov 1, 2007
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              I use both If I can get a good M-mode I will measure off that but commonly with elderly patients and the angle of their septum I use 2D.
              There is one anomaly though...
              In measuring aortic diameters I believe it is common to use leading edge to leading edge in M-Mode and inside edge to inside edge in 2D
              I do not understand why this 'convention' appears to be developing
               

              Chris Brown 
              Shetland UK

              -----Original Message-----
              From: Dr. Bashir H. Samma, MD. [mailto:bsamma_1@...]
              Sent: 31 October 2007 18:29
              To: echocardiography@yahoogroups.com
              Subject: [echocardiography] Role of M Mode in echocardiogram

              Heard that M mode is discouraged these days in measuring the
              ventricular, atrial and valvular parameters in parasternal long axis
              view.

              It is said that B mode images should be scrolled back slowly to acquire
              the systolic and diastolic phases and measure "directly"

              KINDLY COMMENT.

            • akory99@aol.com
              It takes a great skillĀ and experience to measure M-mode accurately. 2D is much easier to measure - there is less of a chance for an erroneous measurement. We
              Message 6 of 10 , Nov 1, 2007
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                It takes a great skill and experience to measure M-mode accurately. 2D is much easier to measure - there is less of a chance for an erroneous measurement.
                We still perform M-mode to assess pericardial effusion, valvular motion (SAM, EPSS, etc), interatrial hypermobility/aneurysms, and some other rare cases, but we generally do not use it for chamber measurements in Adult echo.
                We use M-mode during Pediatric echo. We do it for two reasons: Ped pictures tend to be "on-axis" most of the time, and their heart rates are generally much higher, which makes the M-mode superior to 2D.
                Andre



                -----Original Message-----
                From: Dr. Bashir H. Samma, MD. <bsamma_1@...>
                To: echocardiography@yahoogroups.com
                Sent: Wed, 31 Oct 2007 2:28 pm
                Subject: [echocardiography] Role of M Mode in echocardiogram

                Heard that M mode is discouraged these days in measuring the
                ventricular, atrial and valvular parameters in parasternal long axis
                view.

                It is said that B mode images should be scrolled back slowly to acquire
                the systolic and diastolic phases and measure "directly"

                KINDLY COMMENT.


                Email and AIM finally together. You've gotta check out free AOL Mail!
              • Terry Zwakenberg
                M-Mode in either the long axis or short axis should render the same measurements if done properly. M-Mode due to the higher sample rates is more accurate for
                Message 7 of 10 , Nov 1, 2007
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                  M-Mode in either the long axis or short axis should render the same measurements if done properly.  M-Mode due to the higher sample rates is more accurate for wall thickness and chamber dimensions.  The issue I see most often as an educator is that sonographers are not trained to exert that extra little bit of effort to acquire a proper orientation for image measurement.  The "off axis" heart is more often an excuse than reality, and are the only ones where 2-D measurements are going to be more representative than M-Mode.  For EF estimation in hearts with wall motion abnormalities, 2-D calculations such as Simpsons, or even eyeball assessment is more representative than M-Mode.  Valvular function is best assessed with Doppler and 2-D.
                   
                  Terry J Zwakenberg BS RVT RDCS

                   
                  On 10/31/07, Dr. Bashir H. Samma, MD. <bsamma_1@...> wrote:

                  Heard that M mode is discouraged these days in measuring the
                  ventricular, atrial and valvular parameters in parasternal long axis
                  view.

                  It is said that B mode images should be scrolled back slowly to acquire
                  the systolic and diastolic phases and measure "directly"

                  KINDLY COMMENT.


                • Gerson Lichtenberg
                  If done correctly, why would there be any difference since you are measuring the same thing? The if done correctly part is the catch. Many operators that I
                  Message 8 of 10 , Nov 1, 2007
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                    If done correctly, why would there be any difference since you are measuring the same thing? The 'if done correctly' part is the catch. Many operators that I  have seen do not know how to orient the M-mode line and do not understand that this cannot be done simply by looking at the 2-D. If the transducer is positioned and oriented correctly, both the interventricular septum and the anterior aortic root should be the same distance from the transducer. We used to be able to show this by doing a continuous scan on a strip of paper. It is difficult to demonstrate on a video screen.

                    When an M-mode recording is not technically adequate, it should not be measured. Again, I have seen this done too often. Supposedly, some doctors require measurements on all studies. As far as I can remember, I have never had a doctor require me to make an inaccurate measurement. At the same time, one should understand and incorporate into one's impression the shortcomings of any linear measurement.

                    If you want to really learn to do M-mode well, set up your machine to simulate an old M-mode only machine. Put the M-mode cursor down the center of the screen and expand your M-mode to fill the entire screen with no 2-D. Adjust your M-mode only by angling and moving the transducer. It is harder to do with a rectangular transducer than it was with a round M-mode transducer. If you don't have the patience to learn to do this well, then I would recommend using 2-D for your routine measurements.

                    Good luck!
                    Gershom Lichtenberg, RDCS
                    Haifa, Israel

                    On 11/1/07, akory99@... < akory99@...> wrote:

                    It takes a great skill and experience to measure M-mode accurately. 2D is much easier to measure - there is less of a chance for an erroneous measurement.
                    We still perform M-mode to assess pericardial effusion, valvular motion (SAM, EPSS, etc), interatrial hypermobility/aneurysms, and some other rare cases, but we generally do not use it for chamber measurements in Adult echo.
                    We use M-mode during Pediatric echo. We do it for two reasons: Ped pictures tend to be "on-axis" most of the time, and their heart rates are generally much higher, which makes the M-mode superior to 2D.
                    Andre



                    -----Original Message-----
                    From: Dr. Bashir H. Samma, MD. <bsamma_1@...>
                    To: echocardiography@yahoogroups.com
                    Sent: Wed, 31 Oct 2007 2:28 pm
                    Subject: [echocardiography] Role of M Mode in echocardiogram

                    Heard that M mode is discouraged these days in measuring the
                    ventricular, atrial and valvular parameters in parasternal long axis
                    view.

                    It is said that B mode images should be scrolled back slowly to acquire
                    the systolic and diastolic phases and measure "directly"

                    KINDLY COMMENT.


                    Email and AIM finally together. You've gotta check out free AOL Mail!


                  • Madhu Menon
                    Check this article: http://www.geocities.com/gthomaskochi/dimensions.html ... acquire
                    Message 9 of 10 , Nov 3, 2007
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                      Check this article:
                      http://www.geocities.com/gthomaskochi/dimensions.html

                      --- In echocardiography@yahoogroups.com, "Dr. Bashir H. Samma, MD."
                      <bsamma_1@...> wrote:
                      >
                      > Heard that M mode is discouraged these days in measuring the
                      > ventricular, atrial and valvular parameters in parasternal long axis
                      > view.
                      >
                      > It is said that B mode images should be scrolled back slowly to
                      acquire
                      > the systolic and diastolic phases and measure "directly"
                      >
                      >
                      > KINDLY COMMENT.
                      >
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