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DEFINITY® Delivers High-Quality Images

Image optimization is important when performing a DEFINITY® echo where the image always dictates the appropriate settings.1

Are You Optimizing the Use of Contrast 
Echocardiography? A Case-Based Discussion

Anita M. Kelsey, MD, and Steven Walling, RDCS, explore 2 cases to illustrate the importance of teamwork, operational efficiency, and the appropriate use of DEFINITY® in achieving quality echocardiographic imaging.

Image Optimization Guide

Image Optimization Guide

Ultrasound System Control Adjustments Vary by Patient and Ultrasound System

Key Controls to Optimize Image Quality

Mechanical Index/Power: Strength of Ultrasound Beam2

Adjust power to adequately visualize cardiac anatomy

Frequency: Affects the Penetration
of the Ultrasound Beam and
Image Resolution3

Choose a frequency for optimal image resolution

Focus: Narrowest Area of the 
Ultrasound Beam With the 
Greatest Ultrasound Intensity3

Place focus at the mitral valve level for optimal visualization of the left ventricle

Position focus at area of interest when evaluating pathologies, regional wall motion

High frequencies provide less depth of penetration with greater image resolution.2
Low frequencies provide greater depth of penetration with lower image resolution.2

Power/Mechanical Index Can Have the Greatest Impact on Overall Image Quality

Power adjustments vary by patient and ultrasound system

Power too low

Power Optimized

Secondary Controls to Optimize Image Quality

Gain: boosts the amplification of received echoes1

When gain is set too high, the image may appear too bright

When gain is set too low, the image may appear too dark

Dynamic range/compression: adjusts the range of shades of gray displayed in 2D images1

When setting is too high, the image may appear washed out

When setting is too low, the image may appear dark

Speed of administration and system settings contribute to optimal    
image quality

Optimal Opacification

  • An ideal administration rate enables a homogeneous fill of the left ventricular cavity

Fast Injection — Attenuation1

  • Creates a high concentration of microbubbles in the apex
  • Helps to evaluate apical abnormalities


Insufficient opacification inhibits the adequate assessment of structural abnormalities, wall motion, and left ventricular function

  • Injection rate too slow or insufficient dose
  • Inadequate system settings
  • Poor LV function
Left ventricular function plays an important role in the rate at which DEFINITY® should be injected
  • Poor LV function or low heart rate may require a more rapid speed of injection to allow DEFINITY® to completely fill the entire LV
  • High heart rate may require a slower administration rate

LV=left ventricle.


  1. Witt SA, McCulloch M, Sisk E, et al. Achieving a diagnostic contrast-enhanced echocardiogram: a series on contrast echocardiography, article 4. J Am Soc Echocardiogr. 2001;14(4):327-334.

  2. Burgess P, Moore V, Bednarz J, et al. Cardiac sonographer's communication. Performing an echocardiographic examination with a contrast agent: a series on contrast echocardiography, article 2. J Am Soc Echocardiogr. 2000;13(6):629-636.

  3. Armstrong WF, Ryan T. Feigenbaum's Echocardiography. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:9-38.