Join Dr. Dinesh Thavendiranathan of the University of Toronto for a discussion on 3D volume echocardiography in the left heart. Hear how volume echocardiography enables the acquisition of an entire volume of the heart in a single full cardiac cycle and facilitates faster and more accurate analysis via full automation of endocardial contours. Also learn about workflow improvements, more reproducible echo exams and ways to save costs

1. Sponsored by
Future of Echocardiography
Unlocking the Power of Volume Imaging
Dinesh Thavendiranathan, MD
Cardiologist
University of Toronto, Canada

2. Sponsored by
Evolution of Volume Imaging
1. Multiple 2D images of the heart – sort in sequence to
create 3D datasets
2. Stitched acquisition: Acquire small sub volumes, store in
post processing to generate a full 3D volume.
– Require: Good ECG gaiting; regular heart rhythm

3. Sponsored by
Gated Imaging
Gating depends on the RR intervals:
 Volume segmented into small pieces
 Small pieces of volumes obtained in each part of interval
 Volumes stitched together = full volume
Limitations of stitched acquisition
 Irregularity in data  artifacts
 Single volume is a combination of
multiple different heart beats.

4. Sponsored by
Volume Imaging
Obtainentirevolumeoftheheartinasinglefullcardiaccycle
Benefits:
 No stitching artifacts
 Subsequent datasets from multiple continuous or
contiguous heart beats

5. Sponsored by
Workflow
Previously, post-processing…
 Was done offline
 Directlyonthemachinefromwhichthedataareacquired.
 Is time consuming and sometimes inaccurate
Now,wehavesinglebeatfullvolumeimagingwhichbringbenefits:
 No stitching artifact
 Automationtodetectendocardialcontour
improvesthespeedandaccuracytoa
previouslymanualprocess
 Efficient workflow for sonographers

6. Sponsored by
Workflow & Volume Imaging
More attractive and more practical
Creates datasets free of artifacts when imaging patients that
are sick - arrhythmias or difficulty breath-holding
Enables best volume for analysis

7. Sponsored by
Economic and Cost Savings
with Volume Echo
Cardiac MRI
 Cost is higher
 Wait time is longer
 Takes longer to get a volume dataset Echo more widely
available
Echo
 More widely available
 Offers multiple volumetric datasets
to analyze vs. cardiac MRI with a
single volume dataset, depending
on measurements

8. Sponsored by
Benefits of 3D Echo vs. 2D Echo:
Diagnosis and Prognosis
3D makes a difference in accurate and reproducible ventricular
volumes and ejection fraction
Assists in decision-making:
 For patients with ischemic heart disease and mitral
regurgitation
 When changes in ejection fraction and volume over time
has an impact on clinical decision – ie surgery

9. Sponsored by
Benefits of 3D Echo vs. 2D Echo:
Diagnosis and Prognosis
Today, many labs are using 2D methods vs. 3D methods
3D echo should be our standard for ventricular volume
and function assessment and post processing
Oncology patient population – small changes in ejection
fraction to determine changes in chemotherapy
Patients with valve disease –
volume and function assessment
and valves

10. Sponsored by
Reproducibility of 3D Echo
Interobserver variability: Measurement of the same dataset by
two different people
Intraobserver variability: Measurement of the same twice by the
same person
Test re-test variability: Imaging the person twice, with no
change in physiology and comparing the accuracy of the two
measurements

11. Sponsored by
Reproducibility of 3D Echo
Reproducibility markers very important, better with 3D echo vs.
2D echo
Longitudinal reproducibility: 3D echo function over multiple time
points over a year
3D echo superior in interobserver, intraobserver,
test re-test and longitudinal variability

12. Sponsored by
Reproducibility of 3D Echo
What differentiates 3D echo?
Post-processing method!
Greatest benefit to automated volume technique:
Removes observer variability – learned algorithms detect
endocardial borders and endocardium

13. Sponsored by
Volume Echo vs. Cardiac MRI
Differences in contrast noise ratio and signal to noise ratio
Benefits of cardiac MRI: Superior contrast to noise ratio 
differentiates blood pool from the endocardium; draw
endocardial contours accurately and reproducibly
Benefits of 3D echo: Automated methods to measure the
endocardium border and endocardial contours in an accurate
and reproducible manner
Looking at reproducibility:
Automated 3D echo and cardiac
MRI are quite comparable now vs.
older 3D methods

14. Sponsored by
3D Echo Single Beat Full Volume Acquisition
Benefit  Hemodynamic Data
In the Past:
 DependedonpulsewaveDopplertomeasuremitralinflow,stroke
volumesandaorticoutflowstrokevolumes
 Calculate mitral regurgitation volume and regurgitative
fraction
 With 2D echo we’ve had to make several assumptions:
- Geometry of mitral inflow orifice as well as the left
ventricular outflow tract
- Pulse wave Doppler: Measure
mitral inflow and aortic outflow
in sample volume

15. Sponsored by
3D Echo Single Beat Acquisition Benefit
 Hemodynamic Data
Today:
 Color Doppler volume imaging measures stroke volumes,
velocities intrinsic in data set
 Studies show 3D full volume single heart beat echo with
color Doppler measure stroke volume of aortic and mitral
valves is better than 2D echocardiography
 Applied in patients with mitral regurgitation where it
matters for the quantification of regurgitation
volume and regurgitation fraction
 Hemodynamic data provides
useful information

16. Sponsored by
Benefits of Hemodynamic
Data into the Future
 Mitral valve regurgitation: Quantification of aortic
regurgitation, more accurate quantification of aortic stenosis
and mitral stenosis
 Implication in the quantification of QP/QS in cases when
shunts present – more accurate measure right and left
stroke volume and calculate shunt fraction
 Stroke volume measurements have had limitations – now
with 3D data and 3D color Doppler
we may be able to measure stroke
volumes better and use that as a
marker of severity of underline
cardiovascular disease

17. Sponsored by
Benefits of Hemodynamic
Data into the Future
 Understand the ventricular hemodynamics better 
past: used vortex flows in the ventricle as a marker
of ventricular function and changes in ventricular
geometry – depend on single, 2D plane
 With 3D dataset and real time volume color
doppler data, it may help us to understand
intraventricular hemodynamics better

18. Sponsored by
Single Beat Full Volume Acquisitions:
Changed the Balance Between
Qualitative and Quantitative Echo
Due to limitations of quantification  Depended on qualitative
measures for mitral regurgitation, aortic regurgitation, other
valve of the disease quantification and left ventricular function
quantification
Automated and accurate methods of quantifying volumes
function regurgitation fraction will help us move towards
quantification rather than just use qualitative methods to
access disease severity

19. Sponsored by
Looking Forward
Single beat full volume data acquisition and automation have
really helped us move forward with 3D echo
Future: Single image acquisition for comprehensive
echocardiography study
 Expand volume dataset to cover the whole heart with
real-time color Doppler  we may be able to get a single
dataset acquisition of left and right ventricle; or whole
volume of heart to use for
post-processing and assessment of
right left ventricular function and
valvular disease severity

20. Sponsored by
Looking Forward
Future: Atrial volume and atrial function for disease severity
and prediction
 Full volume 3D dataset could make a difference in the
acquisition of left atrial and right atrial volumes
 Real-time volume dataset over multiple
consecutive heart beats  potentially use
volume to measure atrial function parameters
add to data to use in either clinical
decision-making or prognosticating

21. Sponsored by
Future of Echocardiography
Unlocking the Power of Volume Imaging
Dinesh Thavendiranathan, MD
Cardiologist
University of Toronto, Canada
For more information, visit:
http://usa.healthcare.siemens.com/ultrasound