Cardiac Planning Guide

The following table lists a variety of cardiac examination requirements a physician may request and the
sequence planning to perform those examinations.

When you need to: Refer to these planning guidelines

1 Perform cardiac exams with 1 Basic cardiac views
Vertical Long Axis (VLA) 1.2 Vertical long axis (VLA) – page 6
Horizontal Long Axis (HLA) 1.3 Horizontal Long Axis (HLA) – page 7
Short Axis (SA) 1.4 Short Axis (SA) – page 7
4 Chambers (4CH) 1.5 4 Chambers (4CH) – page 8

2 Perform cardiac exams with Inflow and Outflow
Tracts :
Left 2 Chambers (L2CH)
Right 2 Chambers (R2CH)
Left Ventricular Out flow Tract (LVOT)
Left Ventricular Out flow Tract (LVOT) 3pps
Left Ventricular Out flow Tract –Coronal (LVOT-COR)
Right Ventricular Out flow Tract (RVOT)
Right Ventricular Outflow Tract / Right two chamber
(alternate)
2 Out flow tracts
2.1 Left 2 Chambers (L2CH) – page 9
2.2 Right 2 Chambers (R2CH) – page 9
2.3 Left Ventricular Outflow Tract (LVOT): method 1 –
page 10
2.4 Left Ventricular Outflow Tract (LVOT): method 2 –
page 10
2.5 Left Ventricular Outflow Tract Coronal (LVOT-COR) –
page 11
2.6 Right ventricular Outflow Tract (RVOT) – page 11
2.7 Right Ventricular Outflow Tract / Right two chamber
(alternate) – page 12

3 Perform cardiac exams Through the Arteries: 3 Through the arteries

Aortic arch 3pps 3.1 Aortic arch: method 1 – page 13
Aortic arch 3.2 Aortic arch: method 2 – page 14
Pulmonary Bifurcation (PB) 3.3 Pulmonary Bifurcation (PB) – page 14
Left Pulmonary Artery (LPA) 3.4 Left Pulmonary Artery (LPA) – page 15
Right Pulmonary Artery (RPA) 3.5 Right Pulmonary Artery (RPA) – page 15

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Cardiac Planning Guide
When you need to:
4 Measure Q-flow for Main Pulmonary Artery (MPA)
5 Measure Q-flow for Right Pulmonary Artery (RPA)
6 Measure Q-flow for Left Pulmonary Artery (LPA)
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Refer to these planning guidelines
1 Basic cardiac views
- 1.1 Vertical long axis (VLA) – page 6
- 1.2 Horizontal Long Axis (HLA) – page 7
- 1.3 Short Axis (SA) – page 7
- 1.4 4 Chambers (4CH) – page 8
1 Basic cardiac views
- 1.1 (A stack of) transverse – page 6
2 Outflow tracts
- 2.6 Right Ventricular Outflow Tract (RVOT) – page 11
- 3.3 Pulmonary bifurcation (PB) – page 14
3 Plan Q-flow
- 4.2 Main Pulmonary Artery (MPA) flow – page 16
1 Basic cardiac views
- 1.1 Vertical long axis (VLA) – page 6
- 1.2 Horizontal Long Axis (HLA) – page 7
- 1.3 Short Axis (SA) – page 7
- 1.4 4 Chambers (4CH) – page 8
1 Basic cardiac views
- 1.1 (A stack of) transverse – page 6
2 Outflow tracts
- 2.6 Right Ventricular Outflow Tract (RVOT) – page 11
3 Through the arteries
- 3.3 Pulmonary Bifurcation (PB) – page 14
- 3.5 Right Pulmonary artery (RPA) – page 15
4 Plan Q-flow
- 4.3 Right Pulmonary Artery (RPA) flow – page 17
1 Basic cardiac views
- 1.1 Vertical long axis (VLA) – page 6
- 1.2 Horizontal Long Axis (HLA) – page 7
- 1.3 Short Axis (SA) – page 7
- 1.4 4 Chambers (4CH) – page 8
1 Basic cardiac views
- 1.1 (A stack of) transverse – page 6
2 Outflow tracts
- 2.6 Right Ventricular Outflow Tract (RVOT) – page 11
3 Through the arteries
- 3.3 Pulmonary Bifurcation (PB) – page 14
- 3.4 Left Pulmonary artery (LPA) – page 15
4 Plan Q-flow
- 4.4 Left Pulmonary Artery (LPA) flow – page 17
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When you need to: Refer to these planning guidelines

7 Measure Q-flow for Aorta 1 Basic cardiac views
- 1.1 Vertical long axis (VLA) – page 6
- 1.2 Horizontal Long Axis (HLA) – page 7
- 1.3 Short Axis (SA) – page 7
- 1.4 4 Chambers (4CH) – page 8
2 Outflow tracts
- 2.3/2.4 Left Ventricular Outflow Tract (LVOT) –
page 10
- 2.5 Left Ventricular Outflow Tract Coronal (LVOT-COR)
– page 11
3 Plan Q-flow
- 4.1 Aortic flow – page 16

8 Measure Q-flow for Mitral Valve (MV) 1 Basic cardiac views

- 1.1 Vertical long axis (VLA) – page 6
- 1.2 Horizontal Long Axis (HLA) – page 7
- 1.3 Short Axis (SA) – page 7
- 1.4 4 Chambers (4CH) – page 8
2 Outflow tracts
- 2.1 Left two chamber (L2CH) – page 9
3 Plan Q-flow
- 5.1 Mitral Valve (MV) flow – page 18

9 Measure Q-flow for Tricuspid valve (TV) 1 Basic cardiac views

- 1.1 Vertical long axis (VLA) – page 6
- 1.2 Horizontal Long Axis (HLA) – page 7
- 1.3 Short Axis (SA) – page 7
- 1.4 4 Chambers (4CH) – page 8
2 Outflow tracts
- 2.2 Right two chamber (R2CH) – page 9
3 Plan Q-flow
- 5.2 Tricuspid Valve (TV) flow – page 18

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Cardiac Planning Guide

Step by step for VCG set-up and calibration

1. Position the VCG electrodes on the patient (as shown).

Wireless VCG Wired VCG

Clip color Function

1 White Upper trace

2 Black Common active
3 Red Lower trace
4 Green Common ground

2. To set the network and perform VCG calibration method, in the patient status area, right-click in the
VCG physiology signal.

3. Perform the following steps while the patient is outside the bore:
a. Click VCG + Resp. to specify the type of the physiology signal.
b. Set the physiology signal window to 5 seconds.
c. Click Choose Physiology Properties….
d. From the Network Selection drop down menu and select the network as displayed on the VCG and
respiratory device.
e. To perform manual calibration of the VCG signal, select Manual Calibration and then click Start
Calibration.

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Shim planning
 Place shim volume cover the entire heart.
 Include only the aorta, to reduce the appearance of artifacts when imaging vessels in the same exam.

Shimming is mandatory!
 Always use a volume shim
Important
 Always use a volume RF shim (3.0T)
 Do NOT use a PB volume shim

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Cardiac Planning Guide

1. Planning basic cardiac views

1.1 A stack of Transverse

For any cardiac exam, physicians may
recommend acquiring a stack of
transverse to have a brief overview of
the anatomical structures. If the
survey scan provides good images in
all three planes this may not be
necessary.

 Can be done free breathing

 Can be done right after Survey, or
when needed (for example,
before scanning arch, or RVOT).
 Coverage: whole heart and aortic
arch usually.

1.2 Vertical Long Axis (VLA)

Plan on axial through:
 Apex of left ventricle
 Center of mitral valve (MV)

View:
Sagittal oblique
 Left ventricle (LV)
 Mitral valve (MV)
 Left atrium (LA)

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1.3 Horizontal Long Axis (HLA)

Plan on VLA through:
 Apex of left ventricle
 Center of mitral valve (MV)

View:
Transverse oblique
 Ventricular septum
 Mitral valve (MV)
 Apex of left ventricle

1.4 Short Axis (SA)

Plan on VLA and HLA
 Usually a stack of slices
 Parallel with mitral valve (MV)
 Perpendicular with septum
 Perpendicular to line from apex to
mitral valve
 Include from mitral valve to apex
View:
Sag or Cor oblique
 Left ventricle (LV)
 Right ventricle (RV)

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Cardiac Planning Guide

The planes of the heart in the short axis view.

1.5 Four Chamber (4CH)

Plan on SA and VLA.
Position slice through:
 Center of left ventricle (LV)
 Corner of right ventricle (RV)
 Apex of left ventricle

View:
Transverse oblique
 Left and right atrium (LA, RA)
 Left and right ventricle (LV, RV)
 Mitral valve (left) (MV)
 Tricuspid valve (right) (TV)

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2. Inflow and Outflow tracts

2.1 Left two chamber (L2CH)

Plan on 4CH and SA, through:
 Apex and mitral valve
 Center of left ventricle (LV)
 Center of left atrium (LA)

View:
Sagittal oblique
 Left ventricle (LV)
 Mitral valve (MV)
 Left atrium (LA)

2.2 Right two chamber (R2CH)

Plan on 4CH and SA, through:
 Apex and tricuspid valve
 Center of right ventricle (RV)
 Center of right atrium (RA)

View:
Sagittal oblique
 Right ventricle (RV)
 Tricuspid valve (TV)
 Right atrium (RA)

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Cardiac Planning Guide

2.3 Left Ventricular Outflow Tract (LVOT or 3CH) - Method 1

Plan on basal SA and L2CH.
Position slice through:
 Aorta (basal SA)
 Center of mitral valve (MV)
 Apex
Basal SA may appear as the shape of a
snowman.

View:
Transverse or sagittal oblique
 Left ventricle (LV)
 Mitral valve (MV)
 Left atrium (LA)
 Aortic valve (AV)
 Ascending aorta (AAo)

2.4 Left Ventricular Outflow Tract (LVOT) - Method 2 using 3pps

Plan on COR survey and 4CH.

With 3pps, place the:

 1st point on apex of LV
 2nd point on center of mitral valve
3rd point just above aortic valve in
ascending aorta

View:
 Left ventricle (LV)
 Mitral valve (MV)
 Left atrium (LA)
 Aortic valve (AV)
 Ascending aorta (AAo)

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2.5 Left Ventricular Outflow Tract Coronal (LVOT_cor)

Plan on transverse or sagittal LVOT.

Position slice through:

 Center of aortic valve (AV)
 Center of ascending aorta (AAo)

View: Coronal oblique

 Left ventricle (LV)
 Aortic valve (AV)
 Ascending aorta (AAo)

2.6 Right Ventricular Outflow Tract (RVOT)

Plan on transverse images.
Position slice through:
 Center of main pulmonary artery (MPA)
 Straight sagittal

View:
Sagittal oblique
 Right ventricle (RV)
 Pulmonary valve (PV)
 Main pulmonary artery (MPA)

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2.7 Right Ventricular Outflow Tract / Right two chamber (alternate)

Plan on 4CH and basal SA.

Position slice through:

 Right apex and tricuspid valve. (TV)
 Center of right ventricle. (RV)
 Center of right atrium. (RA)

View:
Sagittal oblique
 Right ventricle (RV)
 Right atrium (RA)
 Pulmonary valve (PV)
 Main pulmonary artery (MPA)
 Right pulmonary artery (RPA)

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3. Through the arteries

3.1 Aortic arch: Method 1 use 3pps

Plan on transverse images, use
3pps:
 1st middle of ascending aorta.
 2nd middle of descending
aorta.
 3rd middle of aortic arch.

Be sure to adjust the slice parallel to thoracic aorta on the coronal survey.

Sagittal oblique
 Ascending aorta (AAo)
 Aortic arch (Arch)
 Descending aorta (DA)

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Cardiac Planning Guide

3.2 Aortic arch Method 2

Plan on transverse images.
Position the slice through:
 Middle of ascending aorta.
 Middle of descending aorta.

View:
Sagittal oblique
 Ascending aorta
 Aortic arch
 Descending aorta

3.3 Pulmonary Bifurcation (PB)

Plan on RVOT
 Position slice centered at the MPA level
 Scan a stack (3-4 slices) to get the best
view of bifurcation.

View:
Transverse
 Main pulmonary artery (MPA)
 Left pulmonary artery (LPA)
 Right pulmonary artery (RPA)

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3.4 Left Pulmonary Artery (LPA)

Plan on pulmonary bifurcation (PB)
Position slice parallel and centered through left
pulmonary artery.

View:
Sagittal oblique
 Left pulmonary artery (LPA)

3.5 Right Pulmonary artery (RPA)

Plan on pulmonary bifurcation (PB)
 Position slice parallel and centered through
right pulmonary artery.

View:
Sagittal oblique
 Right pulmonary artery (RPA)

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Cardiac Planning Guide

4. Q-flow through the arteries

4.1 Aortic flow

Plan on LVOT and LVOT_cor
Position the slice:
 Perpendicular to the aorta on both views.
 2 cm above the aortic valve on both views.
 Confirm the position of the slice does not
touch the aortic valve during the cardiac
cycle.

View:
Transverse
 Ascending aorta
 Descending aorta

4.2 Main Pulmonary Artery (MPA) flow

Plan on ROVT and PB :
Position the slice:
 Perpendicular to the MPA on RVOT.
 Center and straight on MPA on PB.
 2 cm above the PV on the RVOT view.
 Confirm the position of the slice does
not touch the PV during the cardiac
cycle.
View:
Transverse
 Main pulmonary artery (MPA)

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4.3 Right Pulmonary Artery (RPA) flow

Plan on PB and RPA (in plane)
Position the slice:
 Perpendicular to the RPA on both views.
 Approximately 2 cm distal of the pulmonary
bifurcation.

View:
Sagittal oblique
 Right pulmonary artery (RPA)

4.4 Left Pulmonary Artery (LPA) flow

Plan on PB and LPA (in plane)
Position the slice:
 Perpendicular to the LPA on both views.
 Approximately 2 cm distal of the pulmonary
bifurcation.

View:
Coronal oblique
 Left pulmonary artery (LPA)

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Cardiac Planning Guide

5. Q-flow through the valves

5.1 Mitral Valve (MV) flow

Plan on 4CH and L2CH
Position the slice:
 Parallel to the mitral valve on both views.
 Commonly planned after the valve,
downstream of the valve.
 Check with your physician.

View:
Coronal oblique
 Mitral valve flow (MV) flow

5.2 Tricuspid valve (TV) flow

Plan on 4CH and R2CH
Position the slice:
 Parallel to the tricuspid valve on both views.
 Commonly planned after the valve,
downstream of the valve.
 Check with your physician.

View:
Coronal oblique
 Tricuspid valve flow (TV) flow

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NOTES:

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Cardiac Planning Guide

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