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When imaging in longitudinal and sagittal planes, including short‐ and long‐axis views of the heart, maintain the head to the left and tail to the right on the screen. If the area of interest is to the left of the screen, you learn to slide or rock toward the patient's head to center the image and vice versa if to the right of the screen, slide or rock toward the patient's tail whether you are doing AFAST, TFAST or Vet BLUE (see Figure 1.6). In human medicine, physicians performing cardiac FAST and POCUS examinations will not necessarily reverse orientation, but stay consistent with all other imaging, with cranial to the left and caudal to the right of the screen (Walker and Mohabir 2014). I like to call this the “rogue way” in which to capture echocardiography views, but maintaining orientation whatever the region of interest is advantageous for localizing abnormal findings, and the noncardiologist doesn’t have to do any mental spatial adjustments because the cardiac ultrasound orientation is now the same as everywhere else (abdomen and lung).

Figure 5.3. Best practice is the head of the patient and machine in the same sightline. In (A), the assistant, the scanner, and the patient are all facing the ultrasound screen (arrows). This is safest because the patient can be observed for any stress and decompensation while imaging. In (B) the head of the patient is away from the ultrasound screen. Both the assistant and scanner are focused on the screen and thus cannot readily appreciate any stress or decompensation of the patient, and cannot quickly react if the dog turns to bite them. The large "X" denotes that this is risky practice.

Source: Courtesy of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX.

Figure 5.4. The helper hand and probe hand make a difference. In (A) the helper hand moves less haired skin and can help spread the hair for optimal probe head to skin coupling. In (B) and (C) the helper hand in essence V troughs the standing patient, preventing swaying and better stabilizing the probe for maneuvering in small increments, especially important for cardiac imaging.

Source: Courtesy of Dr Gregory Lisciandro, Hill Country Veterinary Specialists and FASTVet.com, Spicewood, TX.