A Guide To Cardiac Imaging

Goal: To obtain standardized cardiac imaging planes in the shortest number of steps possible.  The standard planes include Vertical Long Axis (VLA) or 2 Chamber view (2C), Horizontal Long Axis (HLA) or 4 Chamber view (4C) and multiple, contiguous short axis views.  

Problem: Every heart has a unique orientation and anatomic configuration so how can you quickly determine the correct location and orientation of the imaging planes?


The preferred method of performing Cardiac Function Analysis (CFA) is to obtain a series of contiguous true short axis cines.  The minimal method requires a good long axis view through the middle of the LV although two orthogonal views are better.  As stated above, every heart is different.  In this missive, we will outline a simple method of reliably obtaining good quality cine images in any desired plane.

Before launching into the step-by-step guide, let’s review some terminology.  We are going to be using the terms Pitch, Yaw and Roll and it’s important that you understand which is which and how each applies to the heart.  First, forget about the heart for a moment; instead, think of an airplane.   When looking at an airplane from the side, the angle it makes from horizontal is called the pitch, (Figure 1a).  If a plane is ascending it has an upward pitch, if it is descending it has a downward pitch.  Now look at the airplane from above.  Its’ left-right orientation is called the yaw.  (Figure 1b).  Finally, if you look at the plane from behind, the orientation of the wings determines the roll.  (Figure 1c)  Think of the plane making a barrel roll maneuver.