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On-Line vs Off-Line Measurements (How Echocardiography Entered the Digital Age, Part 6) (Written by: Dr. Harvey Feigenbaum)

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  • On-Line vs Off-Line Measurements (How Echocardiography Entered the Digital Age, Part 6) (Written by: Dr. Harvey Feigenbaum)

    Any discussion as to how echocardiographic measurements are made must begin by stating the obvious fact that these measurements are not easy or simple. Our current experience with using the KeLabs Test and Teach software program dramatically verifies this fact. These measurements are a vital component of every echocardiogram and must be made with the greatest possible accuracy and reproducibility.

    During the videotape era, on-line measurements on video freeze frames were the only available means of making measurements. Overcoming the limitations of this methodology was one of the goals for pursuing digital recordings. On-line measurements are obtained on the ultrasonic instrument either during or immediately following the examination. In either case the instrument, and possibly the patient, are “tied up” while these measurements are being made. Thus, the total examination time is prolonged. One could argue that the expensive ultrasound instrument shouldn’t be used to make measurements which could be made on a much cheaper computer outside of the examining room.

    More importantly, these important and frequently difficult measurements shouldn’t be done in a hurry under the time pressure of needing to evacuate the examining room for the next patient. Frequently, a measurement can be appreciated better if first visualized in real-time before making it on a still frame. That may be difficult if not impossible to do on-line. And lastly, it must be remembered that the ultimate responsibility for echo accuracy is the reading physician. He or she must have the ability to check and change any measurement. Having measurements that the reader may disagree with shouldn’t be permanently embedded in the images. Making on-line measurements in the digital age is not only unnecessary, but can seriously effect the accuracy and credibility of the examination.
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