Targeted Neonatal Echocardiography: Basics of Knobology 101

Abstract

Targeted neonatal echocardiography (TNE) is essential when approaching hemodynamic instability in neonates. Competency in this field requires standardized training, including robust hands-on experience. Proficiency in understanding the key elements of ultrasound knobology is indispensable for optimal acquisition of imaging. This is a narrative review summarizing the key elements of knobology in TNE. Literature review was mainly done through PubMed. There was no funding allocated for the production of this manuscript.

Key Points

• Robust and structured training is essential

• Understanding knobology is required to achieve competency in TNE

• Optimizing knobology is critical for an accurate hemodynamic interpretation report

Keywords

resolution - NICU - knobology - targeted neonatal echocardiography

• References

• 1 Hébert A, Lavoie PM, Giesinger RE. et al. Evolution of training guidelines for echocardiography performed by the neonatologist: toward hemodynamic consultation. J Am Soc Echocardiogr 2019; 32 (06) 785-790
• 2 Papadhima I, Louis D, Purna J. et al. Targeted neonatal echocardiography (TNE) consult service in a large tertiary perinatal center in Canada. J Perinatol 2018; 38 (08) 1039-1045
• 3 Alammary D, Narvey M, Soni R, Elsayed Y, Louis D. Targeted neonatal echocardiography service in neonatal intensive care in Manitoba, Canada. J Perinatol 2022; 42 (05) 655-659
• 4 Giesinger RE, Rios DR, Chatmethakul T. et al. Impact of early hemodynamic screening on extremely preterm outcomes in a high-performance center. Am J Respir Crit Care Med 2023; 208 (03) 290-300
• 5 Giesinger RE, Hobson AA, Bischoff AR, Klein JM, McNamara PJ. Impact of early screening echocardiography and targeted PDA treatment on neonatal outcomes in “22-23” week and “24-26” infants. Semin Perinatol 2023; 47 (02) 151721
• 6 Rahde Bischoff A, Bhombal S, Altman CA. et al. Targeted neonatal echocardiography in patients with hemodynamic instability. Pediatrics 2022; 150 (Suppl. 02) e2022056415I
• 7 Mertens L, Seri I, Marek J. et al; Writing Group of the American Society of Echocardiography (ASE), European Association of Echocardiography (EAE), Association for European Pediatric Cardiologists (AEPC). Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Eur J Echocardiogr 2011; 12 (10) 715-736
• 8 Zander D, Hüske S, Hoffmann B. et al. Ultrasound image optimization (“Knobology”): B-mode. Ultrasound Int Open 2020; 6 (01) E14-E24
• 9 Atkinson NSS, Bryant RV, Dong Y. et al. How to perform gastrointestinal ultrasound: anatomy and normal findings. World J Gastroenterol 2017; 23 (38) 6931-6941
• 10 Roehrig H, Fan J, Chawla A, Gandhi K. The liquid crystal display (LCD) for medical imaging in comparison with the cathode ray tube display (CRT). In: Penetrating Radiation Systems and Applications IV. 2002. ;4786.114-131
• 11 Lamb TD, Pugh Jr EN. Dark adaptation and the retinoid cycle of vision. Prog Retin Eye Res 2004; 23 (03) 307-380
• 12 Lamb TD, Pugh Jr EN. Phototransduction, dark adaptation, and rhodopsin regeneration the proctor lecture. Invest Ophthalmol Vis Sci 2006; 47 (12) 5137-5152
• 13 Manbachi A, Cobbold RSC. Development and application of piezoelectric materials for ultrasound generation and detection. Ultrasound 2011; 19 (04) 187-196
• 14 Ng A, Swanevelder J. Resolution in ultrasound imaging. Contin Educ Anaesth Crit Care Pain 2011; 11 (05) 186-192
• 15 Napolitano D, Chou CH, McLaughlin G. et al. Sound speed correction in ultrasound imaging. Ultrasonics 2006; 44 (Suppl. 01) e43-e46
• 16 Li F, He Q, Huang C, Liu K, Shao J, Luo J. High frame rate and high line density ultrasound imaging for local pulse wave velocity estimation using motion matching: a feasibility study on vessel phantoms. Ultrasonics 2016; 67: 41-54
• 17 Tuma J, Jenssen C, Möller K. , et al [Ultrasound artifacts and their diagnostic significance in internal medicine and gastroenterology - Part 1: B-mode artifacts]. Z Gastroenterol 2016; 54 (05) 433-450
• 18 Chang JH, Kim HH, Lee J, Shung KK. Frequency compounded imaging with a high-frequency dual element transducer. Ultrasonics 2010; 50 (4–5): 453-457
• 19 Trahey GE, Smith SW, von Ramm OT. Speckle pattern correlation with lateral aperture translation: experimental results and implications for spatial compounding. IEEE Trans Ultrason Ferroelectr Freq Control 1986; 33 (03) 257-264
• 20 Treece GM, Gee AH, Prager RW. Ultrasound compounding with automatic attenuation compensation using paired angle scans. Ultrasound Med Biol 2007; 33 (04) 630-642
• 21 Entrekin RR, Porter BA, Sillesen HH, Wong AD, Cooperberg PL, Fix CH. Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound. Semin Ultrasound CT MR 2001; 22 (01) 50-64
• 22 Li PC, Chen MJ. Strain compounding: a new approach for speckle reduction. IEEE Trans Ultrason Ferroelectr Freq Control 2002; 49 (01) 39-46
• 23 Dietrich CF, Bartsch L, Turco V. et al. Knöpfologie in der B-Bild-Sonografie. Onkologie up2date 2020; 2 (03) 187-204
• 24 Merkel D, Brinkmann E, Kämmer JC, Köhler M, Wiens D, Derwahl KM. Comparison between various color spectra and conventional grayscale imaging for detection of parenchymal liver lesions with B-mode sonography. J Ultrasound Med 2015; 34 (09) 1529-1534
• 25 Pye SD, Wild SR, McDicken WN. Adaptive time gain compensation for ultrasonic imaging. Ultrasound Med Biol 1992; 18 (02) 205-212
• 26 Gatenby JC, Hoddinott JC, Leeman S. Phasing out speckle. Phys Med Biol 1989; 34 (11) 1683-1689
• 27 Park J, Kang JB, Chang JH, Yoo Y. Speckle reduction techniques in medical ultrasound imaging. Biomed Eng Lett 2014; 4 (01) 32-40
• 28 Miller DL. Update on safety of diagnostic ultrasonography. J Clin Ultrasound 1991; 19 (09) 531-540
• 29 Hershkovitz R, Sheiner E, Mazor M. Ultrasound in obstetrics: a review of safety. Eur J Obstet Gynecol Reprod Biol 2002; 101 (01) 15-18
• 30 Nyborg WL. Biological effects of ultrasound: development of safety guidelines. Part I: personal histories. Ultrasound Med Biol 2000; 26 (06) 911-964