Indication:
3890645-685800(Patient label)Name: UR:00(Patient label)Name: UR:Date/Time of examination: ________________________Indication: ____________________________________________________________Operator/ Supervisor: ________________________/ ___________________________Image guideText guide (What to look out for)Comments-14859032385ParaLAX0ParaLAXLV wall thickness, size & contractionRV wall thickness, size & contractionLVOT diam.: _______ mmAV appearance & CFDMV appearance & CFDPericardial effusion: _______ mmLeft pleural effusion-148590-1905ParaLAXRV inflow0ParaLAXRV inflowRV wall thickness, size & contractionTV appearance & CFDTR CW Doppler (TR peak gradient)(PAsystolic = 4V2 + CVP)-14859016510ParaSAX0ParaSAXAV appearance & CFDTV appearance & CFDTR CW Doppler (TR peak gradient)(PAsystolic = 4V2 + CVP)-14859022860ParaSAX0ParaSAXLV wall thickness, size & contractionRV wall thickness, size & contractionPericardial effusion: _______ mm-14859029210ParaSAX0ParaSAXLV wall thickness, size & contractionRV wall thickness, size & contractionPericardial effusion: _______ mm-148590-6350Apical 4C0Apical 4CLV wall thickness, size & contractionRV wall thickness, size & contractionRA SizeLA sizeMV appearance & CFDTV appearance & CFDPericardial effusion: _______ mm-14859015240Apical 2C0Apical 2CLV wall thickness, size & contractionLA sizeMV appearance & CFD-14859072390Apical LAX0Apical LAXLV wall thickness, size & contractionLA sizeAV appearance & CFDMV appearance & CFDPW Doppler LVOT (VTI for cardiac output estimation)-14859032385Subcostal 4C0Subcostal 4CLV wall thickness, size & contractionRV wall thickness, size & contractionRA SizeLV sizeMV appearance & CFDTV appearance & CFDPericardial effusion: _______ mm-14859053975Subcostal IVC0Subcostal IVCIVC respiratory variationIVC diameter: _________ mmSummary:Management:Trainee sign: _________________________ Supervisor sign: _________________________ ................
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