ECHOCARDIOGRAPHY

INTRODUCTION

Cardiac ultrasound also known as echocardiography is an invasive method use widely for detailed and accurate evaluation of the cardiac structure and function. Nowadays, the advancement in technologies creates development in the ultrasound machine for better clinical benefit. The aim of this proposal is to recommend new ultrasound machine for cardiac imaging. The remarks which highlighted are technical specification needed and overall budget to purchase this machine. 

TECHNICAL SPECIFICATION

1.1         IMAGING PARAMETER

1.1.1        FREQUENCY

Image quality is superior in this imaging; ability to utilize accuracy in diagnosis. The preference of the frequency is compensate with penetration depth. Higher frequency will lessen penetration depth but image resolution is better.  Adequate resolution needed for echocardiography are axial resolution <0.5 mm, lateral <5 mm at all depths and <2 mm in focal zones (Cavanagh & Smith, 2014).

In cardiac, the imaging depth is deep which depending on the patient size.  Consequently, cardiac ultrasound priority in adults requires the use of lower frequencies regularly 2-4 MHz to enhance penetration depth (Hoffmann & Bahner, 2008). The frequency range of the transducer will influence mode of scanning.  Doppler-based imaging modes usually operate with lower frequencies than the B-mode frequency to minimize aliasing (Szabo & Lewin, 2013).

1.1.2        TRANSDUCER/ PROBE

Selection of transducer or probe determines the coverage of the region of interest, maximum scan depth and coverage of essential diagnostic modes required to optimize a patient’s diagnosis (Szabo & Lewin, 2013). Besides, it can be used to performed advanced function such as 3D and 4D echocardiography. The probe used is small “footprints” either phased or microconvex.  However, curvilinear probes also can be used to visualize the heart, predominantly in the subxiphoid view (Hoffmann & Bahner, 2008).  Microconvex transducer provides larger field of view. Option of the transducer limits the echocardiogram examination. Therefore, requires having more than one transducer for better evaluation.

Figure 1: Transducer from Sonosite manufacturer with frequency 5-1 MHz

1.1.3        SCANNING MODE

The common requirement modes of scanning for echocardiography are B-mode, M-mode, color-flow imaging, and spectral and tissue Doppler. Mode of scanning will intensify contrast enhancement of the image. The high temporal resolution of M-mode echocardiography allows precise depiction of rapidly moving structures. While, basis of assessment of cardiac chambers and valves and enable identification of structural abnormalities is based on 2D transthoracic echocardiography (TTE) (Ashley & Niebauer, 2004).

Moreover, Doppler echocardiography comprising spectral Doppler (pulsed wave and continuous wave) and colour Doppler imaging is used to evaluate the direction, velocity, amplitude and timing of blood flow through the heart. 3D echocardiography also widely used to assess ventricular mechanical dyssynchrony, evaluate valvular disease and long-term response to cardiac resynchronization therapy (Shah, 2013).

Figure 2: Image scanning based on M-mode (left), 2D echocardiography and Colour Doppler

1.1.4        DATA ACQUISITION, INTEPRETATION AND STORAGE

Training like image acquisition and image interpretation is compulsory. So, image analysis and interpretation is well documented and ensure appropriate use of echocardiography in many clinical studies. Position of the transducer play important role in cardiac ultrasound. So, imaging procedure of heart is taken from various orthogonal planes based on the heart’s position within the chest

Echocardiographic data must able to store images in a method compatible with DICOM (Digital Imaging and Communications in Medicine) standards. So, it easily to access, share and discuss about the image. For the real time image visualization, it needs suitable screen size because small screen will limit recognition of diagnostic findings. The compatible ultrasound machine with ECG yield advanced signal processing and electrocardiographic (EKG) gating (Spencer et al., 2013).

1.2         SIZE AND TYPE OF MACHINE

Portable echocardiography machine is most preferable. So, it can take from one place to another place effortlessly. Size of the machine is medium size and not required a lot of space to place it mainly when use in moderate room with limited space.

1.3         POWER OUTPUT

The electrical safety indices (mechanical index [MI] and thermal index [TI]) following American Institute of Ultrasound in Medicine (AIUM) or National Electrical Manufacturers Association (NEMA) display standard. While Certification Acquisition for Quality Management Systems based on ISO 9001:2008. These certifications ensure machine is specification strict according safety standard. The stability of the electrical component within ultrasound machine will yield better image quality.

COMPARISON OF THE CARDIAC ULTRASOUND MACHINE

Table 1: Comparison between Philips iE33 and GE Vivid 7 (Cardiovascular Sale; UMI)

SPECIFICATION	ULTRASOUND MACHINE
	Philips iE33	GE Vivid 7
User interface	·         Monitor size: 20” ·         Monitor type: LCD Flat Panel	·         Monitor size: 17” ·         Monitor type: CRT
Imaging mode	2D and M-mode	2D and M-mode
Doppler Mode	High Frame Rate Color Flow, Color Doppler Velocity, Color Flow Mapping, Color Doppler Energy, Color Power Doppler, Directional Color Power, Direction Tissue Imaging (TDI), Pulse Wave (PW) And Continuous Wave (CW)	High Frame Rate Color Flow, Color Doppler Velocity, Color Flow Mapping, Color Doppler Energy, Color Power Doppler, Direction Tissue Imaging (TDI), Pulse Wave (PW) And Continuous Wave (CW)
Software technologies	3D imaging, tissue harmonic imaging (THI), auto gain	3D imaging, tissue harmonic imaging (THI), auto gain
Cardiac transducers/ probes	·         Adult cardiac: 1-12 MHz ·         Fetal cardiac: 3-8 MHz ·         Pediatric cardiac: 1-12 MHz	·         Adult cardiac: 1.5-5 MHz ·         Neonatal cardiac: 4-10 MHz ·         Pediatric cardiac: 3.5-8 MHz
Cardiac imaging	Adult echo, cardiac screening, fetal echo, ECG, neonatal echo, pediatric echo, stress echo	Adult echo, cardiac screening, ECG, Neonatal echo, pediatric echo, stress echo is option
Structured reporting	DICOM-Cardiac structured reporting and DICOM-Vascular structured reporting	DICOM-Cardiac structured reporting and DICOM-Vascular structured reporting
Power supply	·         AC: 100-240 V, 50/60 Hz	·         AC: 100-240 V
Standard Warranty	1 year	1 year
Price	$55k	$38k
Rating	Best	Best

REFERENCES

Cavanagh, P., & Smith, K. (2014). Standards for the provsion of an ultrasound service. The Royal College of Radiologists. Retrieved from www.rcr.ac.uk

Shah, B. N. (2013). Echocardiography in the Era of Multimodality Imaging. BioMed Research International, 19(3), 175–184. http://doi.org/10.1016/j.hlc.2010.01.006

Spencer, K. T., Kimura, B. J., Korcarz, C. E., Pellikka, P. A., Rahko, P. S., Siegel, R. J., … Angeles, L. (2013). Focused Cardiac Ultrasound : Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography, 26(6), 567–581. http://doi.org/10.1016/j.echo.2013.04.001

Szabo, T. L., & Lewin, P. A. (2013). Ultrasound Transducer Selection in Clinical Imaging Practice. American Institute of Ultrasound in Medicine, (32), 573–582. Retrieved from www.aium.org

 Ashley EA, Niebauer J. Cardiology Explained. London: Remedica; 2004. Chapter 4, Understanding the echocardiogram. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2215

Hoffmann, B., & Bahner, P. D. (2008). Ultrasound Guide for Emergency Physicians. Retrieved 15 May, 2016, from Echocardiographt for emergency Physicians: http://www.sonoguide.com

 Cardiovascular Sale. (n.d.). Retrieved 14 May, 2016, from Cardiac Ultrasound Machine: http://www.cvsales.com

UMI. (n.d.). Retrieved 14 May, 2016, from Ultrasound Machine Comparison Chart: http://www.umiultrasound.com

RADIATION

I'm as student who learn about radiation shall share some knowledge right????

PLASTIK

          Entry kali ini mengenai plastik...Pasal plastik pun nak tulis, tidak ada benda lain nak share k? Well, everything is up to me......PLASTIKKKK??? beg plastik k, nak kempen kurangkan penggunaan beg plastik (Go green, save our precious earth)..

          NO............bukan beg plastik atau industri plastik. Tapi berkenaan manusia "plastik". Kenapa, ada inovasi alat solek atau set rawatan muka menggunakan plastik k.....Ermmmmm

          Aku manusia "plastik", pscyo k?? Plastik dalam perbincangan ini mengenai perwatakan kita seharian dalam berurusan dengan manusia yang pelbagai kerenah. Adik beradik, kawan-kawan, coursemate, business partner, housemate dan ramai lagi, how your day with them ????? Happy or annoying or disaster..

                  As a human being, we have a lot of emotion to handle... Depression and stressful in daily life make us struggle to cope with this situation. When someone mess with your day, felling like better you stay out from my life. Not everyone able to express their feeling especially to who they are really care. Although they make your life become miserable, someone with softhearted just buried it in their heart. 

                 If you don't want other mess with you, you need to understand others too. They also struggle with their feeling and need space in their life. But, reality is not much peoples care about this. They just care about them, others put behind...They will see you or text you when asking for help. BRAVOOOO, it it called friendship ???????? Friend to do something, friend when you had difficult situation, friend when you quarrel with your bff........Hey, YOU with this kind of attitude, you don't deserved to be called a FRIEND...YOU don't deserved to live in this earth, please stay at the Jupiter, become friend with alien...Its alien want share friendship with YOU.

                   I juga selalu menjadi manusia plastik... sacrifice my feeling just to please other..Its I look easy for you ??? You just see the nice side of me. If the bad side of me reveal, I know nobody will not mess with me. I buried the unpleasent, annoying and ever hating felling in my "plastic" body. But, I also have my limit. Even nicer person have their certain limit. If you cross it, I can be a monster like when the volcano is erupted. Don't mess with me?  Its I look pscyo, whatever ?????????? Sometimes, the bad side of me say that I will never forget whatever you done to me and I will make sure You will feel like me one day...

                   A good and nice friends will say just forgive them and you also will happy and peace..Forgive..I can forgive but I never forget..I wish I can express my feeling without concern others but the bad of me, I always be "plastic" just to please other...WHAT SHOULD I DO? see psychiatrist........

Simpan WANG vs simpan GOLD

Simpanan wang

Simpan wang.....bagus, perancangan masa depan ok...............

siapa kata tidak bagus......tapi wang kertas boleh koyak..ermmmm tapi boleh selotepkan, kira boleh lah

Ada sesetengah kedai tidak menerima wang kertas yang koyak, jadi kena pergi bank..

Adat ke bank, kena beratur ikut giliran sebab kena jumpa officer or clerk

Kena menunggu especially peak hour???????? ok lah wang penting kot

berurusan dengan bank ikut office hour....

Simpanan emas "GOLD"

jika patah?

jika hancur?

 jika kemik?

Emas tetap berharga walau macam mana atau masih bernilai dalam apa jua bentuk

Harga emas jatuh? jika kita meneliti pasaran harga pasaran emas, kejatuhan harga tidaklah menyamai kejatuhan mata wang.

Buatlah pilihan yang terbaik.....kita yang menentukan masa depan..

😲😲

AKU PENDOSA JUGA INGIN KE SYURGA

              Kenapa mengharapkan manusia, Allah sentiasa ada untuk kita. Hati manusia sentiasa berubah, kita tidak boleh paksa orang menyukai kita. Dalam persahabatan, kita mengharapkan sahabat kita memahami perilaku kita. Tetapi adakah kita menjaga hubungan kita dengan sahabat dan memahami mereka. Perilaku orang lain terhadap kita mencerminkan sikap kita dengan yang lain. Persahabatan tanpa mengharapkan apa-apa daripada sahabatnya dan bersahabat kerana Allah merupakan yang terbaik.

                     Allah SWT selalu mengizinkan hambaNya yang baik akhlak  bersahabat dengan saya. Dikala saya memerlukan pertolongan, ada yang membantu. Di saat saya tertekan, ada yang memberi nasihat, sentiasa ada sahabat yang ambil berat tentang diri saya. Saya insan pendosa dan lalai ini, Allah tetap jaga diri saya. Nikmat apa lagi yang kita nak pertikaikan. Allah selalu ada bersama kita. 

REALITY AS POSTGRAD STUDENT

Yes, exactly true to say " reality not as wonderful as our illusion dream". So, berbijak pada bumi yang nyata, kalau terjatuh not feel so much pain. My friends always shared the stressful life as postgrad student but me just replied " you need to be strong and all the best. You can do it". We can't exactly estimated others feeling by just understand their stories.

              That time, i feel like its ok, i can just give advice. I maybe underestimated or overestimated your feeling because I'm not at your place. Sometime, we just want to share and story our problem with others. Our stressful will release when our friend spend their precious time to hear what happen really happen. 

              After almost one year struggling to manage for suitable work, finally I decided to further study in master. I make a big decision between my career or my future. I seek advise from my friend who further study, what the best either further study and resign  or just continue to work. I know the decision depend on me, I need to decide for my future. What ever my choice, it has advantage and disadvantage. 

                 My best friend offer to settle about hostel and the fee for me. But I really can't decide it. I'm a big sister who responsible for my family. I'm the one who supposed to support my sibling, helping my parent. If I resign, so I can't help my family anymore. I ask my brother, he say if it best for you than just further study. After received my offer letter via email, I sent my resign letter to my company.

                 Then, I made final decision after discuss with my mum. My bff settle everything for me, really thank to her. Thank God because always send kind peoples around me. There always kind person who care about me. First day of lecture, my coursemate only 4 person include me. Wow, only four person in this course. The lecture just relax because the lecturer hoping for new student coming and our coursemates will increase.

                 My friend say, "zanariah, you are strong". I said why you talk like that. She replied "We strong enough to continue study because we have friend (our classmate during degree) together to talk when we stress and hang out. If not feel like to surrender. But you are alone there". I just say that ok I will make new friends. (ayat sedapkan hati)

                   The third week of lecture, I start to feel pressure but still can endure. The pressure increase day by day. I don't want to burden my friend to share my story. But I feel not strong enough and can't handle this. I think I already facing mild mental depression. I feel I can't control this situation but I need to move on. I tell my situation to my friend, they keep saying be strong and u can do it.

                   At one point, I feel regret resign my work. But I already make decision, I can simply ignore this. I must be responsible to all my action. So, I decide to move one. Although not fully move on, trying to handle my day. When someone expect u to behave like a professor or intelligent student, but u just like ordinary student. Then, I start to depress again. I know master student, should develop creative thinking and figured out situation by yourself. Ok, I will trying to handle this. Please pray for me.

RAYA vs KHAWIN

Raya kali ini tak terasa. Rasa tak meriah pun kat kampung kiter. Korang camne? raya sakan dengan sanak saudara dan jiran tetangga. Masa nak balik kampung, excited giler. Balik pulak hari last ramadhan. Then, orang kata nak balik pantai timur jalan jammed. Kiter pulak first time pengalaman cenggini. Terpikir bila nak sampai rumah. Allah permudahkan urusan. Maybe family dah tak sabar nak jumpa kita kot (ok, mode perasan). Trafik perjalanan ke terengganu smooth j.

Before balik, sempat beli kuih raya dan kerepek kat jalan Tar. Al maklumlah, tak sempat nak buat kuih raya. Penat sebab perjalanan jauh walaupun bukan drive bas. Persiapan raya sangat simple, bukan seperti sebelumnya. Parent sibuk dengan persiapan untuk menyambut menantu. Excited nak sambut orang baru kot? Me, hahahaa x feel langsung. Biasa j.

Raya kedua, dah busy kena arah beli barang goodies bag . Kiter tak sempat nak rest, dah kena arah beli barang ni beli barang tu. Orang lain yang khawin kita yang penat. kiter kan budak baik. Memberontak dalam hati. So, raya kedua kiter ke hulu ke hilir cari barang. Guest what? siapa yang khawin, ok my big brother yang khawin.

Touch up hantaran and siapkan goodies bag. Walaupun kiter ramai adik beradik laki, that ok. Diorang pun tolong kiter jugak. Maybe terharu sebab akak diorg bagi duit raya. Ayat klise bila ada orang khawin, "Abang dah nak khawin, adik bila pulak?"

Terserah gua nak khawin bila? Ada gua kacau teruna, suami korang. Orang kampung always kepoh. Lali dah kiter, suka jaga tepi kain orang. Jaja citer orang lain. Kalah wartawan hiburan. Kalau anak sendiri wat maksiat, senyap sunyi mulut. Menjawab, orang kata kurang ajar. So kiter senyum j kat diorang yang kepoh. 

Then, busy pulak dengan kenduri sebelah my family. Balik kenduri pihak perempuan, bersedia sediakan barang untuk rewang keesokan hari. Penat tak terkata. Kiter, jadi tukang basuh pinggan setelah selesai tugas buat air. Masa duk rewang, those aunty sebarkan segala gosip kat kampung. Pagi-pagi dah buat dosa kering. Kita tak sempat nak pakai cantik-cantik pun. 

Then, malam bertolak ke KL kembali menyambung tugas yang tergendala. Cuti and hari Raya yang tiada feel. Rasa letih n penat. Tapi kalau kiter tak menolong, siapa lagi nak tolong parent kiter. Kita pulak big sister in family. Terpaksa ringankan tangan walaupun tak rela. Mesti raya korang best kan? That ok, kalau panjang umur sempat kiter sambut bulan Ramadhan dan Syawal bersama keluarga tercinta tahun depan.