New ASE Guidelines Enhance Understanding of Cardiac Ultrasound Artifacts

The American Society of Echocardiography (ASE) has issued a comprehensive guideline aimed at improving the identification and management of artifacts in cardiac ultrasound imaging. This guidance is designed to aid professionals in the cardiovascular ultrasound field in recognizing these artifacts to enhance diagnostic accuracy and improve patient safety.

Despite technological advancements in ultrasound imaging, artifacts—misleading or incorrect image features—persist across various echocardiographic techniques such as two-dimensional, spectral Doppler, color Doppler, and three-dimensional echocardiography. These anomalies result from the fundamental properties of ultrasound and can be exacerbated by interference from external equipment, potentially leading to diagnostic errors with serious clinical outcomes.

The document, titled “Recommendations for the Identification and Mitigation of Cardiac Ultrasound Artifacts,” outlines a structured strategy to identify and manage ultrasound artifacts. It explains the typical visual characteristics and underlying mechanisms of these artifacts and discusses their possible effects on clinical interpretations, diagnoses, and patient management. The guideline also presents real-world cases and strategies to help clinicians avoid and mitigate artifacts.

Dr. Muhamed Saric, the guideline's chair and director of echocardiography at New York University Langone, emphasized its significance: “This new ASE guideline is the first document published by an imaging society focused exclusively on cardiac ultrasound artifacts. It is essential for cardiac sonographers and clinicians to recognize these common ‘Achilles’ heels’ in ultrasound to reduce the risk of misdiagnosing critical conditions such as aortic dissection and ventricular thrombus, and to help optimize patient care.”

Prepared by a global group of ultrasound practitioners, the guideline includes a valuable collection of figures and videos designed to facilitate learning and clinical application. Emphasizing education, Dr. Anita Sadeghpour, Co-Chair of the guideline and an advanced cardiac imager at MedStar Health Research Institute, stated: “While innovations in ultrasound imaging hardware and software are promising to minimize the generation of artifacts, operator education remains essential. Everyone involved in performing or interpreting cardiac ultrasound should be familiar with artifacts and their potential for misdiagnosis.”