Written by Judith Buckland, MBA, RDCS, FASE

Avoid These Diastology Measurement Errors

Now that diastology is a mandated part of the scanning protocol for all of our accreditation clients, we are starting to see more diastology measurement errors. We thought that sharing these errors may help others to avoid them. This week, we will review correct tissue Doppler measurement techniques while reviewing two common errors. These errors include:

  1. Cursor Placement
  2. Caliper Placement: Waveform Measurement

Correct Tissue Doppler Measurements (TDI)

how to perform tissue Doppler diastology echocardiography

First, lets quickly review PW Tissue Doppler Imaging:

  • TDI is one of the measurements needed to evaluate diastolic function and is used to estimate myocardial motion.
  • We use TDI to measure the e’ velocity (cm/sec) in both the medial and lateral MV annulus locations.
  • We use these measurements to calculate the average E/e’
  • Correct placement of the cursor should include the sample volume on the septal and/or lateral annulus of the mitral valve.
  • Correct caliper placement includes measuring the e’ wave.

What’s Wrong with these Images?

Let’s review some sample images and see if you can identify the mistake.

Image 1

whats wrong with this image

Did you notice the cursor placement on the septal annulus? You can see that the cursor over-shot the septal mitral valve annulus and is actually placed within the right heart. Incorrect cursor placement will greatly affect your Doppler readings. It’s important to take the time to correctly place your cursor.

correct cursor placement septal mv tissue doppler echocardiography

Image 2

whats wrong with this image - tissue doppler echocardiograhy

Did you notice the caliper placement on the tissue Doppler spectral waveform? The incorrect wave form has been measured. In this image there is a prominent IVRT waveform that was inadvertently measured as the e’ wave. An incorrect e’ will affect your E/e’ ratios.


This week we reviewed two very common mistakes seen with diastology measurements. Both cursor alignment and correct caliper placement will determine the value used for key measurements for assessing diastolic function. It is important to take the time to correctly measure these values.

Previous ‘Whats Wrong With This Image’ posts:


Seri, I., & Kleinman, C. S. (2019). Hemodynamics and cardiology(3rd ed.). Amsterdam: Elsevier. doi:https://www.sciencedirect.com/science/article/pii/B9780323533669000120

Past Articles on Diastology

Judith Buckland

Judith Buckland, MBA, RDCS, FASE

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case studyDiastoleDiastolic FunctionDiastolic Function Basics


Meena Sunathy
Great tips on measurement errors. I have noticed many times in AF e’ velocities are unreliable. Any insight on this is much appreciated.
Mashhour Mohtaseb
Very useful and informative blogs and improving our practice and elevating accuracy in diagnosis
Stephen Ishihara
I would also add that sample volume size is important to clean up the Doppler signal. We tend to forget this regularly.
Kevin Pullins
Mitochondrial dysfx is happening with Mastocytosis or what is now called mast cell activation(becoming more and more prominent) affects all Muscle elasticity as well affects blood vessels responses. No matter the protocol it will affect your results. Just a FYI. 2ndsight. I believe Takotsubo is in this world
william williams
nice one , buh am still a bit confused on how to calculate the value( E/e') is E=EARLY VENTRICULAR FILLING & E'= the average of (BOTH septal $ lateral TDI velocities) ?? ....pls help me

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