n today’s ultrasound community, sonographers sometimes forget about the extra steps we can take to improve a patient’s end result while visiting our lab. How many times have we called a patient back to reassess a valve lesion or to look at pressures that were uninterpretable? Let us not be afraid to manipulate our technical ability to provide the absolute best in imaging. The right heart is difficult to image with echocardiography because of the location, size, and available windows (Figure 1). The traditional apical 4-chamber view allows for a direct, parallel image of the left ventricle and atrium. However, trying to maneuver the probe from this particular area may only bring in more lung artifacts or decrease the appropriate angle we were trying to achieve. Right ventricular inflow patterns, tissue Doppler imaging, tricuspid annular plane systolic excursion, and tricuspid regurgitation interrogation can be of important use in determining a patient’s care plan, given the appropriate angles. We must ask ourselves, are we doing everything we can to provide the necessary information to the reading physician? As a veteran cardiac sonographer, I am compelled to pay close attention to the left ventricle, as it is the “main” pumping chamber of the heart. In this case, we will go out of our way, in difficult cases, to give the reading physician the best we have so the physician might see the endocardium a little clearer. Sonographers must give the physician this information to assess numerous pathologic questions. The reading physician should be given the same opportunity on the right side of the heart. Congestive heart failure, hypertension, valve lesions, and congenital heart defects affect the right side as well. How many patients have had complications because a rightsided congenital defect was overlooked? In most cases, the sonographer can easily slide the probe medially from the traditional 4-chamber view. Looking at the monitor, the atria will be seen moving to the left of the screen, while the apex stays somewhat midline. To improve the parallel flow angle, move anteriorly one rib space if needed (Figure 2). Traditionally, foreshortening the 4-chamber view is frowned upon; however, this movement improves the visualization of this particular area of the heart. Cardiologists are looking to assess right ventricular hypertrophy, tricuspid valve lesions, new findings of congenital defects or ones that might have been missed, pacemaker/defibrillator leads (including infection of the leads), and more.1 One of the most common mistakes made in the field today is underesAddress correspondence to James Michael Rampoldi, RDCS, RVT, The Heart Hospital of Baylor Plano, Center for Advanced Cardiovascular Care, 4716 Alliance Blvd, Pavilion II, Suite 300, Plano, TX 75093 USA. E-mail: james.rampoldi@baylorhealth.edu I