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Tissue Doppler Echocardiography is a medical procedure that uses ultrasound to examine and measure the heart's functions. Used to determine the velocity and direction in which blood is being pumped, Doppler technology, in conjunction with an echocardiogram, helps reveal heart dysfunctions. By using Tissue Doppler Echocardiography to establish velocity measurements, physicians can more precisely assess the function of the patient's cardiac valves. The conditions that can be detected with this procedure include communication between the left and right sides of the heart that is abnormal and cardiac valve leakage. Other data available through the use of tissue Doppler echocardiography are calculations of cardiac output as well as the patient's E/A ratio—a measurement of the time intervals between the heart's pumping and backfilling phases. The results of this test may point to diastolic heart failure. Even though the term "Doppler" is often used in place of "velocity measurement," in medical imaging, the frequency shift (Doppler effect) is not measured. Instead, the phase shift is recorded at the time the signal arrives. The echocardiogram that is subjected to Doppler shift measurement is often referred to by health care providers as a cardiac ECHO. In some cases, the term ECHO is used alone, while in other instances it may be referred to as "cardiac ultrasound." The technology uses normal ultrasound approaches to create two-dimensional images of the heart. The newest systems offer real-time imaging with 3D displays of the heart in action. Aside from creating two-dimensional images, tissue Doppler echocardiography can help the physician assess blood velocity or the condition of the cardiac tissue. Using either continuous-wave or pulsed Doppler ultrasound, vulvular regurgitation—blood leakage through the valves—can be detected. Echocardiography was among the earliest applications of ultrasound technology in medicine and is among the most common technologies used to diagnose heart disease and malfunctions. It is usually administered by cardiac sonographers or doctors with cardiology training. Beyond helping doctors assess valve function, tissue Doppler echocardiography is also useful in establishing the heart's size and shape. It can also reveal a backward flow of blood through partially closed heart valves, a condition known as regurgitation. Observing the motions of the heart wall can help in the detection of coronary artery disease. The procedure is often used to rule out coronary disease when the patient complains of chest pains. Since there is no need to break the skin or enter body cavities to perform tissue Doppler echocardiography, it is considered a noninvasive procedure.