Which adjustment should be made to optimize this video?

The echocardiographic image/video shows decreased brightness and penetration in the near field, making the anterior cardiac structures poorly visualized while deeper structures appear brighter. This indicates under-gain in the near field.

Increasing the time gain compensation (TGC) in the near field enhances the signal strength of superficial structures without affecting deeper tissues. This adjustment improves image quality by balancing the brightness across the field.

Increasing compression or decreasing overall gain would reduce the signal globally and are not specific for near field optimization. Decreasing TGC in the far field would reduce brightness deeper but does not address near-field issues.

This principle is outlined in the "Textbook of Clinical Echocardiography, 6e", Chapter on Image Optimization and Technical Settings【20:70-75†Textbook of Clinical Echocardiography】.