The two-dimensional echocardiographic image has improved greatly over the past decade due in great part to improved technology. Yet it should be remembered that the skill of the cardiac sonographer is still an important factor in acquiring an adequate echocardiographic examination. This article has presented new approaches and adjustments to the standard approaches in acquiring routine two-dimensional images. It is the belief of the authors that the cardiac sonographers may improve their two-dimensional imaging by using the rib hooks, pressure points, and hugs described.