The Sonographer Attachment Programme At USA Report : Mayo Clinic: Sonographer Experience =Echocardiography Laboratory I=

7.1 Mayo Clinic, Rochester : Echocardiography Laboratory

Echocardiography Laboratory

Established in 1981, the Mayo Clinic Echocardiography Laboratory (Echo Lab) is one of the largest clinical, educational and research echocardiographic laboratory facilities of its kind in the world. Outpatient and inpatient echocardiography studies are routinely performed in the lab using state-of-the-art equipment. The Echo Lab is also referred to as the Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory. 

The lab provides a comprehensive assessment of heart structure and function, as well as normal and abnormal blood flow within the heart.An echocardiogram is a noninvasive test that uses sound waves (ultrasound) to produce detailed images of the heart's size, structure and motion. An echocardiogram may also be used to measure the heart's blood volume and the speed and direction of blood flow through the heart.The experienced team of cardiologists in the laboratory provides patients with the highest quality of care. The team performs more than 50,000 comprehensive patient examinations each year using transthoracic and transesophageal echocardiography. More than 200 tests are performed each day. Transthoracic, transesophageal, exercise and dobutamine stress, as well as intraoperative echocardiograms, are the tests most often performed in the laboratory.

The echocardiography laboratory and haemodynamic study mainly  located at Gonda Building, specifically at 5^th and 6^th floor of Gonda Building. It is mainly for outpatient clinic Echocardiography Laboratory. Gonda Building is connected to Mayo Building by skyway and subway to make it easy for patient and staff to mobilized. There are also In Patient Echocardiography Laboratory at Joseph Building, St Mary Hospital. The sonographer that assign there will be doing bedside echo. The echocardiography laboratory operates on Monday through Friday, from 8.00 a.m to 5.00 p.m. Access to the laboratory after office hour and weekends for visitor is not allowed and visitor must wear their name tags at all times in the clinical area.

Echocardiography Laboratory Review Room

Echocardiography laboratory is conducted in proper protocol, they will be separated area for clinical echocardiography laboratory and research echocardiography laboratory. For clinical echocardiography laboratory, they will be echo review room. The echo review room will be separated to different “POD”. POD A (Room 1-4) is for Valvular Heart Disease study. POD B (Room 5-8) is for Transthoracic Fellow’s Teaching POD. POD C (Room 9-12) is for Echo Education. POD D (Room 13-16) is for Strain, Heart Failure, HOCM, Amyloid study. They are POD for Junior Sonographer (Mayo Echo Programme). They are also will be a POD (Room 17,18,19, 26, 27) for Congenital Heart Disease study. POD G (Room 28-31) for Echo Inovation POD.  There are also POD TEE (Room 21-25) for TEE Nurses.

In the POD there will be Consultant Echo Cardiologist, Advanced Clinical Sonographer, and Adult/Congenital Sonographer. Consultant Echo Cardiologist will be read, review and finalized echo report in their respective review room/POD. Advanced Clinical Sonographer will be act as Mentor to the Sonographer that are doing echo in the respective room that connected to respective POD. Advanced Clinical Sonographer will be assisting Consultant Echo Cardiologist to read, review and finalized echo report in their  respective review room/POD. Advanced Clinical Sonographer will review and adding or repeat certain particular study if necessary to make sure all information needed by Consultant Echo Cardiologist is there.

Transthoracic Echocardiography

Sonographer will be performing echocardiography procedure depends on history, indication, and specific requirement needed. Sonographer will performs advanced cardiac ultrasound procedures such as M‑mode, 2‑D, Doppler and Color Flow Doppler utilizing a variety of equipment and techniques and makes the necessary measurements required for the interpretation to obtain accurate, high quality results (for example, muscle wall thickness, diameter of chambers, volume of chambers, valve areas, blood flow velocity and direction). Sonographer will get all patient demographic data (height and weight) , patient medical record and check for blood pressure before they start the echo test. This data may be valuable to get general idea about patient echo diagnosis. The demographic data will be included in the echo measurement data system to completed certain management e.g Cardiac Index.

When procedure has been done in the room, sonographer will enter all the measurement of Echo data in the system at their respective POD. At the same time echo study is reviewed by Advanced Clinical Sonographer or Consultant Echo Cardiologist. They will be evaluating all the data that has been entered in the system. If they need extra information regarding the study. Advanced Clinical Sonographer or Consultant Echo Cardiologist will try to get one. So, patient have to wait until they all satisfied of all information. At every room they are lighting system to know what the progress of the study. Green Light represent room is free for another appointment. Red Light represent study is in progress with sonographer in there. Yellow Light represent study is reviewed by Advanced Clinical Sonographer or Consultant Echo Cardiologist. Blue Light represent nurses is in the room. 

Adult Or Congenital TTE Or TEE Critical Result To Review

A variance considered life treathening unless something is done promptly and for which some corrective action must be taken:

·    Cardiac Tamponade

·    Acute Ventricular Septal Defect Post Myocardial Infarction

·    Acute Aortic Dissection

·    New Obstructed (Clotted) Prosthetic Heart Valve

·    New Left Ventricular Pseudoaneurysm

·    Papillary Muscle Rupture Post Myocardial Infarction

·    New Intracardiac Thrombus

·    New Pulmonary Embolisme

Limited LV Function Assessment

Calculated LV (Include volumetric method if significant regional abnormalities)

Regional wall motion assessment

Stroke volume and cardiac index

MV Inflow/E’/ MV Valsalva if necessary to arrive at LV diastolic function grade and assessment of filling pressure; include views of LA to allow measurement of LA volume (reviewing consultant will give directions regarding exact data they want for diastolic function assessment

Color of MV/AV/TV

TR velocity and IVC view