The Sonographer Attachment Programme At USA Report : Aurora St Luke's: Sonographer Experience =Echocardiography Laboratory II=

Echo Technologist

 

Echo Technologist/Sonographer will be doing echocardiogram only. They don’t do anything else than echocardiogram. Echo technologist will performs 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).

This centre have specific technologist for each area including stress test, nuclear medicine, electrophysiology study, cath procedure and others. Sonographer will be at cath lab during specific procedure only including TEE, TAVI, Mitral Clip, TASH, Emergency Pericardiocentesis and other related echo procedure. In Stress Echo procedure there will be stress technologist that do the stress test and help in injecting contrast agent at peak exercise so Echo Technologist will be focusing on grabbing good echo images. 

Transthoracic Echocardiography

For Transthoracic Echocardiography, Echo Technologist 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. Each Echo test will be 75 minutes slot. So they will be enough time to do a complete echo study that may include Biplane Simpson, 3D Echocardiography, Strain Imaging, Strain Rate, and Dyssynchrony Study if necessary.  In Aortic Stenosis case, they required to use Pedof probe to get good Aortic Valve Doppler tracing in evaluation of Aortic Stenosis. It is part of ICAEL requirements. 

Cardiac Specialty Centre

St. Luke’s also recently opened Cardiac Specialty Centers that offer the latest treatments and research for hypertrophic cardiomyopathy, adult congenital heart disease, Marfan’s and aortic disorders, and valvular heart disease. A. Jamil Tajik, MD, an internationally recognized expert, heads the centers and leads a multidisciplinary team of specialists who coordinate patient care. These complex conditions can be fatal if undiagnosed.

Aurora Health Care wants to be a leader in the treatment of complex heart conditions. Their specialty heart centers serve patients with hypertrophic cardiomyopathy, adult congenital heart disease, Marfan’s syndrome and valvular heart disease. They offer the highest level of care in the hands of experts utilizing advanced diagnostic and therapeutic technologies. In fact, their specialty services for adult congenital heart disease and hypertrophic cardiomyopathy are the only dedicated specialty centers in the state.

An accredited echocardiography laboratory requires the interpreting physicians and practicing sonographers to be adequately trained and experienced to interpret and perform echocardiograms. So they will Consultant or Cardiologist that will be read, review and finalized echo report in their respective review room. At Cardiac Specialty Centre, Cardiologist can review ongoing echo procedure at their review room without any waiting for transferred data to prosolv. Cardiologist can interfere and request any additional information during that echo test.

Ejection Fraction

Ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts. During each heartbeat cycle, the heart contracts and relaxes. When your heart contracts, it ejects blood from the two pumping chambers (ventricles). When your heart relaxes, the ventricles refill with blood. No matter how forceful the contraction, it doesn't empty all of the blood out of a ventricle. The term "ejection fraction" refers to the percentage of blood that's pumped out of a filled ventricle with each heartbeat. During an echocardiogram, sound waves are used to produce images of your heart and the blood pumping through your heart. 

Aurora did not use Teich Method (M-Mode) anymore to measure Ejection Fraction. They made the 2D Biplane EF quantification as a compulsory method to calculated EF. Now, if they all unable or have inability to visualize at least 2 myocardial segments of the left ventricle, they will use contrast agent to make 2D Biplane EF quantification. They are planning to make 3D EF Measurement as a compulsory method next year. The echo technologist is now practicing to make the 3D EF quantification more reproducible and reliable to do when the time come.

Contrast Agent

The cardiac sonographer has the responsibility to carry out the physician’s order for the performance of the examination and therefore initially determines the overall technical quality of the echocardiogram. Thus this person is often in the primary position to identify the need for contrast enhancement. It is well established that in up to 20% of resting studies, the endocardial border definition of the left ventricle is suboptimal. This has been defined as the inability to visualize at least 2 myocardial segments of the left ventricle. 

Suboptimal visualization of certain segments, such as the anterior or lateral walls, may be even worse during stress echocardiography. The enhancement of left ventricular endocardial border definition can be facilitated by using transpulmonary contrast agents. This centre widely used Contrast Agent (Definity) to help to gain good image and diagnosis for the patient that with poor echo window and give echo test more reproducible value in each echo test that they have done. It will be helpful in test such as stress echocardiogram because we can see more better endocardial representation with contrast agent.

Transesophangeal Echocardiography

   

There is respective Echo Room for Transesophangeal Echocardiography, Transthoracic Echocardiogram and Stress Echocardiogram. Transesophangeal Echocardiography procedure will be done by cardiologist assisted by Echo Technologist and accompanied by Registered Nurse (RN) in case needed used of medication especially for sedate patient procedure begin. Registered Nurse will monitored patient vital sign (SPO2, ECG and Blood Pressure). Sonographer will handle knobology and other specific modalities depends on protocol and cardiologist interest.

This centre also involve in Transcatether Valve intervention. They have being doing very well in Mitral Clip Procedure and Transcatether Aortic Valve Implantation (TAVI). Transesophangeal Echocardiography is useful in this procedure that will be done in Hybrid Operation Theater. Echo Technologist also will be doing Transesophangeal Echocardiography at EP Cath Lab for Cardioversion procedure and Transeptal Puncture for RFA. Echo Technologist will be accompanying by Echo Cardiologist.

Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (replacement) is an investigational treatment for severe aortic stenosis. The purpose of the clinical trial is to learn whether transcatheter aortic valve implantation is a safe and effective treatment option for certain patients with severe aortic stenosis. With transcatheter aortic valve implantation, an artificial aortic heart valve attached to a wire frame is guided by catheter to the heart. Once in the proper position in the heart, the wire frame expands, allowing the new aortic valve to open and begin to pump blood.

In This procedure, echo technologist will assist Echo Cardiologist in performing TEE on the patient before procedure, during procedure and post procedure. Before procedure, echo team will assess aortic valve pathology, baseline Aortic Valve Mean Gradient, Aortic Valve Peak Gradient, Aortic Valve Peak Velocity, Severity Of Aortic Regurgitation, and Severity Of Mitral Regurgitation. During procedure, Echo team will be assessing the position of implantable AV if required by interventional cardiologist. After procedure, echo team will assess aortic valve, Aortic Valve Mean Gradient, Aortic Valve Peak Gradient, Aortic Valve Peak Velocity, Severity Of Aortic Regurgitation (Paravalvular Or Transvalvular), any evidence of effusion (Pericardial or Pleural) and any evidence of LVOT Obstructions (Systolic Anterior Motion).

Sonographer Credentialing And ICAEL

Almost all sonographer at Aurora St Lukes Medical Centre are registered under specific organization. American Registered Diagnostic Medical Sonography (ARDMS) will give title Registered Diagnostic Cardiac Sonographer (RDCS) , Cardiovascular Credentialing International (CCI) will give title Registered Cardiac Sonographer (RCS) and American Society Of Echocardiography (ASE) will give title Fellow Of American Society Of Echocardiography (FASE). 

This will required assestment and examination that must be pass by all respective candidates. Aurora St Lukes Medical Centre echocardiography laboratory also is accredited by The Intersocietal Commission For The Accreditation Of Echocardiography Laboratories (ICAEL) that can improved services. An accredited echocardiography laboratory requires the interpreting physicians and practicing sonographers to be adequately trained and experienced to interpret and perform echocardiograms. So they will Consultant or Cardiologist that will be read, review and finalized echo report in their respective review room. 

Online Reporting

For echocardiography reporting, the echo technologist will do the online reporting on Prosolv System and charge every patient by himself. Echo technologist will do all the measurement in Prosolv for cardiologist reference. The conclusion for the echocardiography assessment will be done by the Cardiologist himself. All decision making will depends on the echocardiologist to decide.