The Sonographer Attachment Programme At USA Report : Conclusion

Conclusion

Competency in the performance of cardiovascular ultrasound examinations requires maintenance of skills in each area of practice. Each sonographer should meet the applicable procedure volume requirements and continuing medical education requirements set forth in the ICAEL standards. As of April, 2002, the ICAEL procedure volume standards require the performance of 300 resting transthoracic echocardiograms per year and 100 stress echocardiograms per year.

Sonographers must fulfill such continuing medical education requirements as may be required by the applicable credentialing organization. Those sonographers who provide services in accredited laboratories also should meet any applicable ICAEL continuing medical education requirements.

Sonographers must adhere to the scope of practice for diagnostic ultrasound professionals, and the code of ethics and must in peer review and quality assurance activities as required by the institution that operates the laboratory and by ICAEL standards if applicable.

Three-dimensional echocardiography is a safe, noninvasive imaging modality that is complementary and supplementary to 2D imaging and can be used to assess cardiovascular function and anatomy in various clinical settings. At present, available evidence suggests that 3D echocardiography provides improved accuracy and reproducibility over 2D methods for LV volume and function calculation and the derivation of mitral valve area in patients with mitral stenosis. Further technological improvements and additional clinical studies will broaden the list of appropriate applications for this exciting new ultrasound modality.

The ASE supports and encourages an expanded role of the credentialed cardiac sonographer in the selection of patients and the administration of contrast agents for echocardiography. Such responsibilities require a thorough understanding of micro bubble characteristics and interaction with cardiac ultrasound and the indications (and contraindications) for contrast agent injections. The cardiac sonographer must comply with established policies and procedures, as outlined in specific written protocols developed by the echocardiography laboratory director. When responsible for obtaining IV access, this person must have appropriate training with certification. The injection or infusion of agents ideally should be done by a physician or registered nurse following proper techniques. The use of contrast agents should be reserved for accredited or, at least, Level II echocardiography laboratories in which direct physician supervision and registered nurse support are available.

Echocardiography plays an exciting and evolving role in the care of  patient with CRT, from quantifying improvements in ventricular function and MR to optimizing the device after implantation. Although a great deal of work has been done to quantify mechanical dyssynchrony in hopes of refining patient selection and guiding lead placement, this is a complex and challenging field with future work needed and several promising studies ongoing. Technologic improvements in echocardiographic data acquisition and analysis as well as advances in our understanding of the pathophysiology of dyssynchrony and CRT have great potential to impact future clinical practice and improve patient outcome. The Dyssynchrony Writing Group is indebted to Ashley Prather and the American Society of Echocardiography staff for administrative and organizational assistance.