American Society Echocardiography Conference Coronado Island, San Diego And Minneapolis, Minnessota, USA

USA Sonographer Attachment Programme

Aurora St Luke's Medical Centre, Milwaukee, Wisconsin

&

Mayo Clinic, Rochester, Minnessota

Attended Conference Organized By Aurora St Luke's And American Society Of Echocardiography At Coronado Island, San Diego, California

"Excellence In The Practice Of Cardiovascular Ultrasound"

Attended American Society Of Echocardiography 24th Annual Session At Minneapolis Convention Centre, Minneapolis, Minnessota

Aurora St Luke's Medical Centre Milwaukee Wisconsin United States

Best Of Milwaukee Wisconsin

In Memory. Aurora St Luke's Medical Centre Milwaukee Wisconsin USA

Echo Room At Aurora St Luke's Medical Centre

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.

The Sonographer Attachment Programme At USA Report : Prosolv System

Prosolv System

Introduction

ProSolv® CardioVascular has everything we need to successfully complete any Echo exam. For starters, they offer a unique, highly sophisticated engineering software package that solves even the most complicated calculations. It includes hundreds of possible measurements and calculations that you can modify, expand or group together to identically match your reports. And our other reporting capabilities are unmatched in the industry.

Scoring

ProSolv® CardioVascular offers an innovative feature called wall motion scoring intelligence. Compatible with resting, 2, 3 and 4 stage stress echo exams, it allows us to generate a diagnostic statement based on wall motion scoring performed by a clinician. If the clinician accepts the clinical statements, they can be included in our report and edited as necessary. We can choose to display our findings by using either anatomic or bulls-eye schematics whichever is easiest to reference and embed them into your final report.

Measurements

Their measurement transfer tool lets us transfer all measurements and calculations taken from any ultrasound system directly into our database so they can auto-populate our clinical report. This error proof feature eliminates the need to re enter measurements taken during acquisition. Plus, more than 400 ASE approved default cardiac measurements and calculations are available to use for off-line analysis. And if a measurement is performed off-line, we can access the image where it was made quickly and easily by a simple right mouse click.

ProSolv® CardioVascular also features one click normal report creation. With one mouse click, we can create an entire clinical report either based on ASE guidelines, or on customer-specific parameters. Even in a slightly abnormal report, this allows us to ‘report by exception’ in other words, create a normal report, then quickly change one or two items that are outside of the normal range.

ProSolv® includes several preset measurement routines for 2D, Doppler and M-Mode. And user-defined measurements and calculations can be directly added to our database. To sum it up, ProSolv® CardioVascular saves our loads of time while minimizing errors.

Reports

Their default reports are based on guidelines from the American Society of Echocardiography (ASE) and the Intersocietal Commission for the Accrediation of Echocardiography Labs (ICAEL). Each pre configured template features reporting profiles as well as clinical statements, measurements and calculations. Plus we can add our own comments for site-specific protocols and reporting requirements, embed images and configure our own defined macros for more efficient reporting. Choose from a comprehensive list of fully customizable reports:

• Adult Transthoracic Echo

• Treadmill Stress Echo

• Dobutamine Stress Echo

• Transesophageal Echo

Prosolv System Management And Administration

Aurora : IT Imaging Deployment and Support System Administrator

At Aurora Health Care they believe that each of them can use their knowledge, experience and creativity to help people live well. They are a non profit organization with a clear vision of providing people with better health care then they can get anywhere else. Their strength stems from teamwork and collaboration among a talented and diverse group of professionals.  Aurora Health Care is advancing toward a total digital imaging and patient monitoring environment across all Cardiac modalities, patient care disciplines, and facilities. This multi-year effort involves strategy formulation, migration from current environments, and implementation of state-of-the-art, innovative PACS and patient monitoring solutions.

The Information Services department has a IT Imaging Deployment and Support System Administrator to perform duties related to software release management, systems integration, system administration, interface support and development, and high-level technical support with issue resolution for PACS. The position is primarily technical and analytical in nature, requiring analysis, troubleshooting, and programming skills. The position is responsible for planning, testing, and implementation of application software releases across multiple imaging environments and sites. This role interacts with multiple internal IS teams, the clinical PACS Administrator, vendors, clinical end-users, physicians, and hospital and clinic administration. The person must also have a demonstrated ability for analytical and logical thinking, creativity, self-reliance, and ability to effectively integrate varied components of a system.

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

7.1 Aurora St Luke’s Medical Centre : Echocardiography Laboratory

 Echocardiography Laboratory

Internationally known for expertise in heart care, Aurora St. Luke’s Medical Center offer a large, dedicated heart care unit staffed with highly specialized and experienced teams of physicians, nurses, anesthesiologists and technicians. Here they perform more than 12,000 echocardiograms annually. They are three respective division of Echocardiography Services in Aurora St Luke’s Medical Centre that i get involved in. 

They were Suite 840 (Out Patient Clinic), Suite 575 (Cardiac Specialty Centre) and Hospital Echocardiography Laboratories.  Generally, echocardiography services lead by Dr Bijoy Khanderia and Matt Umland act as Echo Quality Coordinator. But echo technologist is to report to different managers in different areas. For example, echo technologist at Hospital Echocardiography Laboratories will only report for manager at that area. They will be echo technologist leader at each area. Only Suite 575 (Cardiac Specialty Centre) will share experienced echo technologist at that area either from Hospital Echocardiography Laboratories or Suite 840 (Out Patient Clinic).

The Sonographer Attachment Programme At USA Report : Aurora St Luke's Echo Protocol =Contrast Agent=

5.5 Aurora St Luke’s Medical Center:

Protocol For Contrast Agent

Patient Screening

• Definity will not be administered to the following patient population with a known history of

§  Right to left, bidirectional shunts or transient right to left cardiac shunt

§  Sensitivity of Perflutren

§  Prior reaction of Definity

§  Pregnant and nursing mothers

§  Congenital heart defect

• Definity can be administered to the following patient population upon MD approval and with continuous monitoring of BP, ECG and pulse ox during and up to ½ hour after injection

§  Significant pulmonary hypertension

§  Unstable cardiopulmonary conditions

Criteria For Definity Studies

• Definity is used at the discretion of the physician or sonographer
• Studies ordered specifically for LV function where all wall segments are not well visualized and a bi plane EF cannot be accurately measured
• Use of contrast is ordered by physician
• Patient with suboptimal images due to lung interference, obesity, and/or other conditions that might warrant poor visualization of endocardial borders
• Suspicion of other cardiac anomalies ie Apical thrombus

Adverse effects

• Complications are immediately addressed by physician and/or technician
• Patients adverse reaction is documented on the patient report
• Contrast reaction is documented and alerted in patients medical record
• Medical imaging company is notified of the adverse effect and documentation of complication is recorded

Administration

• Definity is stored in refrigerator at 36-46 degrees F
• Vial is at room temperature before activation
• Vial mixer is used to agitate Definity for 45 seconds

§  Do not reactivate the vial if the vial mixer did not complete a full 45 seconds

§  Do not reactivate a successfully activated vial

§  Do not use a vial mixer that is not functioning properly

• Definity is vented with sterile vent spike or needle, ensuring that air is not injected into vial
• Withdraw Definity slowly into injection syringe containing 8.5 cc saline using a plastic cannula, withdrawing the liquid from the middle of the inverted vial, again ensuring that air is not injected into vial
• Intravenous injection (IV using a 20 gauge or larger angiocath) of up to 2 cc diluted Definity is administered slowly at a rate of 1 cc every 10 seconds prior to imaging (Do not administer Definity intraarterial)
• Resuspend Definity with 10 seconds of hand agitation prior to each additional injection or if the product has not been used within 5 minutes of the original activation in the vial mixer
• Discard unused Definity
• Activated Definity is stored at room temperature and should be used within 12 hours
• Definity is a single vial dose and must not be used for more than one patient