Guidelines for Cardiac Sonographer Education ...

1 77 Echocardiography is recognized as a highly valu-able diagnostic modality for the evaluation of cardiacanatomy, function, and hemodynamics. As such, it isthe most commonly used imaging procedure for thediagnosis of heart disease. The Cardiac sonographerplays an integral role in this diagnostic process,applying independent judgment, problem-solvingskills, and the ability to obtain and integrate accuratediagnostic information during the performance ofthe operator-dependent nature andcomplexity of practice dictate that the Cardiac sonog-rapher function at a professional level. A detaileddescription of the profession can be found in thedocument, The Scope of Practice for the DiagnosticUltrasound Professional. 1 The Education required toreach a professional level of competence must in-corporate detailed, structured, and increasing sophistication of echocardi-ographic instrumentation, coupled with the com-plexities of the Cardiac evaluation, make on-the-jobtraining as the primary educational pathwayinadequate.

2 In the interest of the profession and,ultimately,the patient, we recommend that personswho enter the field of Cardiac sonography attendeducational programs that are recognized and sup-ported by the American Society of Echocardi-ography (ASE), such as those accredited by theCommission on Accreditation of Allied Health Pro-grams (CAAHEP),2,3the Joint Review Committee forCardiovascular Technology (JRC-CVT),4and theJoint Review Committee for Diagnostic MedicalSonography (JRC-DMS),5and earn the appropriatecardiac sonography certificate or report serves to update the 1992 document, Guidelines for Cardiac Sonographer Education :Report of the American Society of EchocardiographySonographer Education and Training Committee, 6toincorporate new modalities, techniques, and proce-dures and to explain the manner in which theseadvancements affect the educational process for theGuidelines for Cardiac SonographerEducation: Recommendations of theAmerican Society of EchocardiographySonographer Training and EducationCommitteeDonna Ehler, BS, RDCS, Dennis K.

3 Carney, RCVT, Ann L. Dempsey, MEd, RDCS,Rick Rigling BS, RDCS, Carol Kraft, BS, RDCS, Sandra A. Witt, RDCS,Thomas R. Kimball, MD, Eric J. Sisk, BA, RDCS, Edward A. Geiser, MD,Cris D. Gresser, RN, RDCS, and Alan Waggoner, MHS, RDMS,Kansas City, Missouri; Spokane, Washington; Sunnyvale, California; Danbury, Connecticut;Seattle, Washington; Cincinnati, Ohio; Gainesville, Florida; Toronto, Ontario, Canada;and St Louis, MissouriFrom the American Society of Echocardiography SonographerTraining and Education requests: ASE, 1500 Sunday Drive, Suite 102, Raleigh,NC 2001 by the American Society of $ + 027/1/109922 1992, the American Society of Echocardiographypublished a report of the Sonographer Education andTraining Committee s recommendations for edu-cation of sonographers who perform echocardi-ographic procedures.

4 Since the publication of theoriginal document, there has been continual progressin technology with the development of more sophisti-cated diagnostic applications that allow more infor-mation to be obtained from echocardiographicprocedures. These recent changes in the clinical appli-cation of echocardiography should be included in allcardiac Sonographer Education programs. The Ameri-can Society of Echocardiography, a professional societythat currently represents approximately 2500 cardiacsonographers, provides these updated Guidelines . (JAm Soc Echocardiogr 2001;14:77-84.)AMERICAN SOCIETY OF ECHOCARDIOGRAPHYPOSITION PAPER Cardiac Sonographer . Specific goals of this revisioninclude the following: Define the role of the Cardiac Sonographer Provide recommendations for educational path-ways Provide recommendations for on-the-job orienta-tion and continuing includes the following comple-mentary techniques: 2-dimensional echocardiographicimaging, M-mode tracings derived from the 2-dimen-sional image, continuous wave and pulsed waveDoppler flow velocity recordings, and color flowDoppler imaging.

5 Pharmacologic stress agents andthe performance of exercise are additional methodsthat expand the diagnostic capabilities of echocar-diography. The use of contrast agents may be incor-porated into any of these imaging techniques such as transesophageal,intravascular, intracardiac, and intraoperative echo-cardiography are primarily performed by a ,8 Despite this fact, it is recommendedthat the Cardiac Sonographer have an understandingof these techniques and their diagnostic value for theevaluation of Cardiac anatomy, function, and ROLE OF THE Cardiac SONOGRAPHERThe Cardiac Sonographer is an allied health practitionerwho, as the result of comprehensive, specialized edu-cation in the medical and technical aspects of diag-nostic Cardiac sonography.

6 Is qualified to performechocardiographic examinations in compliance withprotocols and techniques, as outlined in Essentialsand Standardsby the Intersocietal Commission forthe Accreditation of Echocardiographic primary role of the Cardiac Sonographer is toobtain diagnostic recordings of Cardiac ultrasonogra-phy images and Doppler hemodynamic data. Thetechnique is extremely operator-dependant, and itsoptimal performance requires a highly skilled andwell-educated person who can continuously inte-grate known clinical information, ultrasonographicimage content, and related physiologic data to tailorthe examination to ensure that it is comprehensiveand accurate. Continuous application of the princi-ples of ultrasound physics and instrumentation dur-ing the examination is requisite to obtain optimaldata.

7 Accordingly, the Cardiac Sonographer mustassume significant responsibility for the examinationand therefore must exercise independent judgment,apply knowledge of clinical cardiology, and use prob-Journal of the American Society of Echocardiography78 ASE Sonographer Training and Education CommitteeJanuary 2001lem-solving skills. The Cardiac Sonographer mustpossess sophisticated cognitive skills and be profi-cient in the use of sonographic techniques to pro-duce accurate and appropriate anatomic and physio-logic information for the physician to review fordiagnostic Cardiac Sonographer is required to have adetailed understanding of Cardiac and thoracicanatomy, physiology, hemodynamics, embryology,tomographic anatomy, and pathophysiology.

8 Thisknowledge base is a prerequisite to the understand-ing of echocardiographic data and quantitation ofderived parameters. The Cardiac Sonographer mustbe able to recognize abnormalities, form a prelimi-nary set of differential diagnoses, and extend thescope of the examination to explore these possiblepathologic Cardiac Sonographer should be able to obtainpertinent clinical information from the patient, refer-ring physician, and patient s record, including Cardiac -related physical findings and pertinent laboratory data,and to apply the necessary sonographic techniques toobtain comprehensive and diagnostic echocardio-graphic information. Failure to obtain and integratesuch data may lead to an incomplete examination orerroneous clinical interpretation of the echocardio-gram or both.

9 A Cardiac Sonographer must be skilledin interacting with patients, which involves explainingthe procedure to the patient but not discussing theclinical findings of the Cardiac Sonographer must be skilled in select-ing relevant echocardiographic data, making quanti-tative calculations from these data, and communicat-ing his or her impressions to the physician inter-preting the study. Although the performance, focus-ing, and integration of the various components of theechocardiographic examination require the cardiacsonographer to be knowledgeable about cardiacpathophysiology, its sequelae, and the techniquesavailable for evaluating its severity, it is the responsi-bility of the physician, not of the Cardiac sonograph-er, to provide diagnostic clinical Cardiac Sonographer should work under thesupervision of physicians trained to a Level 3 statusor by Training Level 2 physicians who themselves areunder the supervision of a Training Level 3 supervising physician should be availablefor assistance in the performance of the examinationwhen it is technically difficult, confusing.

10 Or nondi-agnostic or when ancillary techniques or interven-tions are needed. The Cardiac Sonographer shouldparticipate with the supervising physician in theinterpretive review of the examination to provideJournal of the American Society of EchocardiographyVolume 14 Number 1 ASE Sonographer Training and Education Committee79input in the evaluation of data and to contribute rel-evant technical collaborative, coop-erative effort is necessary to ensure that the diag-nostic information obtained and reported will be ascomplete as possible. It is also essential for qualityassurance, as recommended by the IntersocietalCommission for the Accreditation of Echocardi-ography Laboratories (ICAEL).9 The Cardiac Sonographer must have a completeunderstanding of the physical principles of ultra-sound, the operation of diagnostic instruments,and the bioeffects of ultrasound.