The Changing Field of Cardiovascular Ultrasound

By David Wiener posted 05-01-2012 08:24


Dear ASE members,

The field of cardiovascular ultrasound is constantly expanding. Innovative technologies, such as 3D and contrast, speckle tracking, and the appearance on the market of hand-held devices are among the latest developments. The diagnostic and therapeutic benefits and the accessibility of cardiovascular ultrasound have resulted in new practice applications in emergency rooms, operating rooms, CCUs and ICUs.

These developments are changing the profile of the users of this imaging modality. While new applications of echocardiography have great potential for patients, they also bring the risk of compromised patient care if the users are not adequately trained and credentialed and if studies are obtained and their results applied inappropriately.

As an example, consider two proposals which recently came before the South Carolina Board of Medical Examiners. The first was to consider independent practice for all advance practice nurses in the state of South Carolina. The second proposal was to add the placement of a transesophageal echocardiogram (TEE) probe in the operating room, image acquisition and interpretation for surgical decision making, to the scope of practice for all certified registered nurse anesthetists (CRNAs) without supporting documentation of training or experience.

ASE was very concerned about the practice of echocardiography by CRNA’s who have limited training. Working with the American College of Cardiology, ASE mobilized our South Carolina members to submit testimony highlighting the concerns these proposals presented.  After a presentation by Scott Reeves, MD, FASE, chairman of the Council for Perioperative Echocardiography, the Board of Medical Examiners voted unanimously against the increase in scope for CRNAs doing TEE. The Board added for the record that it considered the practice of transesophageal echocardiography to be exclusively part of the practice of medicine

As another example, miniaturization of and improvement in transducer technology has facilitated the integration of focused cardiac ultrasound (FOCUS) into practice by specialties other than cardiology, such as specialists in emergency medicine and in critical care. Standards for training and maintenance of competence as well as authoritative guidelines for using FOCUS are lacking. ASE is taking the lead in this realm as we do in other areas of cardiac ultrasound. A writing committee under the leadership of Kirk Spencer, MD, FASE, is authoring a guideline for using handheld devices and focused cardiac ultrasound.

We are sponsoring a symposium on FOCUS at the ASE Scientific Sessions at the Gaylord National in National Harbor, MD. The Focused Cardiac Ultrasound Symposium, which will be held on Saturday, June 30, will review the use of point-of-care cardiac ultrasound by non-cardiologists with special interest in the focused cardiac ultrasound exam. Topics which will be addressed include indications, imaging protocols, available platforms, diagnosis of common cardiac diseases and utility of the focused cardiac examination in different settings. Issues of training, image storage, reporting and quality assurance will be discussed.

ASE is committed to excellence in cardiovascular ultrasound and its application to patient care. We are the home for all cardiovascular ultrasound practitioners.  We are dedicated to ensuring that a patient gets the correct procedure, performed by a qualified and appropriately trained provider, and applied to patient care in a guideline-based, appropriate fashion.