Matt Umland, RDCS, FASE

Forward from Elizabeth McIlwain, Council Chair: As the role of the cardiac sonographer has evolved over the years, sonographers have looked for pathways to advance their careers. Our options were typically to move into management or industry. Unfortunately, such moves often required us to step away from the lab and give up the very thing we love—the actual performing of the echocardiogram and interacting with our patients. After many years of hard work by many dedicated sonographers and physicians, a professional educational career pathway, the Advanced Cardiac Sonographer, is now available. I hope this month’s communication will answer questions about this Advanced Cardiac Sonographer role and encourage you to aim to achieve this next level.

In 2007 the ASE sponsored a sonographer needs survey. The results indicated a desire and a need for an additional, more advanced career pathway for sonographers. A task force was created to investigate the idea and develop a proposal. That proposal outlining the definition, role, education, and credentialing pathway for the Advanced Cardiac Sonographer (ACS) was published in 2009. With the approval and support of the ASE, the development of this new career pathway has moved forward. The ACS is now recognized as a profession by the Committee on the Accreditation of Allied Health Programs (CAAHEP) and there is an accreditation pathway for programs desiring to provide the required educational curriculum.

What is an Advanced Cardiac Sonographer? An ACS is a sonographer practicing at an advanced level in a cardiovascular ultrasound laboratory to ensure quality echocardiographic examinations are performed. The role is multi-faceted. Specific responsibilities include teaching and training less experienced staff sonographers to assess cases thoroughly and accurately using appropriate echocardiographic methods, providing continuing education and training on new echocardiographic methods and protocols, and reviewing studies to ensure completeness and accuracy.

The ACS is not an independent practitioner. The ACS performs preliminary assessment of the sonographic study with a preliminary findings worksheet for the interpreting physician. They work under the direct supervision of physician echocardiographers and function at a high level to improve the quality and efficiency of the lab.

What type of training is involved in becoming an ACS? CAAHEP, Committee on Accreditation for Advanced Cardiovascular Sonography (CoA-ACS), and the ASE cooperate to establish, maintain and promote appropriate standards of quality for educational programs in the ACS profession. Detailed information on the standards and guidelines for an ACS training program and program accreditation information can be found on the CoA-ACS website at www.coaacs.org . Ideally, the best approach for becoming an ACS is to formally attend a CAAHEP accredited program. Sonographers interested in an ACS program should contact the local schools in their area to encourage them to offer the ACS curriculum.

How does the ACS position benefit the echo lab? The ACS provides benefit to the lab in many ways. Utilizing his or her clinical knowledge, the ACS assists less experienced sonographers in modifying studies to ensure the clinical question is answered. He or she also ensures that studies are complete and clinical data is accurate before the patient is allowed to leave the lab. This can lead to fewer repeat or additional studies, as well as providing complete and proper information to better direct the management of the patient’s care. The ACS also provides oversight to staff sonographers thru peer review and performance evaluations to identify training needs and quality improvement opportunities. Such activities are instrumental in assisting the echo lab in meeting the minimum standards for cardiac sonographers set forth by the ASE.

The field of echocardiography has experienced significant development in recent years. New technologies such as three-dimensional echocardiography and wall motion tracking are playing more routine roles in the echo lab. Guidelines for the assessment of cardiac structure and function are routinely updated. Echocardiography is also increasingly utilized in interventional procedures. The ACS is instrumental in training the echo lab staff in these areas and ensuring that new technologies, guidelines, and procedures are implemented effectively.

How does the ACS benefit physician workflow? The ACS role is, in many ways, an extension of the physician supervisor. The ACS’ responsibilities of improving quality in the echo lab, training and developing less experienced sonographers, and reviewing studies to ensure accuracy and completeness all aid the physician(s) in the echo lab. The review of each echocardiogram performed serves to make the physician’s time interpreting studies and creating final reports more efficient and streamlined. The work of the ACS related to introducing new procedures and implementing updated guidelines creates an environment of quality in the echo lab, resulting in the physician having access to information that facilitates patient management.

Is there a nationally recognized credential for the ACS? Cardiovascular Credentialing International (CCI) has developed an ACS examination in response to a need to create a career track for sonographers who practice at an advanced level in the echocardiography laboratory. The ACS examination is in the validation stage. Once this process is completed the exam will be available to sonographers meeting the qualifications.

Currently there are multiple pathways to qualify to take the ACS exam. The pre-requisites include completion of an accredited ACS training program and various experiential avenues. Information on qualification pathways and examination procedures can be found at www.cci-online.org/acs . It is anticipated that once sufficient accredited ACS educational programs are established, the experiential pathways will be discontinued. The ASE and the CoA-ACS neither endorse nor have any financial relationship with the CCI ACS examination.

Many years of hard work by many people have gone into making the Advanced Cardiac Sonographer career pathway a reality. The ACS role may not be applicable in all echo lab environments and is in no way meant to decrease the importance and necessity of the staff sonographer. The mechanisms are now in place for sonographers to take advantage of this career opportunity. For more information on the CoA-ACS, the ACS, and how programs can become accredited to provide the ACS curriculum, visit www.coaacs.org .