Elizabeth F. McIlwain, MHS, RDCS, RCS, FASE, Chair, Council on Cardiovascular Sonography

Author’s note: Special thanks to Cathy Carolan, Ray Musarra, Joan Olson, Margaret Park, Rick Rigling, Cynthia Todd, and Karen Zimmerman for sharing their experiences and insights on implementing new technology in the echo lab .

M-mode echocardiography was originally described by Inge Edler and Hellmuth Hertz in 1953. In the 60-plus years since that original description, the field of cardiovascular ultrasound has experienced tremendous development. Two-dimensional echo, spectral Doppler, color Doppler, tissue Doppler, spectral tissue Doppler, and contrast enhanced echocardiography are now considered standard components of a routine echocardiographic study. Promotion of research and development in cardiovascular ultrasound is a part of the mission of the ASE. The mission of the 2012 ASE Cardiovascular Research and Technology Summit was to assess the state-of-the-art of echocardiography and create a “Road Map to 2020.” This summit placed particular emphasis on three-dimensional echocardiography, cardiovascular ultrasound in valvular heart disease, myocardial deformation echocardiography, and therapeutic ultrasound.

Part of advancing the technology of our field is the introduction of new applications into the daily flow of the lab. Many of us were around when this process occurred for the technologies we now consider a routine part of an echocardiogram. However, each technology had to be introduced, taught, and evaluated before it became an accepted part of the study. That process stills holds true, but what does it look like in today’s echo lab? In an effort to get a better picture of that, I asked for insight from members of the Cardiovascular Sonography Council Board. Their responses revealed a clear pattern that has led to success in those labs. There must be a lab champion, a clear plan for education and training, protocols for using the technology, and a process to evaluate and make adjustments.

Having a champion is a must. Without someone leading the way the implementation will not move forward. Echo requires a team, and therefore, the “champions” are a team also. There must be someone leading the way from the sonographer’s and the physician’s perspective. They will be the ones who first delve into the new application, learn it, determine how it can be introduced, and move it forward. The sonographer will usually be the one to use the new technology and experiment with different methods of optimization. The physician will document correlation and provide feedback to the sonographer. Together they will develop a plan to introduce the application to the lab. It is also helpful to have an administrative champion, as advanced applications often have an impact on financial and personnel needs.

Education and training are vital. A good educational plan will provide an introduction of the concept and follow it up with more in-depth training. This training should address what the technology is, how it works, and what can be learned from it. It is also important to have ultrasound system operation training. The operation of three-dimesional and myocardial deformation packages vary greatly from vendor to vendor. It is important that sonographers understand how the package used in their labs operate. This training should include “knobology” and information on recommended imaging parameters (frame rates, frequencies, etc.), as many vendor packages are calibrated for optimal operation at specific settings.

Some labs utilize the “super user” concept. One sonographer (usually the champion) is trained and is then responsible to train the other members of the lab. Other labs train all staff equally. Regardless of the tact a lab takes, it is important that training is thorough and ongoing. Utilize all training avenues available, on and off site. Consider asking the ultrasound manufacturers for training assistance with advanced applications. They are an important part of the team and should be willing to work with labs that want to implement new technologies.

Once a new technology has been introduced and lab personnel have been trained, the concept of a protocol is important to move the technology forward. Learning about a technology is not helpful if the technology is not used consistently. Policies and protocols should be developed to identify the clinical scenarios that would warrant using the new application. The expectation should be if the technology is indicated by a clinical scenario, the sonographer should acquire and analyze the data and the interpreting physician should include diagnostic information obtained through this in the report.

Finally, there should be an evaluation process. An echo lab should have a quality assurance program that ensures studies are performed and interpreted properly and appropriately. The new technology should be included in the quality assurance activities of the lab. Care should be taken to ensure that the new technology is acquired, analyzed and interpreted properly. Issues identified should be addressed through continued training and adjustments should be made to the protocols as warranted.

Implementing new technologies and applications in the echo lab has the potential to improve the quality of care and the services provided. Our patients deserve this. Cardiovascular ultrasound did not become the diagnostic tool it is by accepting status quo. We have always been a field that has pressed forward. We have never shied away from introducing new things even when the medical world seemed uninterested or unbelieving. Advancing technology in the echo lab is often met with barriers, but with persistence and a good plan it can be done. For echocardiography to continue to be the relevant diagnostic tool it is, we must make it happen.