Sanjiv Kaul, MD, FASE

Over 2000 members of ASE, or 14% of our membership, are from 116 countries outside the USA. Of these about a fourth are from Canada, and another fourth from Europe. A quarter includes members from Australia, Japan, and India; the rest of the countries around the world constitute the final quarter. Why do we have so many international members, and what can we do to support their interests?

We are the oldest and largest cardiovascular ultrasound society in the world, having celebrated our 35th anniversary this year. From the beginning we have emphasized practice standards and excellence, and our guidelines form the basis for the practice of cardiovascular ultrasound worldwide. Our Website attracts 40,000 visitors a month, and many of those download our guidelines. Our members are also among the most scientifically productive in the world and have pioneered many disciplines within our field. Since 1989 we have had a very well attended annual scientific session, with luminaries from all over the world serving as faculty.

Historically we have partnered well with the European Academy of Echocardiography, and have co-authored many guidelines and position papers with them. We have a long-established relationship with the Japanese echo society, and have participated in one another’s annual scientific sessions. We have developing relations with the Chinese, Indian, South and Central American, and Korean echo societies, among others. Recently, 21 South and Central American countries got together to form a single echo society (ECOSIAC); ASE now has a strong relationship with ECOSIAC, facilitating our dealings in that region. The potential formation of an Asian-Pacific echo society will make our interactions with Asia more streamlined.

We believe that we need to focus more on our international members by providing them with educational products specifically developed for their markets. These include translations of guidelines and posters that have proven very popular among our members. We have just completed Spanish and Chinese versions of our poster and guidelines on chamber quantification. We plan to translate more of these in the next few years. All of our guidelines and standards documents can be downloaded from our Website, www.asecho.org , free of charge.

While our annual scientific sessions and other North American meetings have strong international attendance, many are unable to come for economic and other reasons. Our aim is to bring practical training in cardiovascular ultrasound to different parts of the world. To this end, we will partner with several international echo societies to hold our first joint international meeting in July 2011 in Buenos Aires, Argentina. Faculty will consist of members of the various echo societies from around the world, so a wide range of clinical expertise will be available to attendees. This meeting could be the model for a similar conference in Asia in 2013 and then a rotation to different parts of the world on a biennial basis.

Standardization of the cardiovascular ultrasound examination is arguably best done here in the USA. To a large extent this is because of the availability sonographers, as these professionals have backgrounds in anatomy, physiology, and ultrasound physics, and are specifically trained in the practice of cardiovascular ultrasound. Unfortunately, in many parts of the world sonographers are not a part of the clinical team, for reasons including a lack of sonography schools, low levels of reimbursement, and patient reluctance to be examined by anyone other than their physicians. While some physicians are excellent sonographers, because of time and other constraints the average physician performing echocardiography is not as skilled as a well-trained sonographer. Consequently our sonographer members are taking leadership roles in training sonographers from all over the world and looking at ways of starting sonography schools and courses in other countries. The anticipated outcome is that, as more cardiovascular ultrasound examinations are performed by well-trained sonographers around the world, the quality of echocardiography will be enhanced.

Another area where we can assist our international colleagues is in certification examinations, whether for physicians or for sonographers. Certification of laboratories for quality and consistency is another area in which we can help. Although ASE does not directly certify physicians, sonographers, or laboratories, we are encouraging the National Board of Echocardiography, the American Registry of Diagnostic Medical Sonographers, and the Intersocietal Commission for the Accreditation of Echocardiography Laboratories to enter in to the dialogue with echo societies around the world to provide them with means of achieving their goals.

Members of ASE pride themselves on being responsible citizens of the world. Many of us who practice in the USA were born in other countries. I urge these members to act as individual ambassadors to their countries of birth and help their peers to bring echocardiography to a single world standard.

An example of what individual members can do was brought to our attention by William Battle, MD. At his behest, a number of ASE members became involved in the Hopital Sacre Coeur Cardiac Ultrasound Program in Milot, Haiti, where cardiovascular disease is very prevalent. Teams of physicians and sonographers have visited the hospital to provide cardiovascular consultations as well as training and instruction in the use of echocardiography. ASE thanks physicians Charles Pollick, David Marsh, Bruce Lloyd, Deborah Barbour, Mark Callahan, Robert DiBianco, William Vosik and Russell Cross, and their sonographer counterparts: Charles Polosky, Cindy Rocker, Francisca Porras, Cincy Gallucci, Kathleen Garcia, Jami Brenner, Kim Balsley, Linda Nguyen, Mary Davis, Mary McConnell, Michael Ashworth, Nancy Patterson, Rosanna Garrish, Sandra Owen, Sheila Waters, Susan Phillip, Ursula Misiraca and Shelley Eaglehunter, for answering the call to volunteer for this very noteworthy and exciting project.

The world is coming together like never before. Global health is attracting attention from various governmental and non-profit organizations. ASE can and should do its part though education and training of the practitioners of echocardiography throughout the world.