Athletes from all age groups and skill levels cross train by incorporating physical exercise and functional movements that are unrelated to their specific specialized competitive sport. Cross training enhances power, agility, and speed along with the strengthening of muscle groups to gain a competitive advantage. Athletic cross training leads to an overall diverse, well-trained, competitive athlete. Cross training benefits reach far beyond the walls of the local gym and personal fitness achievements. Analogous to cross training in athletics, cardiac sonographers have been cross training in vascular imaging to add to their diversity of knowledge, and to strengthen their critical thinking. The push for additional knowledge of the entire cardiovascular system is leading to enhanced critical thinking for both cardiac and vascular sonographers.
When you think about cardiac and vascular imaging, one might think that they are completely different mindsets. The two imaging tracts actually go hand-in-hand. Abnormalities that are present in the vascular imaging realm can be traced back to the heart. Vascular imaging sonographers commonly record waveform hemodynamic abnormalities. The common causes of waveform abnormalities can include pathologies in both arterial and venous systems. They are commonly secondary to cardiac effects. For instance, in reviewing venous spectral Doppler waveforms in a lower-extremity deep vein, venous duplex vascular imaging might show pronounced pulsatility in the femoral and popliteal waveforms. This pulsatility is caused by an increase in right atrial pressure, which is allowing right heart hemodynamics to show retrograde flow all the way to the lower extremities. Also, the elevation of right atrial pressure might cause a diminished venous emptying of the lower-extremities. When we think of cardiac physiology, less return to the heart equals less cardiac output. The abnormalities causing this phenomenon are all too common on the cardiac side of imaging: heart failure, valvular disease, cardiomyopathy, and pulmonary hypertension. On the arterial side, common knowledge of cardiac arrhythmias and low ejection fraction are helpful to assess Doppler waveforms. Aortic stenosis and aortic coarctation can cause dampened arterial flow signals distally throughout the peripheral circulation. Knowledge of aortic regurgitation may affect both the systolic and diastolic waveforms seen in vascular imaging, leading to vascular phenomenon with two double peaks known as pulsus bisferiens. As passionate cardiac and vascular sonographers, believe it or not, we are linked closely together, by the heart pump and flow hemodynamics.
Is there potential growth in echocardiography and vascular imaging? According to the Bureau of Labor and Statistics (BLS), diagnostic medical sonography is expected to increase by 24%, which is much faster than average, through the year 2024. The BLS predicts that our career field will grow by 27,600 sonographers within the next seven years. A local or regional search for ultrasound jobs reveals many organizations actively seeking employable, educated, skilled, professional sonographers. We are continuing to grow as a profession, and students entering the field have a great future.
Ultrasound schools have been adding to their didactic and clinical curriculum to benefit knowledge, experience, and marketability. Graduating ultrasound students who possess a dual registry in both cardiac and vascular imaging have an added benefit for many marketable job situations. Students who have both cardiac and vascular registries are in demand in many urban and rural communities nationwide. Currently there are 217 ultrasound programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP); 76 programs have cardiac concentrations, and 71 have vascular concentrations. For program directors in ultrasound education there are opportunities to add to this growing and expansive field of study. To find out more information please visit the Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS) website and review the CAAHEP Standards and Guidelines for the Accreditation of Educational Programs in Diagnostic Medical Sonography for programmatic information and accreditation requirements.
As cardiac sonographers we certainly are a specialized group. We pride ourselves in our daily routine of excellent patient care, always growing in our ultrasound knowledge, and leading the way in the advances in cardiac imaging technology. We are passionate about education and continued learning throughout our careers. Vascular imaging is the next step in adding to our diverse ultrasound knowledge. As cardiac and vascular sonographers, we have a common link that binds us together: the heart.
Chris Kramer, BA, ACS, RDCS, FASE is a Cardiac Ultrasound Education Program Director at Aurora Health Care in Milwaukee, Wisconsin. He is an advanced cardiac sonographer and has been a cardiac sonographer for the past 10 years. He is the JRC-DMS and CAAHEP representative for the ASE.
Editorial note: This article does not necessarily reflect the viewpoints or policies of the ASE organization. This article was submitted by an ASE Council volunteer, and the organization is grateful to him and our other members who contribute to the JASE blue pages as we value their willingness to share their personal and professional insights and experiences with the ASE community.