Dr. Thomas with (L to R), Drs. Dali Fan, Xin Fang Wang, and Feng Xie.

Guidelines are a lot like DNA. They are the building blocks for all that ASE is and does, yet guidelines and standards, and the committee that oversees their creation, can all too easily be overlooked in the face of glitzier and more public activities like our educational meetings and Scientific Sessions.

ASE’s guidelines, however, are read and used by echocardiographers all over the world. Our online guidelines page is open access and freely available to all. Our guidelines have been the core of ASE’s global outreach, and our international colleagues have responded enthusiastically; seven documents have been translated to Chinese, and two to Spanish, with more on the way. In the picture you can see me at the Great Wall International Congress of Cardiology meeting presenting plaques of appreciation to our Chinese translators. On the far right is Dr. Feng Xie, who organized a veritable army of translators, including Dr. Dali Fan (far left) and Dr. Xin Fang Wang, the “Feigenbaum of China” (or is Harvey the “Xin Fang Wang of the US”?) who will receive the first Honorary FASE for a Chinese echocardiographer at next year’s ASE Scientific Sessions. Links to our guideline page can be found on society Websites throughout the world, and the page consistently has more views than any other on ASE’s Website, recently with over 17,000 page views from over 150 countries, even Kazakhstan (maybe Borat?). Compact disks containing all of our current guidelines are distributed at meetings and courses throughout the world. All of our guidelines are published in JASE , and they are among the most often cited of all the papers we publish; the 2005 chamber quantification document by Roberto Lang et al has been cited in over 1,760 documents. These high volume and high quality citations keep Dr. Pearlman and the Editorial Board happy, as they boost JASE’s impact factor by the year.

A record 6 guidelines were published in 2011, with topics as varied as our members’ needs: quality in laboratory operations, advanced assessment of cardiac mechanics, hypertrophic cardiomyopathy, transcatheter interventions, neonatal intensive care, and guidance of vascular cannulation. ASE also collaborated with the American College of Cardiology (ACC) and others on revised appropriate use criteria (AUC) for echocardiography. This document is central to our reimbursement strategy, both by the Centers for Medicaid and Medicare Services (CMS) and by private payers, which we hope will forestall echo precertification and improve patient care.

This astounding body of work was produced by writing groups comprised of invited volunteers with recognized expertise on the guideline topics who spent countless hours meeting, writing, and reworking them. Partnerships are often formed and nurtured as part of the guideline process: ASE often collaborates with the European Association of Echocardiography (EAE), and included representatives of the American Society of Nuclear Cardiology (ASNC), the Society for Cardiovascular Computed Tomography (SCCT) and the Society for Cardiovascular Magnetic Resonance (SCMR) on the multi-modality hypertrophic cardiomyopathy document. Watch for more multi-modality collaborations in the future!

And volunteer participation does not end with the writing group. Extensive reviews take place, first within the Guidelines and Standards Committee, then by the Board of Directors, and finally the Executive Committee. Front and center throughout the entire process is the Guidelines and Standards chair, who must have an eye for detail, the ability to juggle many documents at once, and a keen understanding of the direction and vision of the Society. Our current chair is Dr. Kirk Spencer, who has impressed me with a wonderful sense of which topics we should write on and which we should leave for another day. Kirk was preceded by Drs. Patricia Pellikka and Neil Weissman, and it is no coincidence that they have advanced to ASE leadership roles. Guidelines and Standards gives an excellent insight into the needs and current issues of all of ASE’s constituencies.

But wait…there’s more! The work of ASE volunteers on guideline-related projects doesn’t end with publication of the new documents, either. Courses, Webinars, lectures at our annual scientific sessions, posters, pocket guidelines, Web apps: all have their foundation in our guidelines. Currently, as part of our outreach to China, six of our guideline posters have been translated into Mandarin and can be found in echo labs throughout China, thanks to sponsorship and dissemination by Philips China.

What’s coming in 2012? We’re very excited about the 3D echo document which is the centerpiece of this focused issue! Roberto Lang and EAE President Luigi Badano have done a masterful job in standardizing how we will acquire and display 3D views of cardiac anatomy for years into the future. Still to come are multi-modality documents on aortic root diseases and pericardial diseases; echo and hypertension; a 3D pediatric guideline; a document on the use of echocardiography during and after cancer chemotherapy and another on the ravages of radiation in the treatment of heart disease; and directed/focused bedside TTE, as well as updated versions of old favorites. ASE is also writing guidelines to address the non-traditional uses of echocardiography as it becomes a popular tool in the emergency room and critical care units.

I hope you’ll look at guidelines a bit differently now. I know in the past I had a sense that they arrived, deus ex machine , fully formed from heaven. I now know that it starts with someone identifying a need, convincing the G&S committee to prioritize it, and then finding volunteer experts willing to put in thousands of hours of work to draft a document that we, as a society, can stand behind with pride. If you can identify such a gap in our current guidelines or wish to make yourself available for a writing committee, I hope you’ll contact me or Kirk Spencer. We’re always looking for good talent willing to work hard for the betterment of our society, patients and the greater echocardiographic community.