The current landscape of cardiovascular medicine makes multimodality ultrasound laboratories not only viable but also an advantage to the patient, the referring physician, and the cardiologist. The following paragraphs will present some considerations for the integration of a vascular laboratory within an established adult echocardiography laboratory.
Equipment, Space, and Scheduling
The physical needs for a vascular laboratory are greater than that of an echocardiography laboratory. Ultrasound systems will typically perform both echocardiography and vascular procedures, but probes and a vascular package need to be added. If the laboratory intends to perform lower extremity arterial studies, an ankle brachial index system will be needed. These systems are also used to perform multi-segmental pressures and pulse volume recording studies. Rapid cuff inflation systems may also be considered if the laboratory plans to perform venous insufficiency testing.
Cardiovascular laboratories require additional space. In the echocardiography lab, the bed usually remains in the same position. In the vascular lab, the bed is constantly rearranged in order to gain access to the specific limb to be interrogated, in addition to moving all of the equipment associated with vascular procedures.
Additional considerations include Picture Archival and Communication Systems and scheduling. Picture Archival and Communication Systems typically include echocardiography and vascular packages, however, there is often a cost to unlock the vascular reporting module. Lastly, scheduling vascular procedures interspersed with echocardiograms can add scheduling complexity due to the varying length of each exam.
Staffing the Vascular Lab
When considering sonographer staffing, there are three approaches. 1) Many schools train sonographers in both echocardiography and vascular ultrasound, so it is typical for sonographers who perform echocardiography to have vascular experience. The sonographers that show the ability and interest can be formally cross-trained in vascular. 2) A number of companies offer vascular ultrasound training. This can be done on site or off site depending on the needs of the lab and the staff. 3) A dedicated vascular sonographer can be hired to train and coordinate the vascular portion of the lab. This technologist may serve as the technical director for the laboratory as well. Reading physicians must also have experience and training in order to interpret vascular ultrasound exams. The American Registry for Diagnostic Medical Sonography offers a Registered Physician in Vascular Interpretation credential for vascular ultrasound interpretation.