Cultivating Competency in Cardiac Sonography: Aligning Entrustable Professional Activities With Industry Expectations.

BACKGROUND & AIM: Echocardiography education involves the teaching and assessment of multiple competencies to ensure work-ready graduates. To connect these competency standards to professional practice, it is important that the industry expectation around specific entrustable professional activities (EPAs) is determined. In Australia, echocardiography examinations are eligible for Medicare reimbursement when performed by sonographers listed on the Australian Sonographers Accreditation Registry (ASAR), either as an Accredited Medical Sonographer or as an Accredited Student Sonographer. A key criterion for acceptance onto the registry is the completion of, or active enrolment in, an accredited cardiac sonography course. Eligible courses apply for accreditation and are assessed by ASAR against their Standards for Accreditation of Sonographer Courses. This study sought to investigate the existing cardiac EPAs and provide insights into the industry's expectations for graduate cardiac sonographers in Australia. METHODS: Using an anonymous online survey tool, an invitation to participate was circulated via professional sonography groups and social media platforms. Accredited Medical Sonographers, Accredited Student Sonographers or interested stakeholders (academic, employer, medical specialist) working in Australia or New Zealand were invited to complete the survey. Survey questions were structured around the existing EPAs and knowledge items described in published sonography competency documents. Participants were asked if each individual EPA should be considered appropriate at the threshold of graduation, or at a higher level following a period of working in the profession. RESULTS: There were 211 cardiac sonographers who completed the survey. The majority of respondents (148 of 211, 72.2%) indicated that the current EPAs should be updated. At 80% agreement, the following EPAs were considered essential for the graduate: left ventricular structure and function, right ventricular structure and function, atrial size, valvular disease, systemic hypertension, cardiomyopathies, diseases of the aorta, coronary artery disease, pulmonic hypertension, and basic congenital heart disease. This list is more extensive than the current ASAR-endorsed EPAs, and the findings in this research will guide the revision of current ASAR-endorsed EPAs for graduate-level cardiac sonography. CONCLUSIONS: The results of this study show Accredited Medical Sonographers completing a cardiac sonography course in Australia should be entrusted to perform a wide range of examinations however, greater alignment between educational providers, ASAR and industry is still required.

The safety profile of perflutren microsphere contrast echocardiography during rest and stress imaging: results from an Australian multicentre cohort.

BACKGROUND: Contrast enhanced echocardiography (CEE) is utilised when sub-optimal image quality results in non-diagnostic echocardiograms. However, there have been numerous safety notices issued by regulatory authorities regarding rare but potentially serious adverse reactions (AR). This multi-centre, retrospective analysis was performed to assess the short-term safety of CEE in a broad range of indications. METHODS: All CEE performed over 58 months at three institutions were assessed for AR within 30 min. RESULTS: A total of 5956 CEE were performed in 5576 patients. A total of 4903 were stress CEE and 1053 resting CCE. Bolus administration in 5719, infusion in 237 cases; 89.9% of CCE were outpatients. Commonest CEE indication was functional stress testing (82.3%). There were 16 AR related to CEE (0.27%). All AR were mild, transient and all patients made a full recovery. No cases of serious anaphylaxis or death within 30 min of contrast administration. Comparing those with and without an AR, there were no significant differences in age, gender, BMI, LVEF, patient location, exam type or RVSP. There was a slightly increased likelihood of an AR during infusion versus bolus dosing (p = 0.02). CONCLUSION: CEE is a safe investigation in a broad range of indications and clinical scenarios. AR are very rare, mild and transient.

Detection of right-to-left atrial communication using agitated saline contrast imaging: experience with 1162 patients and recommendations for echocardiography.

BACKGROUND: Right-to-left shunting via a patent foramen ovale (PFO) has a recognized association with embolic events in younger patients. The use of agitated saline contrast injection (ASCi) for detecting atrial shunting is well documented, but the optimal technique is not well described. The purpose of this study was to assess the efficacy and safety of transthoracic echocardiographic (TTE) ASCi for the assessment of right-to-left atrial communication in a large cohort of patients. METHODS: A retrospective review was undertaken of 1,162 consecutive patients who underwent TTE ASCi, of whom 195 had also undergone clinically indicated transesophageal echocardiography. ASCi shunt results were compared with color flow imaging, and the role of provocative maneuvers (PM) was assessed. RESULTS: Four hundred three TTE studies (35%) had paradoxical shunting seen during ASCi. Of these, 48% were positive with PM only. There was strong agreement between TTE ASCi and reported transesophageal echocardiographic findings (99% sensitivity, 85% specificity), with six false-positive and two false-negative results. In hindsight, the latter were likely due to suboptimal right atrial opacification and the former to transpulmonary shunting. TTE color flow imaging was found to be insensitive (22%) for the detection of a PFO compared with TTE ASCi. CONCLUSIONS: TTE color flow imaging is too insensitive for PFO screening. TTE ASCi, however, is simple and highly accurate for the detection of right-to-left atrial communication, on the proviso that a dedicated protocol, including correctly implemented PM, is followed. It is recommended that TTE ASCi with PM be considered the primary diagnostic tool for the detection of PFO in clinical practice.

Estimating left atrial enlargement parameters from the electrocardiogram using wavelets.

BACKGROUND: The aim of this article was to examine the utility of using the P wave of the electrocardiogram to indicate left atrial enlargement measures determined from the echocardiogram and cardiac magnetic resonance. METHOD: Wavelet-based features extracted from the beat-averaged P wave were correlated to the left atrial diameter, left atrial area, and left atrial volume index measures from echocardiogram and cardiac magnetic resonance. RESULTS: Significant correlations were found between several of the wavelet features and the left atrial enlargement size measures (r > 0.5, P < .01). Left atrial diameter and left atrial area correlated best to the derived Z lead, and left atrial volume index correlated best to the derived X lead. CONCLUSIONS: The good correlations illustrate that it is feasible to estimate the size of the left atrium from the P wave using wavelet techniques.