Contributed by: James N. Kirkpatrick, MD, FASE, Director, Echocardiography Laboratory, University of Washington Medical Center, Associate Professor of Medicine and Cardiology, and Adjunct Associate Professor of Bioethics and Humanities, University of Washington, Seattle, WA.
Scenario: you show up to the echo lab one morning in July. A trainee wearing scrubs introduces herself as a pulmonary fellow wanting to learn â€œechocardiography so I can scan patients in the medical intensive care unit (ICU).â€? The ICU has an older lap-sized ultrasound device with a cardiac transducer. She intends to spend the next month in your lab, after which she will start independently scanning. There is no denying the amazing diagnostic power of cardiac ultrasound. The ability to assess cardiac anatomy and motion with high fidelity images provides an incredible insight into the size, shape, and function of the heart. Coupling these advantages with real-time imaging at bedside affords a tremendous advantage to patients, particularly patients with life-limiting illnesses. Perhaps best of all, diagnostic cardiac ultrasound is non-toxic and relatively inexpensive. The development of small, portable, and even hand-carried ultrasound devices with excellent image quality has further expanded the field. The evolution from carts on wheels to laptops to devices the size of smart phones to devices that display images on smart phones means that diagnostic quality imaging can travel anywhere. Modern cardiac ultrasound devices are increasingly easy to use, and the price has dropped such that a hand-carried device is affordable to many practicing physicians. It is no wonder that devices have made their way into hands outside the cardiovascular field. Studies have examined the use of cardiac ultrasound by non-cardiovascular practitioners in a wide-range of settings, from rural areas in the developing world,1 to subspecialty clinics,2 to emergency departments,3 to intensive care units.4 Cardiac ultrasound is now frequently employed for a wide-range of diagnoses, from rapid differentiation of shock and acute hypoxia5 to the identification of subclinical rheumatic valve disease.6,7
Of course, every technological advance comes with certain risks. Despite ease of use and excellent image quality afforded by modern machines, performance of cardiac ultrasound remains a complex task. Obtaining diagnostic quality images on patients with severe lung disease or obesity can be a herculean effort. Artifacts are common, even in uncomplicated patients.
VOLUME 7 ISSUE 1 ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////
What Should an Echo Lab Be Concerned About When Teaching Cardiac Ultrasound to Other Specialties?