Standard

Posted: 10/11/07

R State Standard         £  Institutionally Developed          College: N/A

ECH 240 - Comprehensive Registry Review

 

Course Description

This course will be an overall review of Echocardiography to include demonstration of normal and abnormal cardiac anatomy, cardiac physiology, pathophysiology and hemodynamics/physics in the different types of cardiac disease/dysfunctions.  Also included will be a review of clinical non-invasive cardiac diagnostic procedures, laboratory values, pharmacology and test validation and measurements. Topics include: normal and abnormal cardiac anatomy, techniques, pathology, physics/hemodynamics, test validation and measurements, and laboratory values. Emphasis is placed on reviewing information so that the student will successfully pass the ARMDS and/or CCI certification examinations.

 

Competency Areas

Hours

Normal/abnormal cardiac anatomy

Class

1

Techniques

D. Lab

0

Pathology

P. Lab/O.B.I.

3

Physics/hemodynamics

Credit

2

Test validation & measurements

 

 

Laboratory values

 

 

 

Prerequisite:

CVT 103, CVT 110, CVT 111, ECH 131, ECH 133, ECH 231

Corequisite:

ECH 237

 

Course Guide

 

Competency

After completing this section, the student will be able to:

Hours

Class

D.Lab

P.Lab/

O.B.I.

Normal/abnormal cardiac anatomy

3

0

6

 

Review basic embryology.

 

 

 

 

Review ventricular wall segments as recommended by the ASE.

 

 

 

 

Recognize nomenclature

 

 

 

 

a. subdivisions of ventricles.

 

 

 

 

b. valves.

 

 

 

 

c. great vessels.

 

 

 

 

Differentiate coronary sinus versus descending aorta

 

 

 

 

Review coronary arteries

 

 

 

 

Review normal cardiac pressures and great vessels pressures.

 

 

 

 

Review the phases of the physical cardiac cycle and the relationship to the timing of events relative to the ECG.

 

 

 

 

Review pulmonary veins.

 

 

 

Techniques

1

0

2

 

Review use of Equipment Control.

 

 

 

 

Review and recognition of technical artifact.

 

 

 

 

Recognition of setup errors.

 

 

 

 

Review appropriate approach for doppler studies.

 

 

 

 

Review two-dimensional study and M-mode patterns.

 

 

 

 

Review CPR.

 

 

 

 

Review use of contrast agents.

 

 

 

 

Review provocative maneuvers.

 

 

 

 

Review indications/contraindications of trans-esophageal echocardiography.

 

 

 

Pathology

3

0

8

 

Review the sonographic appearance and various etiologies of valvular heart disease.

 

 

 

 

Review the sonographic appearance and various etiologies of pericardial disease.

 

 

 

 

Recognize types of prosthetic valves.

 

 

 

 

Review Systemic & Pulmonary Hypertensive Heart Disease.

 

 

 

 

Review the sonographic appearance and various etiologies of cardiomyopathies.

 

 

 

 

Review the sonographic findings of ventricular function.

 

 

 

 

Review the various benign and malignant cardiac tumors.

 

 

 

 

Review the sonographic appearance and clinical indications for endocarditis.

 

 

 

 

Review the sonographic appearance, identification of, and surgical repair of congenital heart disease in the adult.

 

 

 

 

Review the various diseases and etiologies of the aorta.

 

 

 

 

Review and correlate stress echo performance and indications.

 

 

 

 

Describe and identify abnormal/normal exercise testing.

 

 

 

Physics/hemodynamics

2

0

6

 

Review the concepts surrounding transmission of sound through tissues including:

a.  Propagation speed

i.         Stiffness

ii.       Density

b.  Compression and rarefaction

c.  Angle of incidence

d.  Impedance.

 

 

 

 

Review the principles that govern transmission of sound into patients and the changes affecting the sound beam’s return to the transducer including:

  1. Impedance mismatch
  2. Reflection/refraction.

 

 

 

 

Analyze the following dynamic factors in the role of hemodynamics including:

  1. Energy gradient
  2. Effects of viscosity, friction, inertia
  3. Pressure/flow relationships
  4. Velocity
  5. Steady flow vs. pulsatile flow
  6. Laminar versus turbulent flow
  7. Effects of stenosis on flow characteristics
  8. Venous resistance
  9. Hydrostatic pressure
  10. Pressure/volume relationship.
  11. Effects of respiration (phasicity)

 

 

 

 

Review the methods for evaluating instrument performance and the parameters to be evaluated.

 

 

 

 

Define the concepts of prudent use (ALARA)  in reducing acoustic exposure including:

a.       Recite the key points of the following Guidelines and Regulations regarding ultrasound safety

b.       American Institute of Ultrasound in Medicine (AIUM) statements (e.g., mammalian, epidemiology, in vitro)

c.       National Electrical Manufacturers Association (NEMA)

d.       Food and Drug Administration (FDA)

 

 

 

 

Discuss the Electrical and mechanical hazards of ultrasound examinations.

 

 

 

 

Patient susceptibility to electrical hazard equipment components which could present a hazard.

 

 

 

 

Discuss the primary mechanisms of biologic effect production.

 

 

 

 

Cavitation mechanisms to include: relevant acoustic parameters.

 

 

 

 

Thermal mechanisms to include: relevant acoustic parameters.

 

 

 

 

Distinguish the details of the various experimental biological effect studies including:

a.       Animal studies

b.       In vitro studies

c.       Epidemiologic studies.

 

 

 

 

Analyze the Doppler equation and the factors influencing the magnitude of the doppler shift frequency.

 

 

 

 

Discuss the Doppler Effect as it relates to the sampling of red blood cell movement.

 

 

 

 

List the range of the doppler shift frequency.

 

 

 

 

Describe the basic principles of  color flow imaging including:

a.       Sampling methods.

b.       Display of Doppler information.

c.       Reflector direction.

d.       Average velocity.

e.       Velocity variance.

f.         Advantages and limitations.

 

 

 

 

Discuss the Doppler effect based on the following:   

a.       beam angle

b.       transmitted frequency

c.       flow velocity

d.       flow direction

e.       Duration

f.         Character

g.       Magnitude

h.       Fast Fourier transform (FFT)

 

 

 

 

Define the basic principles and instrumentation associated with duplex ultrasound and spectral analysis.

 

 

 

 

Identify and diagram Doppler Instrumentation including

a.       Receiver

b.       Demodulater

c.       Wall filter for clutter rejection

d.       Directional devices

 

 

 

 

Discuss aliasing and the nyquist criteria including range ambiguity.

 

 

 

 

Compare and contrast continuous wave and pulsed wave dopplers listing the advantages and disadvantages of each.

 

 

 

 

Diagram and define Instrumentation issues including

a.       Autocorrelation

b.       Time domain processing

c.       Color field size and frame rate

i.         Ensemble length (packet size, pulse packet)

ii.       Line density

iii.      Maximum depth

d.       Color maps, assignment, or coding

i.         Hue

ii.       Saturation

iii.      Luminance (significance, brightness, intensity).

 

 

 

 

Define and analyze Doppler Artifacts

a.       Compare and contrast the properties, advantages and limitations of Color Power (Energy) Mode.

 

 

 

 

Review formulas for measurement including pressure half time method and Bernoulli equation.

 

 

 

 

Review Doppler effect: principle as related to sampling red blood cell movement.

 

 

 

 

Review and discuss the properties of sound including:

a.       The relationship of wavelength, frequency and propagation speed

b.       The relationship between amplitude, power, pressure and intensity

c.       The factors affecting

i.         Reflection

ii.       Refraction

iii.      Attenuation

 

 

 

 

Define and discuss the concept of the piezoelectric effect.

 

 

 

 

Define Curie point.

 

 

 

 

Compare various piezoelectric materials.

 

 

 

 

Discuss the construction and characteristics of ultrasound transducers to include:

a.       Thickness resonance of crystal

b.       Operating (resonance) frequency

i.         Crystal thickness

ii.       Speed of sound in crystal material

c.       Frequency characteristics (spectrum)

i.         Bandwidth

1.       Quality factor

2.       Effect of damping

ii.       Multi-Hertz:

       1.   Harmonics

d.        Damping

e.       Matching Layer

 

 

 

 

Discuss sound beam formation.

 

 

 

 

Compare and contrast transducer Arrays and Image appearance based on the following items:

a.       Mechanical and/or electronic construction

b.       Multiple element construction

i.         Linear array

ii.       Curved array

iii.      Annular array

iv.      Multi-dimensional array

c.       Multiple element operation

i.         Sequenced

ii.       Phased

iii.      Annular

iv.      Vector

v.        Multi-dimensional

 

 

 

 

Evaluate transducer care and maintenance.

 

 

 

Test validation & measurements

1

0

6

 

Review and understand the methods of acquiring measurements need for test validation.

 

 

 

 

Review Sensitivity, specificity, positive predictive value, negative predictive value.

 

 

 

 

Review display modes including: 2D, A-mode, B-mode, and M-mode.

 

 

 

 

Review Effects of Abnormal Pressures and Loading, Volume Concepts

 

 

 

 

Compare and contrast the Methods for Evaluating Instrument Performance including

a.       Test objects

i.         Phantoms (tissue, Doppler, flow)

ii.       Parameters to Be Evaluated

iii.      Test object

iv.      Dead zone

v.        Axial resolution and lateral resolution (beam width)

vi.      Depth calibration accuracy

vii.     TGC characteristics

viii.   Uniformity

ix.     System sensitivity

b.       Tissue equivalent (mimicking) phantom

i.         Dead zone

ii.       Depth calibration accuracy

iii.      Lateral (horizontal) distance measurement accuracy

iv.      Axial, lateral, and section thickness (elevational) resolution

v.        GC characteristics

vi.      System sensitivity

vii.     Dynamic range

viii.   Contrast resolution

ix.     Lesion detection

c.       Doppler flow, string, or belt phantoms

i.         Maximum depth

ii.       Pulsed Doppler sample volume alignment (gate position accuracy)

iii.      Velocity accuracy

iv.      Color flow penetration

v.        Image congruency test

 

 

 

 

Review Doppler measurements and calculations.

 

 

 

 

Calculate Statistical Indices including:

a.       Sensitivity/specificity

b.       Negative/positive predictive value

c.       Accuracy

 

 

 

 

Demonstrate the general concepts regarding the need for and nature of a quality assurance program.

 

 

 

Laboratory values

0

0

2

 

Phases of the Cardiac Cycle (Electromechanical Events)

 

 

 

 

Review Normal Heart Sound Generation and Timing

 

 

 

 

Review  other Diagnostic tests MR, Angiography,CT,Angiography

 

 

 

 

Suggested Resources

 

Krebs C., Odwin, Charles S., Fleischer, Arthur C., (2004). Appleton & Lange Review for the Ultrasonography Examination. (3rd ed.) McGraw Hill. ISBN-13: 978-0-071-36516-1

Kremkau, Frederick. (2005). Diagnostic Ultrasound: Principles, Instruments, and Exercises. (4th ed.)  Elsevier:  W.B.Saunders. ISBN-13: 978-0-7216-3192-9

Lane, K. (1993). National Certification Examination Review Adult Echocardiography.  Dallas: Society of Diagnostic Medical Sonographers

Linker David T. (2001) Practical Echocardiography of congenital Heart Disease: From Fetus to Adult. Philadelphia: Churchill Livingstone.

Miele, Frank R. (2006). Ultrasound Physics and Instrumentation. (Vol. I, II, IV) Pegasus. ISBN-13: 978-1-933250-08-3

Morehead, A. (2006). National Certification Examination Review Cardiovascular Principles and Instrumentation. Dallas: Society of Diagnostic Medical Sonographers

Mosby’s Pocket Dictionary of Medicine, Nursing & Health Professions. (5th ed.) Elsevier. ISBN-13: 978-0-323-03943-7

Taber’s Cyclopedic Dictionary. (20th ed) F. A. Davis. ISBN-13: 978-0-8036-1207-5

 

Posted: 10/11/07