Publication

Echocardiography Training Programme – Module A-CS-S1 Introduction to Clinical Echocardiography

Filed under
Echocardiography Training Programme
Published
2021
Publication type
Curriculum
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Module details

  • Module code – A-CS-S1
  • Module title – Introduction to Clinical Echocardiography
  • Programme – PG Certificate – Echocardiography (PGCert)
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Learning outcomes

  1. Perform and report high quality transthoracic echocardiography.
  2. Employ strategies to manage risk in the practice of echocardiography.
  3. Apply the principles of patient-centred care to provide a high-quality echocardiography service.
  4. Practice echocardiography in accordance with local and national guidelines.
  5. Appraise the role of echocardiography and complementary technologies in the patient pathway.
  6. Demonstrate effective communication in the practice of echocardiography.
  7. Identify and appraise new developments in echocardiography practice.
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Work-based competencies

The work-based competencies listed below include considerations for completing the competency.

Competency number Learning outcomes Title Considerations for completing the competency (concepts to think about)
1 1, 2, 3, 4, 6 Discuss the values and principles as laid out in the NHS Constitution, describe how will you demonstrate these in your daily practice
  • Consider the key principles and core values that guide the NHS
2 2, 4, 6 Control risks in accordance with departmental protocols for echocardiography procedures
  • Local SOPs
  • National guidelines
  • Current issues and adaptations
  • Risk assessments
  • Ergonomics, Moving and Handling, ALARA, Infection prevention, information governance
  • Patient and echocardiographer safety
3 2, 4, 6 Demonstrate competency in appropriate level of resuscitation as per local policy
  • Consider which level of resuscitation is required for your role in accordance with local policy
  • Complete appropriate training course
  • Understand and fulfil requirements to ensure maintenance of competency
4 3, 4, 5, 6, 7 Review the literature and evidence base for best practice regarding assessment of a pathology; compare best practice to local practice and make recommendations for service improvement
  • Literature and evidence base resources
  • Audit skills
  • Communication of complex information
  • National guidelines
  • The role of professional bodies in setting standards
5 4, 5 Identify common indications for transthoracic (Level 1 and 2) bubble contrast, LV opacification, stress and transoesophageal echocardiography
  • Consider local protocol and procedure for triaging of request forms
  • Awareness of national guidelines which feature echo as a primary tool for the diagnosis and management of pathologies
6 5, 6, 7 Discuss a case where complementary technologies may be useful to further assess cardiovascular disease where echocardiography cannot differentiate fully between pathologies and/or artefact
  • Limitations and advantages of echocardiography and complementary technologies
  • Differential diagnosis
  • Local protocols
  • Awareness of national guidelines for diagnosis and management of specific conditions, e.g. chest pain
  • Consider indications, contraindications, and
  • limitations and barriers for each technology, including ease of access
7 6 Explain an echocardiography procedure to another healthcare professional, address any questions they may have related to the procedure
  • Benefits and limitation of the procedure
  • Communicating complex concepts
  • Underpinning physics of the technology
  • Application in clinical practice
  • Physiology and pathology
8 2, 4, 6 Gain informed consent for an echocardiography procedure, under direct supervision
  • Consider the concept and different types of informed consent
  • Communication with the patient and/or representatives
  • Taking consent in the vulnerable patient
  • Risk vs benefit
9 2, 3, 4, 5, 6 Present a clinical history together with the images obtained for a procedure to another healthcare professional; discuss progression of disease/symptoms and agree outcomes and next steps
  • Methods for obtaining and presenting clinical histories
  • Patient history; relevant symptoms, history, comorbidities and current treatment
  • Communication skills
  • Knowledge of limitations; when to ask for advice and escalate/flag concerns
  • Application of echocardiography in the patient pathway
  • Electronic patient records; image retrieval, archive systems
10 2, 3, 4, 6 Take appropriate action to respond to the specific needs of the patient to ensure equitable access to echocardiography procedures
  • Patient capacity to understand
  • Communicating appropriately to aid understanding Inpatient versus outpatient requests
  • Adapting behaviours and practice for the needs of the individual
  • Local SOPS
  • Protected characteristics
  • Consider steps to reduce bias
  • NHS Constitution
11 3, 4, 6 Explain the procedure for obtaining results to the patient, alleviating any concerns the patient may have
  • Consider local policy and procedures and legislation for discussing test results with patients
  • Reflect on how the way you communicate information may impact psychologically on the patient
  • Consider when you may need to involve or seek advice from a senior or medical colleague
12 1, 4 Produce high-quality cardiac ultrasound images, demonstrating use of a full range of machine controls and ultrasound probes including standalone probe
  • Effect of all machine controls on the 2D image: depth, sector width, focus, TGC’s, harmonics, gain and compression/dynamic range
  • Optimisation of 2D image in a challenging patient
  • Consider the impact of the ECG on image acquisition
13 2, 4 Set up appropriate equipment in preparation for an advanced echocardiography procedure, including resuscitation equipment where appropriate, and ensure daily checks have been carried out
  • Local SOPS
  • National guidelines
  • Emergency procedures/medication
  • Availability of appropriate medical personnel
  • Mandatory training compliance
14 1, 3, 4, 6 Identify correct anatomical structures demonstrated on 2D image planes including cardiac and extracardiac anatomy
  • Recognise cardiac chambers to include segmental wall analysis, vessels, valve anatomy including cusp and scallop recognition, in standard imaging planes
  • Normal appearance of extra cardiac structures Knowledge of limitations; when to ask for advice
15 1, 4 Acquire standard views in accordance with local and national protocol for Level 2 transthoracic Echocardiogram
  • Awareness of national protocol and minimum dataset for performing a standard trans-thoracic echo
  • Parasternal: long axis, inflow, outflow, short axis
  • Apical: four chamber, five chamber, two chamber and long axis
  • Subcostal: four chamber, IVC
  • Suprasternal: Arch
16 1, 4 Obtain standard measurements using 2D or M-mode in accordance with the local and national protocol
  • Standard measurements of chamber and vessel dimensions
  • Recognise when measurements may not be able to be performed and limitations which may lead to inaccurate measurements
17 1, 4 Recognise imaging artefact and normal variants, including Eustachian valve, Chiari network, LV tendon
  • Distinguish between cardiac structures and artefact
  • Understand how and when artefact may occur and how to eliminate where possible
  • Explain non cardiac structures e.g. pacing wire
18 1, 4 Utilise colour flow mapping in at least two planes for all valves, optimising gain and box size
  • Colour Doppler images required in accordance with national protocols
  • Uses machine controls to optimise colour gain, baseline and scale
19 1, 4 Acquire & optimise pulsed and continuous wave Doppler traces and make measurements in accordance with the local and national protocol including use of a standalone CW probe
  • Recognise when to use pulsed and continuous wave Doppler and the limitations of each modality
  • Use of machine controls to optimise Doppler traces: sweep speed, baseline, gain, and scale
20 1, 4, 6 Produce a clear and accurate written report of a transthoracic echocardiography procedure in accordance with local and national protocols
  • BSE normal reference ranges including indexing to height and body surface area
  • Interpreting and communicating complex information
  • Scope of practice
  • Escalation policy; ensuring patient safety in urgent cases
  • Document challenges i.e. suboptimal image quality, fast heart rate, limited acoustic windows
21 6, 7 Critically assess a new technology being introduced into practice; consider benefits and barriers to introduction
  • Horizon scanning
  • Evidence base for the technology
  • Safety, feasibility, efficacy
  • Cost, benefit, and risks
  • Managing change
  • Research and Development considerations
22 1, 4, 6 Interpret results for a myocardial deformation/speckle tracking analysis study in line with local and national protocols
  • National guidelines
  • Manufacturer specific reference ranges
  • Uptake of new technologies
  • Impact of these findings in relation to patient management

 

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Work-based assessment

  • Complete 4 Case-Based Discussions (CBDs)
  • Complete 4 of the following Direct Observation of Practical Skills (DOPS) and/or Observed Clinical Event (OCE)
Type Title
DOPS Carry out a procedure for an infectious patient
DOPS Demonstrate appropriate care of the equipment pre, during and post procedure
DOPS Identify cardiac structures in all image planes
DOPS Generate high quality ultrasound images of all standard image planes
DOPS Perform standard 2D/M mode measurements of the left ventricle
DOPS Acquire and optimise colour Doppler of the mitral, aortic, pulmonary and tricuspid valves
DOPS Acquire, optimise and perform standard measurements of pulsed and continuous wave Doppler of the left ventricular outflow tract, aortic valve and mitral valve
DOPS Review the indication for the test and any appropriate records prior to a procedure
OCE Introduce yourself to a patient, confirm patient identity and explain the procedure
OCE Present finding of critical appraisal of ultrasound related topic at departmental meeting
OCE Obtain informed consent prior to a procedure
OCE Obtain a suitable clinical history during an appointment
OCE Explain and discuss the procedure for obtaining results with a patient
OCE Demonstrate to another healthcare professional how to manage infection risks for an echocardiography procedure including managing operator and equipment risks
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Recommended clinical experience

To develop a broader understanding of their specialty practice and support the completion of assessments and competencies, it is recommended a trainee should:

  1. Observe the use of stress echocardiography in the diagnosis & assessment of coronary artery disease.
  2. Observe the use of stress echocardiography in the assessment of structural heart disease.
  3. Observe the use of trans-oesophageal echocardiography in the diagnosis & assessment of structural heart disease to appreciate what additional information may be acquired when compared to TTE.
  4. Observe the use of transoesophageal echocardiography for the investigation of Infective Endocarditis to appreciate its role in the diagnostic process including advantages compared to transthoracic echo.
  5. Observe the use of transoesophageal echocardiography in cardiac interventional procedures such as PFO/ASD/VSD closures, LAAO, TAVI, MV clip, MV balloon valvotomy and paravalvular leak closures.
  6. Observe left ventricular opacification studies to appreciate the application of pharmacological contrast agents in echocardiography and compare with bubble studies.
  7. Observe the use of 3D echocardiography and reflect on its applications, advantages and disadvantages in the assessment of common pathologies for both transthoracic and trans- oesophageal echocardiography.
  8. Observe complimentary cardiac imaging such as CMR, cardiac CT, angiography and MPI.
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Learning outcomes: knowledge and understanding (PGCert)

On successful completion of this module the trainee will be able to:

  1. Evaluate and critique the role of echocardiography with respect to clinical presentation, diagnosis and management.
  2. Explain and apply the fundamental physical imaging principles relating to clinical echocardiography.
  3. Explain and apply anatomical and physiological correlates to the traditional imaging planes used in transthoracic echocardiography.
  4. Plan, execute and evaluate detailed echocardiographic data within the context of normal findings using nationally recognised clinical guidelines and reporting techniques.
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Indicative content

  • Indications for and effectiveness of echocardiography with respect to patient presentation, diagnostic and treatment pathways.
  • Ultrasound physics and equipment function / manipulation.
  • Normal cardiovascular anatomy and physiology.
  • Echocardiographic imaging planes with respect to cross sectional anatomy.
  • Normal parameters and advantages versus disadvantages relating to the measurement of normal parameters.
  • Introduction to the current national standards for performing and analysing data obtained during transthoracic echocardiography.
  • Alternative clinical imaging techniques used in cardiology practice.

Last updated on 30th December 2022

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