Examining The Echo Protocol
FEATURING A SAMPLE TRANSTHORACIC ECHO PROTOCOL

pro-to-col : a detailed plan of a scientific or medical experiment, treatment or procedure

As stated in Part II of The ICAEL Standards, "A protocol must be in place that defines the components of the standard examination" (Section 3.2.1). Critical to the review of each laboratory's application for accreditation is a comparison of the submitted representative cases with the "laboratory specific and appropriate protocol" (Section 3.1.1) as provided within the application.

While The ICAEL Standards list the 2D views, the measurements, and the Doppler evaluations that, at a minimum, must be included in every complete transthoracic examination, laboratory staff members often still seek guidance to ensure that their protocols meet the ICAEL requirements.

A protocol must be detailed.

The laboratory's protocol must specify each view to be obtained, and must state which measurements, color Doppler and/or spectral Doppler, must be obtained in each view. When developing a protocol specify the structure to be measured, the anatomic landmarks to be used and the part of the cardiac cycle in which it should be measured. Be sure to indicate which valves should be interrogated with color Doppler, and which flows should be examined with spectral Doppler.

The protocol should be written for comprehension by a trained sonographer. That is, it is not necessary to provide instruction on how to obtain each view or explain detailed knobology; there are textbooks and manuals for that. A qualified sonographer just starting in the laboratory should be able to utilize the protocol to perform an echocardiogram in a consistent manner with all other sonographers in the laboratory.

A protocol specifies a certain order.

All sonographers in a laboratory are required to acquire images in the same order, as dictated by the protocol. Therefore, the protocol must be written in the order in which images are to be obtained. Conventionally, transthoracic echoes begin with a parasternal long axis. However, a protocol may specify a different order as long as it is followed by all sonographers for all echocardiograms performed.

A protocol must be comprehensive.

Part II, Section 3 of The ICAEL Standards outlines the elements and components of examination performance as well as the components that must be included in each transthoracic echo.

Laboratory staff members are advised to review these standards carefully to ensure that their protocols contain each component - 2D view, measurement and Doppler - of the ICAEL minimum standards. Laboratories are encouraged to include a section within their protocols that addresses issues of study quality, such as definition of endocardium, avoidance of foreshortening and recording of Doppler signals in multiple views, and issues of study performance such as proper patient positioning and optimization of machine settings.

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