Examining The Echo Protocol [continued]

A protocol must be laboratory-specific.

While all of the ICAEL standard components must be included within a protocol, it is crucial to recognize that any additional views, measurements and/or Doppler that are regularly performed within the laboratory are also included. For example, many laboratories assess diastolic function with tissue Doppler, trace the LA and RA for volume, or use the PISA calculation to evaluate MR. Specific instructions must be included for such data that is routinely obtained. A protocol copied directly from a textbook or from The ICAEL Standards is not acceptable because it is not laboratory-specific. When evaluating the representative case studies submitted by applicant laboratories, reviewers compare the case studies with the protocols and any discrepancies are apparent.

Be sure to submit representative cases that contain all of the laboratory's protocol elements; as each application is reviewed for "adherence to the laboratory specific and appropriate protocol" (Part II, Section 3.1.2).

A protocol must contain instructions for AS cases.

The ICAEL Standards address specific requirements for the evaluation of aortic stenosis (Part II, Section 3.2.2.C.2). Therefore, the laboratory's protocol must include instructions for obtaining the highest AS velocity from multiple transducer positions, using the dedicated CW (non-imaging) probe in the suprasternal and right parasternal areas. This specific information should be reflected within the protocol.

The sample protocol

[ DOWNLOAD SAMPLE PROTOCOL ]

The particular format of the sample protocol illustrated above is being provided as an example but is not specifically required by the ICAEL. Positive attributes of this protocol include the fact that it is detailed, yet also concise. The use of bolded subtitles, bullets and numbering make it easy to read and follow. The protocol provides some technical instruction, without rewriting a textbook. Most importantly, this protocol complies with The ICAEL Standards, yet is also lab-specific.

By providing a means for the systematic evaluation of each patient, a well-written protocol facilitates a complete, consistent diagnostic echocardiographic evaluation, ultimately resulting in quality patient care.

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