Changes: The Latest Revisions To The ICAEL Pediatric Standards
[continued]
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the April 2007 issue |
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B)
Core level of expertise: basic set of technical and interpretive
skills required for graduation from a pediatric cardiology
training program accredited by ACGME and includes 4 to 6 months
of echocardiography, performance and interpretation of at
least 150 pediatric echocardiograms, including at least 50
in patients one year of age or younger, under the supervision
of the laboratory director or other qualified staff pediatric
cardiologist-echocardiographer(s). Each trainee should also
review at least 150 additional pediatric echocardiograms.
Physicians with this level of expertise are expected to be
able to perform and interpret TTEs in normal infants, children,
and adolescents, and in those with childhood heart disease
with consultation as needed.
C)
Three years of echocardiography practice experience with at
least 450 echocardiogram/Doppler examination interpretations
in children and patients with congenital heart disease.
Comment:
It is recognized that the number of pediatric echocardiography
studies performed in some laboratories, particularly those
that perform a majority of studies on adults, will not achieve
the above numbers. However, the individual pediatric medical
staff member must have this experience, even if it is not
achieved at a single institution.
The
Ancillary Personnel section was changed to Support Services
with newly added guidelines for supervision and sufficiency
to allow for quality care.
Within
Section 4, related to Patient Confidentiality, a statement to
assure compliance with HIPAA regulations is now included: "All
laboratory personnel must ascribe to professional principles
of patient-physician confidentiality as legally required by
federal, state, local or institutional policy or regulation."
The
Quality Assurance section now states: "There must be
a written policy regarding quality assurance for all procedures
performed in the laboratory." Slight changes for peer review
and the frequency of echocardiography conferences were added.
Previously
included as policy in the application, guidelines related to
multiple sites and mobile services are now included within the
Standards.
PART II, III, and IV
Summary Of Revisions To The Testing Standards
CHANGES
MADE TO ALL TESTING STANDARDS
Reporting
standards were removed from the Part I Organization Standard
and now exist for each Testing Standard, with specific differences
based on the procedure.
While
the same recommended minimum procedure volumes exist (TTE:
200 per laboratory per year, 300 per staff per year; TEE: 50
per laboratory per year, 50 per staff per year; Fetal: 50 per
laboratory per year, 25 per staff per year), the section
now includes language explaining that while numerous studies
have confirmed that accuracy, performance, and interpretation
of studies are all enhanced when high volumes are obtained,
the optimal numbers of studies that should be performed and
interpreted annually to maintain competence are unknown. Therefore,
laboratories with lower volumes than those recommended that
are otherwise compliant with the ICAEL Standards should
not be dissuaded from applying for accreditation.
PART II: PEDIATRIC TRANSTHORACIC
The
Examination Interpretation section was moved from the Part I
Organization Standard to Section 4 of Part II Pediatric Echocardiography
Laboratory Operations, and more detail is now provided.
Under
components of the Transthoracic Echocardiogram, standard Doppler
flow evaluations, the following two guidelines were added, as
items 2 and 7 in Section 3.2.2 C:
2)
For pressure gradient estimation, multiple windows of interrogation
must be attempted.
7)
Doppler interrogation of the aortic arch
The
following comment was also added to this section:
Comment:
These may be different in congenitally malformed and/or surgically
repaired complex malformations and cases with abnormalities
of cardiac position.
PART III: PEDIATRIC TRANSESOPHAGEAL
A
requirement to obtain pertinent clinical history was added to
the Verification of the Indication section.
Additional
guidelines, entitled "Indications and Guidelines for Performance
of Transesophageal Echocardiography in the Patient with Pediatric
Acquired or Congenital Heart Disease: A Report from the Task
Force of the Pediatric Council of the American Society of Echocardiography,"
were added to the training section for physicians.
Section
3.2, Elements of Examination Performance, was revised to read
as follows:
STANDARD
- Elements of Examination Performance
3.2
Examination performance must include proper technique.
3.2.1
Elements of study performance and quality include but are
not limited to:
A)
Transducer selection and insertion
B)
Optimization of equipment gain and display settings
C)
Performance of a 2-D/Doppler transesophageal examination
according to the laboratory-specific and appropriate protocol
that incorporates all views and imaging planes mandated
by the ICAEL Standards (3.3.6)
D)
Utilization of appropriate Doppler technique and measurements,
including optimization of image orientation and Doppler
alignment for optimal recording and evaluation of Doppler
flows.
E)
Appropriate 2-D/Doppler evaluation of all areas of abnormality,
including unrepaired and repaired/palliated congenital
heart defects (when applicable).
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