Echocardiography

A survey of United Kingdom intensive care echocardiography provision (2024)

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Type of publication:
Journal article

Author(s):
Akhtar W.; Marshal L.; Buglass H.; Billyard T.; Goedvolk C.; Mildner R.; Conway H.; Soliman Aboumarie H.; *Miller A.; Peck M.; Rubino A.

Citation:
Journal of the Intensive Care Society. (no pagination), 2024. Date of Publication: 2024. [epub ahead of print]

Abstract:
This study, conducted under the oversight of National Health Service Blood & Transplant, aimed to evaluate the current feasibility and implementation of both comprehensive and focused donor echocardiography in United Kingdom Intensive Care Units through a nationwide survey. Responses from 95 hospitals across all 4 UK nations showed each ICU had median 4 (IQR 2, 6) personal with 3 (IQR 2, 5) consultants and 1 (IQR 0, 2) registrar trained in focused echocardiography. A comprehensive echocardiogram can be acquired in 48% (n = 46) of hospitals within 6 h during regular working hours. This percentage drops to 11% (n = 10) outside of regular working hours, with 53% (n = 50) indicating this would require more than 24 h. In the case of focused echocardiogram acquisition, 60% (n = 57) of hospitals can obtain it within 6 h during normal working hours. This figure decreases to 20% (n = 19) outside of regular working hours, with 32% (n = 30) indicating that this would require more than 24 h to obtain. Overall, 98% of responding units (n = 93) have point-of-care ultrasound machines (median 2 (IQR 2, 3) machines per ICU) all equipped with echocardiographic capabilities. However, only 52% (n = 49) of respondents indicated have the ability for remote viewing of echocardiogram images.

British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab (2021)

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Type of publication:
Journal article

Author(s):
Dobson R.; Ghosh A.K.; Stanway S.; Manisty C.; Ky B.; Marwick T.; Stout M.; Pearce K.; Harkness A.; Steeds R.; Robinson S.; Oxborough D.; Adlam D.; Rana B.; *Ingram T.; Ring L.; Rosen S.; Plummer C.; Harbinson M.; Sharma V.; Lyon A.R.; Augustine D.X.

Citation:
Echo Research and Practice; Mar 2021; vol. 8 (no. 1)

Abstract:
The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor (EGF) receptor (HER) 2-positive targeted treatment (e.g. trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.

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Effective echo screening and inter modality agreement in the assessment of ascending thoracic aorta dimension (2020)

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Type of publication:
Conference abstract

Author(s):
*Botley S.; *Challinor E.; *Ingram T.; *Lee E.; *Pakala V.

Citation:
Heart; Jul 2020; vol. 106

Abstract:
Introduction: Accurate measurement and interval monitoring of the ascending aorta for at risk individuals are crucial for prevention of life-threatening complications. Echocardiography (echo) is the first line screening test. Positive results are referred for computed tomography (CT) or magnetic resonance imaging (MRI), both are considered gold standard methods for imaging the whole aorta. These tests involve radiation (CT) and contrast (CT & MRI) exposure. An effective screening echo streamlines subsequent referrals to CT and MRI. Several published references (1,2,3) are in clinical use. Measurements are normalised to body surface area (1,3), height (2), gender (2,3) and age (3). The aims of this study were: Assess the inter-modality agreement of ascending aorta measurements between echo and CT. Compare the rate of 'dilated aorta' using the existing references (1,2,3). Methods Between Sep 2018 and Sep 2019, 107 patients underwent gated CT thoracic aorta at our institute as per clinically indicated. We retrospectively examined these records. We used Bland Altman plot to assess inter-modality agreement (echo & CT) of ascending aorta measurements. We reported inter and intra-observer variability for echo measurements as coefficient of variation. Echo aorta measurements were coded into 'dilated' or 'normal' after normalising for age, sex, height and weight as per the existing references (1,2,3). The rates of 'dilated aorta' using the three reference methods (1,2,3) were compared using Chi-squared test with Bonferroni adjustment. Statistical analysis was performed using SPSS 25 (IBM). Results Data were excluded from analysis due to incomplete biometrics (9), poor echo images (27). 71 subjects were included for analysis (age 68 +/- 14 years, BSA 1.9 +/- 0.2 m2, 52.1% male). 16 had bicuspid aortic valves. Intra- and interobserver variability for echo measurements were 1.2% and 1.4% respectively. Figure 1 shows the inter-modality agreement of ascending aorta measurements. Echo underestimated ascending aorta dimensions by a mean of 1.4 +/- 2.7 mm (95% CI 0.7-2.0 mm). There was a significant difference in the rates of 'dilated aorta' using the existing reference ranges (1,2,3): 59% (1), 27% (3) and 59% (2) of subjects had 'dilated aorta', c2 = 15.3, p=0.00. Conclusion Echo is an effective screening test for detecting ascending aorta dilatation. In our department, it has excellent intra- and inter- observer variability and good measurement agreement with CT. Normalising aortic dimension (3) resulted in the fewest 'positive test' requiring further imaging; potentially improving clinical efficacy of the service and avoiding contrast and radiation exposure for the patients.

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A patient-centred model to quality assure outputs from an echocardiography department: consensus guidance from the British Society of Echocardiography (2018)

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Type of publication:
Journal article

Author(s):
*Ingram TE, Baker S, Allen J, Ritzmann S, Bual N, Duffy L, Ellis C, Bunting K, Black N, Peck M, Hothi S, Sharma V, Pearce K, Steeds RP, Masani N.

Citation:
Echo Research and Practice. 2018 Dec 1;5(4):G25-G33

Abstract:
Background Quality assurance (QA) of echocardiographic studies is vital to ensure that clinicians can act on findings of high quality to deliver excellent patient care. To date, there is a paucity of published guidance on how to perform this QA. The British Society of Echocardiography (BSE) has previously produced an Echocardiography Quality Framework (EQF) to assist departments with their QA processes. This article expands on the EQF with a structured yet versatile approach on how to analyse echocardiographic departments to ensure high-quality standards are met. In addition, a process is detailed for departments that are seeking to demonstrate to external bodies adherence to a robust QA process. Methods The EQF consists of four domains. These include assessment of Echo Quality (including study acquisition and report generation); Reproducibility & Consistency (including analysis of individual variability when compared to the group and focused clinical audit), Education & Training (for all providers and service users) and Customer & Staff Satisfaction (of both service users and patients/their carers). Examples of what could be done in each of these areas are presented. Furthermore, evidence of participation in each domain is categorised against a red, amber or green rating: with an amber or green rating signifying that a quantifiable level of engagement in that aspect of QA has been achieved. Conclusion The proposed EQF is a powerful tool that focuses the limited time available for departmental QA on areas of practice where a change in patient experience or outcome is most likely to occur.

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A patient-centred model to quality assure outputs from an echocardiography department: consensus guidance from the British Society of Echocardiography (2018)

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Type of publication:
Journal article

Author(s):
*Ingram, Thomas E; Baker, Steph; Allen, Jane; Ritzmann, Sarah; Bual, Nina; Duffy, Laura; Ellis, Chris; Bunting, Karina; Black, Noel; Peck, Marcus; Hothi, Sandeep S; Sharma, Vishal; Pearce, Keith; Steeds, Richard P; Masani, Navroz

Citation:
Echo research and practice; Dec 2018; vol. 5 (no. 4); p. G25

Abstract:
Background Quality assurance (QA) of echocardiographic studies is vital to ensure that clinicians can act on findings of high quality to deliver excellent patient care. To date, there is a paucity of published guidance on how to perform this QA. The British Society of Echocardiography (BSE) has previously produced an Echocardiography Quality Framework (EQF) to assist departments with their QA processes. This article expands on the EQF with a structured yet versatile approach on how to analyse echocardiographic departments to ensure high-quality standards are met. In addition, a process is detailed for departments that are seeking to demonstrate to external bodies adherence to a robust QA process. Methods The EQF consists of four domains. These include assessment of Echo Quality (including study acquisition and report generation); Reproducibility & Consistency (including analysis of individual variability when compared to the group and focused clinical audit), Education & Training (for all providers and service users) and Customer & Staff Satisfaction (of both service users and patients/their carers). Examples of what could be done in each of these areas are presented. Furthermore, evidence of participation in each domain is categorised against a red, amber or green rating: with an amber or green rating signifying that a quantifiable level of engagement in that aspect of QA has been achieved. Conclusion The proposed EQF is a powerful tool that focuses the limited time available for departmental QA on areas of practice where a change in patient experience or outcome is most likely to occur.

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