The Miriam Hospital was recently accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories, one of the first 1,000 facilities across the nation to gain this credential.
Echocardiograms, or sonograms of the heart, can help clinicians detect and manage many types of cardiovascular disease by allowing them to visualize heart structure and movement. The Miriam performs about 4,800 echocardiograms each year.
Dr. Kenneth Korr, director of cardiology at the hospital, spoke about the technology and the significance of pursuing ICAEL accreditation.
PBN: How does echocardiography work?
KORR: Echocardiography is a technique where sound waves are sent out from a transducer. They interact with organ surfaces, and then the sound waves are reflected back, and we create an image. In echocardiography, we use sound waves to image the heart and the cardiac structures; it’s the same thing as neonatal ultrasound in obstetrics and gynecology … and we use ultrasound in other areas of vascular disease to look at narrowings in carotid arteries and leg arteries and kidney arteries.
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PBN: When is it used in cardiac cases?
KORR: It’s used all the time. It’s used to evaluate the heart function – is the heart squeezing appropriately, or is there an area of weakness? So patients who come in with congestive heart failure, we typically do an echo. … It’s used to assess and follow the severity of valvular heart disease; if somebody has a valve narrowing or a valve leak, it is the gold standard to diagnose that, and it’s a way to do serial studies, once a year or so, to follow the progression of the valve disease and help clinicians decide, in conjunction with the patient’s clinical symptoms, when an intervention like surgery would be appropriate. And then it’s also a way of evaluating an artificial valve after somebody’s had surgery, to make sure it functions well. So it has a myriad of uses in the world of cardiology.
PBN: What kind of expertise is involved in this?
KORR: It’s done by specially trained technologists, who train in echocardiography as a separate discipline to understand the physics of sound waves transmission and the techniques of getting a good image. They also need to understand cardiology to know what they are looking for. Technicians usually go to school for two years, and then do a year of internship or apprenticeship in the lab. In our echo lab, we have five or six technicians who are very well trained. And then there’s a physician interpretation piece, and for echocardiography, the physicians who interpret these studies are predominantly cardiologists.
I’m the director of cardiology, but I’m not an echo guy – I do other kinds of vascular ultrasound, but the cardiologists in our group who are specialized in echo have advanced training during their three-year fellowship where they read in a supervised manner a large number of echo studies, and then most docs sit for an examination that attests to their skill levels that is given by the American Society of Echocardiography.
PBN: How big a population do you serve? Are you one of the largest providers in the state?
KORR: I don’t think we’re the biggest; I think we and Rhode Island Hospital probably do an equivalent number of echocardiograms a year. We certainly do a very large volume, and certainly we’re one of the largest two or three labs in the state.
PBN: Why did you pursue this accreditation?
KORR: The ICAEL is a national group that sets quality standards for the performance of echo studies … how much information should be included in evaluating an aortic valve, … what views and angles the technologists should take, … how physicians should read and interpret these studies. In acquiring ICAEL certification, it’s a fairly long and arduous process, where we have to submit CDs and tapes of studies we have performed, and they get reviewed in terms of the completeness of the study, the skill and quality of the study and of how the physician interpreted. ICAEL also requires that we have an ongoing education process … and we have a quality assurance process, in which docs blindly read other docs’ studies. … So it’s a way to say we have a high-quality lab that meets national standards, … we have an ongoing education and quality assurance process … and we are committed to high standards.
