23rd Annual Feigenbaum Lecture: History of Echocardiography: A Personal Perspective.

Ultrasound was first used to examine the cardiovascular system about 70 years ago. The evolution of echocardiography as a family of diagnostic methods has been marked by ongoing development of novel technologies and clinical applications. The history is interesting and may be of particular interest to those practitioners who use echocardiography to enhance the care of their patients but who do not remember the "early days" of this field. In this article, based on the 23rd Feigenbaum Lecture, the authors discuss the history of echocardiography from the personal perspective of one of the clinicians, who has been a leader in this field for more than 60 years.

Ethical Challenges in the Practice of Echocardiography: What Is Right and How Do We Do It?

At the 2018 Scientific Sessions, the American Society of Echocardiography inaugurated the Richard E. Kerber Ethics/Humanitarian Lecture, continuing its tradition of providing ethics education and exploring the use of echocardiography to improve cardiovascular care in medically underserved settings. Echocardiography is one of the most widely applicable, safe, and cost-effective diagnostic tools available in cardiovascular medicine. The American Society of Echocardiography Foundation is well known for harnessing the power of echocardiography in its many successful humanitarian outreaches all over the world. Some practitioners might conclude that because of its important advantages, echocardiography involves few ethical complexities; however, several historical and recent scandals involving conflicts of interest and lapses in quality suggest otherwise. Every day, sonographers and echocardiographers grapple with ethical issues: integrity, truth telling, doing good and avoiding harm, altruism, and humanism. In the near future, population aging and technological advances, among other issues, will ensure that a steady stream of ethical issues will confront the practitioners of echocardiography. Medical science and engineering have given us many things that can be done, but central to the art of medical practice and research are decisions about what should be done. In this article, based in part on the first Richard E. Kerber Ethics/Humanitarian Lecture, the authors discuss ethical challenges in the practice of echocardiography, illustrated by accompanying online videos, and offer a general principle for meeting these challenges.

Reimbursement for new diagnostic imaging technologies: process, progress, and problems.

The use of a new diagnostic procedure involves many challenges, including securing reimbursement for its use. Although this may seem a mundane concern, technologies that are not reimbursed are often not used and, certainly, are not used widely.

The role of contrast enhancement in echocardiographic assessment of left ventricular function.

With or without contrast, echocardiographic evaluation of left ventricular (LV) function is qualitative, subjective, and experience dependent, because it is mostly based on visual interpretation of gray-scale 2-dimensional images or, at best, relies on tedious and time-consuming manual tracing of the endocardial boundaries. Adequate endocardial visualization is essential for accurate interpretation of regional wall thickening abnormalities, which constitute the diagnostic hallmark of coronary artery disease, and for reproducible assessment of LV ejection fraction. Studies performed in the last decade have estimated the number of patients with suboptimal endocardial delineation by fundamental imaging at 30%. These studies have highlighted the problem of variable image quality as a major limitation of transthoracic echocardiography because failure to adequately visualize a segment, either at rest or during stress, may compromise the ability of this technique to identify areas of dysfunctional myocardium. Several remedies based on different technologic and methodologic approaches have been tested over the years with variable success. In this review we discuss the most recent techniques that have had a positive impact on endocardial visualization, as well as the potential benefits of these approaches.

Implementing contrast echocardiography in the laboratory.

Contrast echocardiography is an important and a significant addition to a modern echocardiography laboratory. Its successful implementation is dependent on a team approach between sonographers, nurses, and physicians. A practical plan is one that includes a proper understanding of indications, logistical matters, technical and performance standards, and reimbursement issues.

American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography.

UNLABELLED: ACCREDITATION STATEMENT: The American Society of Echocardiography (ASE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit.trade mark Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing International recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The ASE is committed to resolving all conflict-of-interest issues, and its mandate is to retain only those speakers with financial interests that can be reconciled with the goals and educational integrity of the educational program. Disclosure of faculty and commercial support sponsor relationships, if any, have been indicated. TARGET AUDIENCE: This activity is designed for all cardiovascular physicians, cardiac sonographers, and nurses with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, sonographers, and other medical professionals having a specific interest in contrast echocardiography may be included. OBJECTIVES: Upon completing this activity, participants will be able to: 1. Demonstrate an increased knowledge of the applications for contrast echocardiography and their impact on cardiac diagnosis. 2. Differentiate the available ultrasound contrast agents and ultrasound equipment imaging features to optimize their use. 3. Recognize the indications, benefits, and safety of ultrasound contrast agents, acknowledging the recent labeling changes by the US Food and Drug Administration (FDA) regarding contrast agent use and safety information. 4. Identify specific patient populations that represent potential candidates for the use of contrast agents, to enable cost-effective clinical diagnosis. 5. Incorporate effective teamwork strategies for the implementation of contrast agents in the echocardiography laboratory and establish guidelines for contrast use. 6. Use contrast enhancement for endocardial border delineation and left ventricular opacification in rest and stress echocardiography and unique patient care environments in which echocardiographic image acquisition is frequently challenging, including intensive care units (ICUs) and emergency departments. 7. Effectively use contrast echocardiography for the diagnosis of intracardiac and extracardiac abnormalities, including the identification of complications of acute myocardial infarction. 8. Assess the common pitfalls in contrast imaging and use stepwise, guideline-based contrast equipment setup and contrast agent administration techniques to optimize image acquisition.

Evolving trends in the use of echocardiography: a study of Medicare beneficiaries.

OBJECTIVES: We studied the use of echocardiography among Medicare beneficiaries between 1999 and 2004 to determine the rate of growth in these services and evaluate the drivers of growth. BACKGROUND: Concerned about increasing health care costs, federal and private payers have highlighted growth in diagnostic imaging studies and begun to develop approaches to curb this growth. METHODS: Medicare Part B Physician/Supplier Procedure Summary Master File and enrollment data from 1999 to 2004 were reviewed. Total Medicare carrier-paid spending for echocardiography services was determined from procedure volumes and allowed charges. The 5% standard analytic file of physician claims was used to evaluate geographic variations in use and to document the specialties of physicians who request and those who interpret echocardiograms. RESULTS: Between 1999 and 2004, echocardiography services grew at a rate similar to that for all medical services subject to Medicare's sustainable growth rate (SGR) calculation. Increasing provision of echocardiograms in physicians' offices contributed to increased spending under the SGR. Accounting for this shift, actual annualized per capita growth in echocardiography was 7.7%. Variations in the prevalence of heart disease contributed to geographic variations in use. Although cardiologists were the most common providers of echocardiographic services, primary care physicians ordered the majority of these diagnostic procedures. CONCLUSIONS: Growth in the use of echocardiography is in keeping with the general growth in medical services. Nonetheless, physicians who order echocardiograms and those who provide them must work together to ensure that in the future these diagnostic services are used appropriately and not excessively.