2D Echocardiography sTRAIN IMAGING
To STRAIN or not to STRAIN!?! That is the question.....
2D Strain imaging has been around for quite some time now, but it seems as though many echo labs still don't use it in day to day echo protocols. This leaves us wondering why?!
Strain is useful for so many reasons and has been proven to be more accurate than traditional method of disks ejection fraction measurements when evaluating patients at risk for heart failure. Strain can be highly effective for the detection of cardiotoxicity, with strain abnormalities often showing on echo before there are any measurable declines in ejection fraction or any onset of clinical symptoms. Strain can be a valuable resource to evaluate decreased cardiac function and cardiotoxicity in patients with compromised left ventricular function, such as chemo patients.
Many sonographers simply don't understand the benefits of strain and how to best utilize it within the day to day echo routine. The negative values with strain can be a little confusing, but in reality strain is simple and once you have a good understanding of how it works, you will see that it is easy to incorporate this into your lab protocols and is extremely beneficial to your patients.
Left ventricular ejection fraction is the most commonly used parameter of systolic function. It is essential for the management of heart failure patients. The assessment of ejection fraction by Simpson’s biplane, measures changes in volume. It is often limited in sensitivity and reproducibility. Due to geometric modeling and inadequate visualization of the left ventricular apex, as well as measurement variability, this often limits the ability to detect small changes in left ventricular contractility and can often lead to decreased sensitivity and inaccurate EF measurements. Utilization of strain imaging can reduce many of these errors and provide a more reliable assessment.
So what is strain? There are three fundamental types of strain or deformation: Longitudinal, Radial and Circumferential. During systole, the left ventricle shortens along the longitudinal and circumferential axis, and it thickens in the radial dimension. Of the three, longitudinal strain has been proven to be the most reproducible. It has also been documented to correlate well with clinical outcomes.
Global Longitudinal Strain assesses the twist of the left ventricle as it shortens along the longitudinal axis. Imagine a rubber band... when the 2 end points move away from each other as in diastole, strain is increased or positive. When the two points move closer together as in systole, strain is decreased or negative. Because of it's negative normal values, many sonographers aren't quite sure of how to assess strain and it can be confusing when you think in positive terms regarding ejection fraction.
So what is normal and what do we do with it?
Normal global longitudinal strain has a value of -20%. Some literature suggests that values higher than -17% predict severe heart failure or cardiotoxicity. Imaging with strain is pretty simple, if you can get your apical views, you can do strain imaging! Here are a few tips and tricks:
In summary, strain imaging is a simple tool that can be put to everyday use within your echo lab. Protocols for establishing baseline global longitudinal strain are extremely valuable when evaluating chemo patients for left ventricular function. Strain imaging can be easily incorporated into your daily routine.
What's new with echocardiography accreditation?
The updated IAC Adult Echo Standards were published and went into effect on December 1st. So what do you need to know? The biggest operational change to the standards that will affect your scanning protocols and reporting methods is the requirement of evaluation of left ventricular diastolic function which now must be evaluated through a combination of PW and tissue Doppler techniques. In previous IAC Echo standards, this was an option. It is now a requirement for inclusion in echo scanning protocols. Diastolic function must now also be reported within the final echo report text.
While for some, this may be a significant change to protocols and reporting, for others, this has been incorporated in their daily operations for quite some time. Left Ventricular Diastology can be a hot topic with newly updated diagnostic criteria published in 2016. We have you covered for a quick assessment of diastology according to the updated criteria, use our FREE LV Diastology Analysis Tool.
Echocardiography Accreditation can certainly be difficult to navigate when there are so many other aspects to running an echo lab that need your attention every day. If you are overwhelmed and need an easy method to simplify your accreditation process and improve quality within your lab, our DIY Accreditation Toolkit can help!
As sonographers, we've all been there... the referring physician enters vague orders because they are just trying to get an echo for their patient and you are left searching for an appropriate indication to perform the echocardiogram. This is unfortunately common place in echo labs across the country. Ultimately ensuring exam appropriateness lies on the shoulders of the sonographer, as we are the last stop before the exam is performed. This leaves the sonographer digging through H&P's trying to come up with something that might meet the criteria and calling the referring physician for clarification on orders.
With Appropriate Use Criteria becoming a factor for pre-authorization and insurance payment, it is evident that education and ease of access to Appropriate Use Criteria is needed for referring physicians and sonographers. The published standards for appropriateness are detailed and thorough and cover just about every aspect of clinical care and exam indications you may encounter in your day to day routine schedule. However, it can be difficult to navigate the details of the standards and guidelines to quickly determine appropriateness with 7 STATS and 3 TEE's waiting when you walk in the door.
So that's where we come in. Our FREE (yes you read that correctly... FREE) Appropriate Use Criteria analysis tool helps referring physicians and cardiac sonographers quickly get the information they need to determine appropriateness. Just plug in your indications and we do the rest. The corresponding appropriateness level is displayed quickly and easily, saving you time and streamlining patient care.
Whether you need to search this quickly before ordering an echo or you are doing an Appropriate Use Criteria review for accreditation, this can save you time and simplify this once very tedious task. Our simple analysis search tool is free to use. You can find it HERE.
If your facility needs a more detailed report of AUC results for accreditation or internal tracking, our DIY Accreditation Toolkit includes this option with quick data entry and tracking. Also use our DIY Accreditation Toolkit to implement a Quality Improvement Program with tracking of employee and physician Quality Scores. Set a benchmark and track quality in the lab. Identify key areas for training and learning opportunities. Our detailed quality tools will help you set a standard of excellence for your lab. Learn more about that or start your FREE 7 day trial HERE.
2011 Appropriate Use Criteria
2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease
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