UPDATE 2008:

Technical Director requirements have changed

Technical Directors - As of January 1, 2007, all technical directors are to be credentialed as either RDCS (Registered Diagnostic Cardiac Sonographer) or RCS (Registered Cardiac Sonographer).  No other pathways are recognized. 

The Technical Director is generally a full time position. If the Technical Director serves as Technical Director in more than one laboratory, an appropriately credentialed sonographer who is a member of the technical staff must be present in the laboratory in the absence of the Technical Director and assume the duties of the Technical Director.

In a laboratory with no sonographers, the physician Technical Director must have either Level II or III echocardiography training, or equivalent if trained before 1990, as defined by the ACC/AHA guidelines for physician training in echocardiography1 or an appropriate sonographer credential from the ARDMS or CCI.

Continuing Medical Education:  All staff members must meet the following CME requirements on the initial and reaccreditation applications:

• Medical Director: at least 30 hours of AMA Category I CME credits in echocardiography over a period of three (3) years
• Technical Director: at least 30 hours of echocardiography-related continuing education over a period of three (3) years
• Medical Staff: at least 15 hours of AMA Category I CME credits in echocardiography over a period of three (3) years
• Technical Staff: at least 15 hours of echocardiography-related continuing education over a period of three (3) years

Quality assurance

• Regular records MUST be maintained of the quality assurance process. These records should include, but not be limited to, correlation data and information gained from other required components in Section 5.1.
  To learn more go to: http://www.icael.org/icael/pdfs/Standards/Adult_Org.pdf.
• A minimum of two echocardiography quality assurance conferences per year MUST be held to review the results of comparative studies and peer review
• A minimum of four echocardiographic departmental conferences per year, in conjunction with or in addition to quality assurance conferences, MUST be held for the continuing education of the laboratory.

NEW Provisional status

The ICAEL Board of Directors adopted a new decision pathway: Provisional Grant for one year only. The anticipated use of the Provisional Grant will be for laboratories that have demonstrated quality diagnostic studies through their application process, but:

• have staff members who are not in compliance with the Continuing Education Requirements.
• Medical Director: at least 30 hours of AMA Category I CME credits in echocardiography over a period of three (3) years
• Technical Director: at least 30 hours of echocardiography-related continuing education over a period of three (3) years
• Medical Staff: at least 15 hours of AMA Category I CME credits in echocardiography over a period of three (3) years
• Technical Staff: at least 15 hours of echocardiography-related continuing education over a period of three (3) years
• do not have a credentialed Technical Director.
• The Technical Director must have an appropriate credential in echocardiography from the American Registry of Diagnostic Medical Sonography (ARDMS) or Cardiovascular Credentialing International (CCI) by January 1, 2007.
• do not have QA documentation for correlation or peer review
• Regular records must be maintained of the quality assurance process. These records should include, but not be limited to, correlation data and information gained from other required components in Section 5.1. The records must include a description of how the information is used to improve quality in the echocardiography laboratory and be supported by at least three months of QA data.

NEW: CHANGE IN POLICY: DELAYED LABORATORIES
The following policy will be applied to all application deadlines occurring after September 1, 2008.

Upon receiving a delayed accreditation decision, the laboratory will:

• have one year to provide the additionally requested documentation demonstrating adherence to the Standards as outlined in the accreditation notification letter
• be permitted to submit one set of delay material to be reviewed by the applicable IAC division, free of charge
• be assessed a $200 review fee if, after providing the additional material, the laboratory still has not demonstrated compliance and further information is required
• have a maximum of only three delay material submissions to demonstrate compliance; if continued non-compliance is documented after review of the three resubmissions, the laboratory will be required to fully reapply for accreditation and undergo a complete application review.  (Note: Each testing area in which a lab applies is considered independent and allowed a total of three submissions each.)
• All accreditation fees are non-refundable and will be due at the time of subsequent application submissions.

To learn more go to http://www.icael.org/iac/news/changeinpolicy_delaystatus.htm

QUESTION:

What do reviewers look for in the adult transthoracic case study?

ANSWER:

Beverly Gorman conducted a chat on Echo-web and list the actual questions that the reviewers use to evaluate the studies submitted for accreditation, I suggest you read the entire transcript at:
http://www.echo-web.com/asp/Chattranscript-ICAEL-Quality.asp

QUESTION:

Why do we have to submit case studies?

ANSWER:

Case studies are the only way that the reviewers of your application can see if you know how to perform an echocardiogram.

Questions you need to make sure you answer when performing the case studies are: Are you on axis? Are you too high or too low on the cardiac structures? Are you following your protocol exactly? Do you know how to change the controls so that the image looks clear and is optimized. Where do you take your Doppler measurements? Where do you take your chamber and valve measurements? Are you optimizing the Doppler waveforms? Are you using Color flow mapping correctly?  Do you use a Pedoff transducer for aortic stenoses with a greater than 2m/sec velocityh

The key thing to understand with case studies, is that you need to submit only the very best of your examinations. This is VERY IMPORTANT.

QUESTION

Have the types of case studies changed?

ANSWER:

Yes, as of January 1, 2006, the case studies require the use of  Pedofff  CW Doppler  for aortic stenosis  with velocities greater than 2m/sec.  The  ICAEL requires only regional wall motion abnormalities for the LDFV requirement, no global wall motions case studies should be submitted.

QUESTION:

What is the number of case studies that our laboratory needs to submit?

ANSWER:

The required TTE case studies are based on the total number of staff (medical and technical) in an applicant laboratory. Following are the required number of TTE case studies per base laboratory:

3 or less staff = 4 cases per lab (2 AS, 2 LVDF)
4 to 8 staff = 6 cases per lab (3 AS, 3 LVDF)
9 to 15 staff = 8 cases per lab (4 AS, 4 LVDF)
16 to 25 staff = 10 cases per lab (5 AS, 5 LVDF)
Greater than 25 staff = 12 cases per lab (6 AS, 6 LVDF)

All cases must be abnormal (moderate + disease)
Cases must represent as many staff as possible.
One case study must be submitted from the Technical Director.
All cases must be complete examinations and not limited or followup exams.
All representative cases should have been performed within the last twelve months.

Adult Stress Representative Cases:

3 or less staff = 4 cases per lab
4 to 8 staff = 6 cases per lab
9 to 15 staff = 8 cases per lab
16 to 25 staff = 10 cases per lab
Greater than 25 staff = 12 cases per lab

All cases must be abnormal.
Cases must represent as many staff as possible.
One case study must be submitted from the Technical Director.
All representative cases must have been performed within the past three years.
Please note: Cath correlation is not required with case studies - effective 5/04.

Adult Transesophageal Representative Cases:

One representative Adult TEE case and its final report for each physician that performs TEE.

1 case per physician that includes an indication or finding of a greater than mild mitral regurgitation source of emboli.

All representative cases should have been performed within the last twelve months.

Submit as many TEE cases as possible on a single video tape or CD

Multiple Site Applications:

If an application includes one or more multiple sites, the following cases are required in addition to the base laboratory case studies outlined above:

2 abnormal transthoracic case studies (1 AS, 1 LVDF) from each site
2 abnormal stress echo cases from each site (if applicable)

For pediatric & fetal requirements, check the ICAEL website

What do the reviewers look for in an adult transthoracic case study?
Beverly Gorman recently conducted a chat on Echo-web and list the actual questions that the reviewers use to evaluate the studies submitted for accreditation, I suggest you read the entire transcript at http://www.echo-web.com/asp/Chattranscript-ICAEL-Quality.asp

The  actual questions that the reviewers use to evaluate the studies submitted for accreditation are:

• Are the 2D and/OR M-mode measurement of the LVIDd performed accurately?
• Is at least 3/4 of the endocardium clearly defined in the four standard views?
• Is the Apical 4 Chamber NOT foreshortened?
• Is the mitral inflow Doppler accurate (parallel to flow with complete spectral envelope)?
• If TR is present, is a complete TR envelope aggressively sought from more than one view?
• Are AI and MR evaluated for (with color flow) in at least 2 planes?
• For views obtained, are at least 5 cardiac cycles of each 2D, M-mode and Doppler view taped/acquired?
• For views obtained, is caliper location (in 2D and/or M-mode AND Doppler meas) shown on tape OR print?
• Does the study include all ICAEL standard 2D OR M-mode measurements?
• Does the study include all ICAEL standard views?
• Does the study include all ICAEL standard Doppler flow evaluations?
• Does the study include all components (2D views, 2D/M-mode and Doppler meas) of the lab's own protocol?
• Does the study adhere to the lab's sequence as written?

The ICAEL recently released “ A Guide to Performing Complete Ttransthoracic Echocardiograms.  The guide includes the standard 2D views, tips and pitfalls.  It is a must read for everyone involved in the field of echocardiography  Go to http://www.icael.org/iac/news/div_icael/performingtte.htm to read and download the full document.

QUESTION:

Are there any advantages to implementing a digital echocardiographic PACS system for accreditation?

ANSWER :

There are two (2) advantages to going digital:
Digital archiving systems make the job of collecting case studies for the accreditation application a lot simpler and less time consuming. You need to have a digital system that “packs the reader” on the disc with the case studies. Packing the reader is the file that allows others to review the case studies on the disc without buying the whole digital archiving system. The reader will not allow any other function, it is just a review function. This capability is also good for storing images for lectures and teaching or even publication.

The second advantage to a digital echocardiographic PACS system is the use of the interpretation package. Frequently one of the largest problems during the accreditation process is getting all the physicians to follow the same interpretation format. If you have a large number of interpreting physicians from various practices reading at your hospital or clinic, this is usually the number one problem that has to be addressed. So if you purchase a PACS system, decide if you want the interpretation module for this very reason. The next step after purchasing this module is to design and implement the interpretation template.

QUESTION:

Why should I get my credentials through either the American Registry of Diagnostic Medical Sonographers (RDCS) or Cardiovascular Credentialing International (RCS)?

ANSWER:

The Center for Medicare and Medicaid Services (CMS) are investigating how they can assure their members of quality diagnostic testing. Credentialing and lab accreditation will be one of the primary requirements which will be easy to track. So if you want to stay in the Diagnostic Ultrasound field, you will need to become credentialed. The Cardiovascular Credentialing International (CCI) and American Registry of Diagnostic Sonographers (ARDMS) are equally recognized for their cardiac sonography credentials.