|
The IAC Standards
and Guidelines |
Click here for a printer-friendly PDF of the Adult
Echocardiography Standards |
3.1A Provisions
must exist for the generation and retention of examination data for all
echocardiograms performed. Measures for HIPAA compliance and IT security must be in place.
3.1.1A A
system for recording and archiving echocardiographic data (images, measurements
and final reports) obtained for diagnostic purposes must be in place.
3.1.2A A
permanent record of the images and interpretation must be made and retained in
accordance with applicable state or federal guidelines for medical records,
generally five to seven years. Images and interpretation
must be retrievable for comparison with new studies.
3.1.3A Acceptable
archiving media includes videotape and digital storage (including PACS,
CD/DVD or other digital archiving media). Digital storage will be
required by January 1, 2024.
(See
Guidelines below for further recommendations.)
3.2A Provisions
must exist for the timely reporting of examination data.
3.2.1A There
must be a policy in place for communicating critical results.
3.2.2A The
findings of a STAT echocardiogram must be made available immediately by the
interpreting physician.
Comment: Sonographer worksheets, comments (verbal or written) or electronic
summary of findings must not be provided to anyone other than the interpreting
physician.
(See Guidelines below for further
recommendations.)
3.2.3A Preliminary
reports can only be issued by a physician. There must be a policy in place for
communicating any significant changes between the preliminary and final
reports.
3.2.4A Routine
inpatient echocardiographic studies must be interpreted by a qualified
physician within 24 hours of completion of the examination. Outpatient studies
must be interpreted by the end of the next business day. The final verified (by
the interpreting physician) signed report must be completed within 48 hours
after interpretation.
(See Guidelines below for further
recommendations.)
3.3A Echocardiography reporting must be standardized in the facility. All physicians interpreting echocardiograms in the facility must agree on uniform diagnostic criteria and a standardized report format.2
3.3.1A The
report must accurately reflect the content and results of the study. The report
must include, but may not be limited to:
i. date
of the study;
ii. name
and/or identifier of the facility;
iii. name
and/or identifier of the patient;
iv. date
of birth and/or age of the patient;
v. indication
for the study;
vi. name
or initials of the performing sonographer;
vii. name
of the ordering physician and/or identifier;
viii. height;
ix. weight;
x. gender;
and
xi. blood
pressure – systolic and diastolic blood
pressure must be obtained on or around the time of the study and displayed on
the report.
Comment: The
3.3.1.2A A summary of the results of the examination. Summary comments must
include any pertinent or positive and negative findings particularly
those relative to the indication for the examination, and communication
of critical findings.
3.3.1.3A The
final report must be completely typewritten, including the printed name of the
interpreting physician. The final report must be reviewed, signed and dated
manually or electronically by the interpreting physician. Electronic signatures
must be password protected and indicate they are electronically recorded.
Stamped signatures or signing by non-physician staff is unacceptable.
3.4A Adult
Transthoracic Echocardiogram Report Components
3.4.1A The
report must accurately reflect the content and results of the study. The report
must include, but may not be limited to:
3.4.1.1A quantitative date which must
include:
i. The
measurements performed in the course of the
examination and/or interpretation.
ii. 2-D,
3-D and/or M-Mode numerical data for transthoracic echocardiograms, must
include, but not be limited to (except where technically unobtainable):
· left ventricular internal dimension and/or volume at
end-diastole;
· left ventricular internal dimension
and/or volume at
end-systole;
· left ventricular posterobasal free wall thickness at end-diastole;
· ventricular septal thickness at
end-diastole;
· left atrial dimension at
end-systole or indexed LA volume; and
· aortic root dimension at end-diastole
or ascending aorta.
Comment:
(See Guidelines below for further
recommendations.)
3.4.1.2A A
report of the Doppler evaluation must include, but not be limited to:
i. evaluation of peak velocities, and peak and mean gradients, as appropriate for each valve (if stenotic or prosthetic);
ii. valve
area, if stenotic;
iii. degree of pathologic regurgitation (and quantification data if performed);
iv. right
ventricular systolic pressure value reported when tricuspid regurgitation is
present; and
v. other
pathology.
3.4.1.3A Report
text must include comments on:
i.
left ventricle (LV size; ejection fraction; presence or absence of
regional wall motion abnormalities; diastolic function; and strain, if performed);
ii. right
ventricle (size and function);
iii. right
atrium;
iv. left
atrium;
v. mitral
valve;
vi. aortic
valve;
vii. tricuspid
valve;
viii. pulmonic
valve;
ix. pericardium;
and
x. aorta.
Comment: If any structure is not well
visualized this must be noted. The report text must be consistent with the
quantitative data. Where appropriate, this must include localization and
quantification of abnormal findings.
3.5A Adult
Transesophageal Echocardiogram Report Components
3.5.1A The
report must accurately reflect the content and results of the study. The report
must include, but may not be limited to:
3.5.1.1A Report
text (including procedure comments) must include:
i. medication used for the procedure (If sedation was provided by the anesthesiology service, this must be referenced.);
ii. ease
of transducer insertion;
iii. complications
(yes or no); and
iv. components
of procedure (i.e., color flow Doppler, PW/CW Doppler, contrast
administration).
3.5.1.2A Report
text must include comments on:
i. left
ventricle;
ii. right
ventricle;
iii. right
atrium;
iv. left
atrium;
v. left
atrial appendage;
vi. interatrial
septum;
vii. mitral
valve;
viii. aortic
valve;
ix. tricuspid
valve;
x. pulmonic
valve;
xi. pericardium;
and
xii. aorta.
Comment: If any structure is not well visualized or was not imaged due to the need for a targeted examination this must be noted.
3.5.1.3A Measurements
and Doppler (if obtained):
i. Linear
and/or volume/area measurements
ii. Color
and spectral Doppler interpretation statements regarding antegrade and retrograde
flow abnormalities for each valve, along with any other Doppler velocity,
gradient and/or volume measurements generally accepted as needed for
documentation of pathology.
3.6A Stress
Echocardiogram Report Components
3.6.1A The
report must accurately reflect the content and results of the study. The report
must include, but may not be limited to:
3.6.1.1A Report
text must include the following non-imaging data:
i. exercise
time, or maximum dose of pharmacologic agent (if used);
ii. target
heart rate;
iii. maximum
heart rate achieved;
iv. whether
or not target HR was achieved and/or stress adequate;
v. resting blood pressure and blood pressure response to exercise stress (For pharmacologic stress, resting and peak BP should be recorded.);
vi. reason
for termination;
vii. patient’s cardiac symptoms, if any, during the examination;
viii. if complete image acquisition of the left ventricle exceeds 90 seconds post stress; and
ix. summary
of stress ECG findings.
Comment: If the electrocardiographic portion of the stress test is reported
separately, the imaging report must include the items listed in 3.6.1.1A.
Image description must include:
· Pre-exercise segmental wall motion
and global systolic function
· Post-exercise wall motion comparison and global systolic function
· for Doppler stress testing, the report must contain the relevant baseline and peak / immediate post stress Doppler data.
Comment: If imaging data is delayed in order to obtain Doppler data, this must be noted in the report.
3.6.1.2A A
summary of the results of the examination, including any pertinent positive
(e.g., ischemia, viability and coronary distribution,
Comment: An accurate, succinct impression (e.g., normal, abnormal, stable).
This must clearly communicate the result of the study and, when possible,
answer the clinical question that was the cause for the examination. This final conclusion must resolve any
inconsistencies or discrepancies (e.g., abnormal stress test with normal
images) or provide guidance for further studies to do so.
3.6.1.3A Any
need for additional studies based on the results of the procedure being
reported.
(See
Guidelines below for further recommendations.)
3.1.3A Digital
storage: The number of images acquired post stress must be sufficient
to allow for adequate review, generally 2 or more images are
recommended for each view obtained.
3.2.2A Suggested
method for reporting life-threatening findings: The interpreting
physician or physician designee in the facility will notify the
appropriate provider.
3.2.4A Comment: An interpretation can be in the form of paper, digital storage or an accessible voice system.
3.3.1.2A When
available and relevant, comparison with a prior echocardiographic study
and/or report should be done and noted in the final report.
3.4.1.1A
Additional measurements may be indicated and when performed, should be
included.
3.6.1A
Comment: Stress Echocardiography interpretation includes at a minimum an
assessment of regional and global