|
The IAC Standards
and Guidelines |
Click here for a printer-friendly PDF of the Adult
Echocardiography Standards |
2.1C Facilities must
have a process in place to evaluate the QI measures outlined in sections 2.1.1C
through 2.1.4C. A minimum of two cases per modality (TTE, TEE, SE) per quarter
must be evaluated and the same cases may be used for the first four measures.
2.1.1.1C
A minimum of two cases per modality (TTE, TEE, SE) per
quarter must be evaluated for the appropriateness of the test performed and
categorized as:
i. appropriate/usually
appropriate;
ii. may be
appropriate; or
iii. rarely
appropriate/usually not appropriate.
2.1.2C Technical Quality
Review (Sonographer Performance Variability)
2.1.2.1C The facility must
evaluate the technical quality of the images and, if applicable, the safety of
the procedure. The review must include but is not limited to the evaluation of:
i. the clinical
images for clarity of images and/or evaluation for suboptimal images or
artifact;
ii. completeness of
the study; and
iii. adherence to the
facility imaging acquisition protocols.
2.1.2.2C Two cases per
modality (TTE, TEE, SE) per quarter must be reviewed for image quality,
completeness of the study and adherence to the facility protocol to be reviewed
in QI meetings. The cases must represent as many sonographers as possible.
Discrepancies in acquisition quality and variability must be reconciled to
achieve uniform examination quality.
2.1.3C Interpretive
Quality Review (Physician Interpretation Variability)
2.1.3.1C The facility must
evaluate the quality and accuracy of the interpretation based on the acquired
images.
i. A minimum of two
cases per modality (TTE, TEE, SE) per quarter must be evaluated for the quality
and accuracy of the interpretation based on the acquired images. The cases must
represent as many physicians as possible. Differences in interpretation must be
reconciled to achieve uniform examination interpretation.
2.1.4C Final Report
Completeness and Timeliness
2.1.4.1C The facility must
evaluate the final report for completeness and timeliness as required in the
Standards.
i. minimum of two cases per modality (TTE, TEE, SE) per quarter must be
evaluated for completeness and timeliness of the final report as required in
the Standards (refer to Standards 3.2A, 3.2.4A for report completeness and Standards 3.3A through 3.6A for report timeliness). The reports
must represent as many physicians as possible.
(See Guidelines below for further
recommendations.)
2.1C Correlation and Confirmation of Results
Transthoracic, Transesophageal,
and Stress Echocardiograms should be routinely compared with other
imaging or diagnostic modalities (another echocardiographic modality,
cardiac CT or MRI, cardiac catheterization, nuclear perfusion studies,
etc.) or surgical findings. Correlation data for each physician
responsible for the interpretation of transthoracic echocardiograms in
the facility should be accumulated by the facility and distributed to
the interpreting physician. A process for addressing discrepancies
between echocardiogram examination results and results of other
procedures should be in place.
Appropriate areas for correlation of transthoracic echocardiograms may include, but are not limited to:
• left ventricular function, regional wall motion abnormalities and ejection fraction;
• aortic stenosis;
• aortic regurgitation;
• mitral valve regurgitation;
• mitral stenosis; and
• pulmonary artery pressure.
Appropriate areas for correlation of transesophageal echocardiograms may include, but are not limited to:
• left ventricular function and regional wall motion analysis;
• mechanism and severity of valvular dysfunction;
• presence or absence of thrombi or vegetations; and
• presence or absence of aortic dissection, atheromas, hematomas or ruptures.
Appropriate areas for correlation of stress echocardiograms may include, but are not limited to:
• left ventricular function, regional wall motion abnormalities and ejection fraction;
• myocardial viability
• myocardial perfusion
• valvular disease: and
• pulmonary artery pressure.