October 23, 1998

Echocardiography lab among first to gain new accreditation

Echocardiography lab among first to gain new accreditation

Using sound waves to visualize the heart and detect abnormalities has become one of the most common diagnostic tools in cardiology, with an estimated 10 million echocardiograms performed each year in the United States.

Vanderbilt University Medical Center's Echocardiography Laboratory is setting a new standard as one of the first 30 laboratories in the United States ‹ and the only one in the Mid-South ‹ to achieve accreditation by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL).

Accreditation is a voluntary process, but Dr. Benjamin F. Byrd III, associate professor of Medicine and director of the VUMC Echo Lab, said he expects that many more labs will seek it in the future as the demand grows for assurance of quality.

"Accreditation is like a seal of approval, a guarantee that a lab has met established standards of quality," said Byrd, who has directed the Echo Lab for 14 years. "'A set of standards in this field is long overdue."

Byrd noted that echocardiography studies represent one of the Medicare program's highest expenditures for a diagnostic medical procedure. There are thousands of echocardiography laboratories throughout the United States, but until now, no standards existed by which to judge their quality.

ICAEL was established in 1997 with the support of the American College of Cardiology, American Society of Echocardiography, and the Society of Pediatric Echocardiography to provide a peer-review mechanism, to establish quality standards, and to recognize laboratories that meet or exceed those guidelines. Byrd is one of two American College of Cardiology representatives on the ICAEL board of directors.

The ICAEL accreditation review closely examines the background and qualifications of the sonographers and physicians who conduct and interpret "echo studies," the quality of a lab's equipment and facilities, the technical quality of studies conducted, and the appropriateness of the interpretation of those studies.

Each year, VUMC's Echo Lab conducts more than 5,000 echo studies each year, including several hundred stress echo (either exercise- or medication-induced) and transesophageal echo (TEE) studies. In 1989, VUMC was the first echo lab in the region to begin using TEE, which uses an endoscope to provide superior images of the heart in lightly sedated patients or during surgery.

More recently, the Echo Lab has added a new echocardiography technology, harmonic imaging, which improves images by helping to eliminate "clutter" reflected from bone and tissue in patients with suboptimal echo quality. Also, harmonic imaging greatly improves echo contast imaging, essential to echocardiographic assessment of blood flow patterns within heart muscle.

For the past five years, the VUMC lab has had an active research program to evaluate new echo contrast agents. VUMC's lab was one of only 10 in the country selected to study the first of these new agents, Albunex, which consists of air-filled "microbubbles" made from the natural blood protein albumin. Since then, four "second-generation" contrast agents have been studied in the VUMC lab. Currently, a microbubble containing perfluorohexane is under Phase III investigation.

In 1996, VUMC's Vascular Lab was the first laboratory in the Nashville area to be accredited by ICAEL's sister organization, the Intersocietal Commission for the Accreditation of Vascular Laboratories.