Rotation Name:
Non-Invasive Cardiology-Echocardiography
Rotation
Director(s): Daniel Spevack, MD
Full Time
Faculty:
Drs. Daniel Spevack, Garet
Gordon , Divya Malholtra, and
Sanjay Doddamani
Goals and
Objectives:
1. To learn the
proper indications for a transthoracic (TTE) and transesophageal (TEE) and
stress echocardiographic studies.
2. To acquire
the skills necessary to perform a complete TTE.
3. To gain
familiarity with the skills necessary to complete TEE.
4. To interpret
the images obtained during TTE and TEE examination. This includes a thorough
understanding of cardiac hemodynamics in normal subjects and subjects with
cardiovascular disease. This includes a thorough understanding of all
techniques used in ultrasound imaging such as M-mode, 2-D, and 3-D imaging as
well as pulse wave, continuos wave, tissue and color Doppler.
5. To become
proficient in the performance and interpretation of exercise and pharmacological
stress testing and stress echocardiography.
Laboratory Hours:
Routine and emergent TTE performed from 8:30am until 5:20pm by the sonographers
(Monday through Friday). On Saturdays, a sonographer will perform the ten most
urgently requested TTE studies. Stress testing and stress echocardiography are
performed from 8:30 until 4:30pm by the sonographers and physician’s assistant.
TEE is performed from 9:00am until 4:30pm (most cases should be finished by
2:00pm) by one of the echo attendings and echo fellow. Interpretation of all
echo studies takes place throughout the day until all studies have been
interpreted.
During the fellows; first echo rotation it is expected that they will spend the
majority of their time learning to perform TTE studies. This will be
accomplished by learning from the sonographers and through practice scanning
while patients are waiting to be imaged by the sonographers. Fellows should
provide an interpretation of the TTEs performed in order to get feedback from
the attending once the study is officially interpreted. More senior fellows
will be expected to participate in TEE procedures.
Emergent TTEs on night and weekends (except ten studies on Saturday) are to be
performed by the cardiology fellows on call. The on call fellows will provide a
preliminary interpretation to the physicians caring for the sick patient. In
addition they will document their interpretation on an echo lab worksheet. On
call studies will be officially read by the echo attending during echo lab
hours. The echo attending interpreting on call echos will review the studies
with the fellow who performed the study to give feedback on echo quality and
interpretation. The echo attending on call will be available to assist in
interpretation of TTE findings as requested by the on call fellow. Emergent
TEE’s on nights and weekends are to be performed and interpreted by the on call
fellow and on call echo attending.
Curriculum:
Moses and
Weiler Campus:
Didactic instruction will be provided by the echo lab attendings covering a wide
range of topics including the physics of ultrasound, cardiac hemodynamics,
contrast echocardiography, exercise physiology and prosthetic valves. In
addition, direct instruction from TTE, TEE and stress studies will take place
during each reading session. It should be understood that competency in
echocardiography can not be attained though didactic sessions alone. It is
expected that fellows will read a text with a systematic approach to
echocardiography throughout their rotation. Examples of such texts are cited
below.
At Moses:
On Friday from 9:00 until 10:00am a teaching conference is held in the echo
lab. Attendance from the echo fellows, sonographers and echo attendings is
mandatory. All fellow on other rotations, medical students, and residents are
welcome. It is expected that the echo fellows will prepare cases of particular
interest.
One day each month there will be a joint radiology and cardiology imaging
conference. It is expected that the echo fellows will assist with selecting
appropriate cases and in presenting cases at the conference. This conference
will help to highlight the strengths and limitations of various cardiac imaging
modalities.
Research:
Fellows are encouraged to propose their own research projects involving
echocardiographer and to participate in ongoing projects in the lab. Also, we
frequently see interesting cases in the lab that you may publish as case
reports.
Requirements for Board Certification:
Level II Training:
It is expected that all graduating fellows will achieve this level of competency
in echocardiography. This level of training necessitates that graduates attain
knowledge and experience necessary to fully capable of performing and
interpreting an M-mode, two-dimensional and Doppler examination independently
under the supervision of a laboratory director. This level of training requires
six months of echocardiography training and the performance/interpreation of
3000 TTE studies.
Level III Training:
Cardiology fellows with the particular interest in echocardiography may purse
this level of training. This level would enable the training to direct
echocardiography laboratories, as well as perform various special ultrasound
procedures (i.e. transesophageal, stress, intraoperative). This level of
training requires 12 months of echocardiography training,
performance/interpretation of 750 TTE studies and performance/interpretation of
special procedures, such as TEE, stress and contrast echocardiography.
Board certification:
The national Board of Echocardiography offers certification in
echocardiography. Minimum requisites for board certification can be found on
the NBE website (www.echoboards.org)
Evaluation:
1. Direct
meeting with the fellow at the end of the rotation
2. Written
feedback on myevaluations.com
3. Discussion
meetings with faculty on respective campus.
See evaluation section
Textbooks:
1.
Feigenbaum. Echocardiography (sixth edition). Lippincott, Williams &
Wilkins. 2004.
2.
Weyman. Principles and Practice of Echocardiography (Third Edition). Lea
& Febiger 2004
3.
Oh. The Echo Manual. Lippincott, Williams & Wilkins. 1994.
4.
Otto. The Practice of Clinical Echocardiography (Second Edition).
Saunders. 2000.
5.
Otto. Textbook of Clinical Echocardiography (Third Edition). Saunders.
2000.
For More Information Contact:
Albert Einstein College of Medicine / Montefiore Medical Center Cardiology Fellowship Program
1300 Morris Park Avenue, Suite G46, Bronx, NY 10461
Tel: 718 430-3315
FAX: 718 430-8989
Internet:
programdirector@cardiologyfellowship.org
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