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Practice Variations in Pediatric Echocardiography Laboratories

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Abstract

Quantification guidelines for pediatric echocardiograms were published in 2010 establishing consensus regarding standard measurements. However, a standard protocol for performance and analysis of pediatric echocardiograms was not defined. This study aims to identify practice variations among pediatric laboratories. A survey was sent to 85 North American pediatric laboratory directors. The survey included 29 questions assessing: demographics, methods of image acquisition, parameters routinely evaluated and reported, and methods used to assess chamber sizes, valves, and ventricular function. There were 47/85 (55%) responses; 83% were academic centers and 77% in an urban setting. Wide variations exist in acquisition method (clips versus sweeps) and color scale settings. The most commonly used methods for left ventricular (LV) function are M-mode shortening fraction, qualitative assessment, and Doppler Tissue Imaging. The most commonly used parameter for right ventricular function is qualitative. LV mass is routinely measured by the majority of centers with variations in methods of calculation. Conversely, while a minority measure left atrial volume, there is consensus regarding the preferred method. While multiple techniques exist for assessing valves, qualitative assessment is reported to be the preferred method. Despite quantification guidelines, there is a lack of uniformity in performance and analysis of pediatric echocardiograms. Further studies are needed to determine why variations exist and whether development of consensus guidelines might improve interpretation, consistency and quality of reports, patient care, and provide a standardized system allowing for comparative research among centers.

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Authors and Affiliations

  1. Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box 21, Chicago, IL, 60611-2991, USA

    Joseph A. Camarda, Angira Patel & Michael R. Carr

  2. Division of Cardiology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Luciana T. Young

Authors
  1. Joseph A. Camarda
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  2. Angira Patel
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  3. Michael R. Carr
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  4. Luciana T. Young
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Corresponding author

Correspondence to Joseph A. Camarda.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research Involving Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors. The survey was approved by our institutional review board.

Appendix: Survey

Appendix: Survey

We are reaching out to you as you have been identified as the head of your echocardiography lab. Please take 10 min of your time to answer questions regarding the pediatric echocardiography protocols used at your institution.

We are conducting a study, entitled “Protocol Variations in Pediatric Echocardiography Labs” to assess variations in pediatric echo practices across the country. The study is being conducted by Drs. Joseph Camarda, Angira Patel and Luciana Young, imaging faculty at the Ann & Robert H. Lurie Children’s Hospital of Chicago. This survey is voluntary and questions may be skipped. Answers will remain anonymous. Once answers are submitted, they cannot be removed from the study. By completing this survey, participation consent is implied. This study has been approved by the Lurie Children’s Institutional Review Board, IRB Protocol # 2014-15574. Thank you for your time.

  1. 1.

    What is your current position? [Pediatric echo lab director; other].

  2. 2.

    How would you describe your area of practice? [Urban; suburban; rural; other].

  3. 3.

    Your practice is best characterized by: [Private practice; academic center; mixed model; other].

  4. 4.

    How many total cardiologists are in your practice? [Free response].

  5. 5.

    Is your echo lab ICAEL accredited? [Yes; no].

  6. 6.

    How many echocardiographers are in your practice?

  7. 7.

    How long have you been reading pediatric echocardiograms? [< 5 years; 5–10 years; 10–15 years; 15–20 years; 20 years].

  8. 8.

    Approximately how many pediatric echocardiograms are performed at your institution per year? [< 5000; 5000–10,000; 10,000–15,000; 15,000–20,000; > 20,000].

  9. 9.

    Does your institution have a written protocol for complete congenital echocardiographic studies? [Yes; no].

  10. 10.

    Does your institution have a written protocol for limited/follow up echocardiograms? [Yes; no].

  11. 11.

    Which of the following best describes your institution’s imaging practice? Check all that apply: single or two beat clips; two beat clips; time-triggered sweeps].

  12. 12.

    What is an acceptable minimum frame rate at your institution? [For 2D image; for patient less than 30 kg; for patient greater than 30 kg; for color images].

  13. 13.

    How does your institution assess left ventricular function on routine echoes? [Check all that apply: qualitative assessment; 4 chamber EF; 2 chamber EF; SAX SF; M-mode SF; MPI; 3D EF; strain imaging].

  14. 14.

    How does your institution primarily assess right ventricular function on routine echoes? [Check all that apply: fractional area change; TAPSE; MPI; DTI; qualitative assessment].

  15. 15.

    Does your institution routinely comment on LV diastolic function? [Yes; no].

  16. 16.

    Does your institution routinely comment on RV diastolic function? [Yes; no].

  17. 17.

    Does your institution routinely perform DTI? [Yes; no].

  18. 18.

    Does your institution routinely report DTI values? [Yes; no].

  19. 19.

    Does your institution routinely measure left atrial volume? [Yes; no].

  20. 20.

    How does your institution measure left atrial volume? [4 chamber trace; 2 chamber trace; Biplane method].

  21. 21.

    What is the accepted ideal Nyquist limit at your institution? [0.6 m/s; 1 m/s; maximized; other—please specify].

  22. 22.

    Does your lab use the same Nyquist limit to assess cardiac valves and MPA/branch PAs/AO arch flow? [Yes; no].

  23. 23.

    What parameters does your institution use to grade MR? [Check all that apply: qualitative; pulmonary vein Doppler pattern; LA size; LV size; Doppler envelope density; vena contracta width; area of regurgitant jet; length of regurgitant jet; other—please specify].

  24. 24.

    What parameters does your institution use to grade TR? [Check all that apply; qualitative; RV/RA/IVC size; Doppler envelope density; hepatic vein flow; vena contracta width; area of regurgitant jet; length of regurgitant jet; other—please specify].

  25. 25.

    What parameters does your institution use to grade PI? [Check all that apply: qualitative; RV size; Doppler envelope density; deceleration rate; vena contracta width; Area of regurgitant jet; length of regurgitant jet; other—please specify].

  26. 26.

    What parameters does your institution use to grade AI? [Check all that apply: qualitative; flow reversal in descending aorta; pressure half-time; LV size; vena contracta width; area of regurgitant jet; length of regurgitant jet; other—please specify].

  27. 27.

    Where does your protocol begin? What is the order of your protocol, please rank 1–4 [Subcostal; parasternal; apical; SSN].

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Camarda, J.A., Patel, A., Carr, M.R. et al. Practice Variations in Pediatric Echocardiography Laboratories. Pediatr Cardiol 40, 537–545 (2019). https://doi.org/10.1007/s00246-018-2012-7

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  • DOI: https://doi.org/10.1007/s00246-018-2012-7

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