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Reading echocardiograms, stress echo/nuclear stress echo?

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Was wondering if a PA-C is able(by laws, and obviously training by either MD or some certicate program that I'm not aware of) can read echo/stress echo/nuclear stress test?

 

I am an echo tech in PA school right now. I have extensively looked into this and the simple answer is: no we can't read echoes. However, ARDMS has been working on getting the Ultrasound Practitioner position passed (since 2008). If that is passed, that will allow experienced, lead echo techs to complete a program that will monitor the accuracy of their reading abilities and certify them to read echoes. That is my dream! I think my echo tech/PA/Ultrasound Practitioner combo would be killer! I could run my own show! haha

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Guest JMPA

of course we can read echos, just like we can interpret x-rays, ekgs, ct/mri, and lab results. as far as final reads, well those are left to radiologists for legal reasons

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I have not seen any PA scope of practice laws which specifically prohibit echocardiogram interpretation, and most have wording to the regard that PA's may "order, perform and interpret diagnostic testing".  I'm a cardiology PA in Boston and recently returned from the American Society of Echocardiography (ASE) conference, where I had the chance to spend some time very actively exploring this issue with leaders in the echocardiography community.  PAs in echocardiography seem to be virtually nonexistent, but I don't think it's out of the question for us to become much more actively involved.  There are two organizations that will allow PAs to test for cardiac sonographer credentialling with on the job training.  The Fellow of the American Society of Echocardiography (FASE) designation is also now open to PAs with 5+ years of experience in the use of echocardiography, as well as significant contributions to echocardiography education or leadership.  PAs are also allowed to become ASE members.  I have asked the executive director of the National Board of Echocardiography to consider a policy change at their fall board meeting in October which would allow PAs to sit for physician-level echo boards, and am in the process of preparing a written proposal to be presented to them.

 

PAs interested in echo are definitely in uncharted territory, but there is nothing to say that we cannot change or drive policies as needed for our practices or the growth of our profession.  I think it is time for policies that establish PAs in the field of cardiac diagnostic imaging.  I am fortunate to work in an institution where I have a tremendous amount of support from the cardiology attendings and fellows, and will continue to work on this issue.  I would love to hear from any PAs who currently have privileges in transthoracic, transesophageal and/or stress echo, as well as anyone who is interested in contributing to the proposal to the National Board of Echocardiography or drafting letters to them to support opening their certification process to the PA community.

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Current EM PA fellow here- I order, interpret and chart the results of my own POC bedside echochardiograms as I see fit.  Granted, bedside US is a different beast than a stress test.

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I've been a cardiology PA for nearly 9 years. From what I've been able to gather, the limitation on reading echos and stress tests is on the billing side. Medicare rules, etc. It's certainly something we can learn how to do.

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If anyone is interested in joining a PA group with a focus on Ultrasonography and point of care Ultrasound, with the goal of forming a specialty organization to represent goals, credentialing, billing, education and training, please contact me at finorman@aol.com 

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I did cardiology for 4 years...for ultrasound, I agree with most of the above, that with enough training and practice, it's theoretically possible to become somewhat proficient...though keep in mind US techs do it all day, every day, and cardiac ultrasonography is really one of those things that is so user-dependent...a tech's technique can completely change the outcome and usefulness of the test, a bad tech can produce a useless echo, while a great tech can make diagnosis easy.  If anything, I think some US techs should be allowed to diagnose sooner than PAs!  I have met great ones who can take one look and say "sure, that about a mild to moderate mitral regurg, with EA reversal, and there's hypokinesis of the lower septum, EF is probably XX and i'd guess ischemia of...."  As for nuclear, it's also a tough one...so much of the processing and interpretation of the images is, again, user-dependent, an experienced nuclear tech, especially one who sits with the MD every day during readings as ours did, will have a vast base of experience....nuclear images must be properly processed, with the myocardium properly aligned and regions of interest properly selected, a slight change it any of these, and EF and coronary flow numbers  will be thrown off...as well, reading them requires a keen eye, extensive training, and experience (though software these days estimates it pretty well), and currently only nuclear certified cardiologists can do it...again, I'd sooner have a very experienced nuclear tech reading it than a PA.  Just my two cents.

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U/S > echoes are the work of the devil. I did almost four years of cardiology back in late 80's and NEVER got comfortable looking at m-mode echoes. For whatever the reason I just couldn't wrap my head around the image and what I was seeing. 2D/4 chamber view I could work with. Belly echoes? Is this done on a living/former living creature? Which cavity? Seriously, this will prove to be one of my career regrets having never gotten comfortable with these things. I used to oversee/interpret ETT's all the time for the cardiologists if they were both upstairs in the hospital. ED years? There was no bedside U/S until the tech came in hours later.

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