Job Task Analysis for ARDMS Pediatric Echocardiography Data Collected: June 17, 2010 Reported: Analysis Summary For: Pediatric Echocardiography Exam Survey Dates 05/24/2010-06/07/2010 Invited Respondents 1,830 Surveys with Demographics Completed Surveys 693 (completed at least one question) 750 (completed all questions) Response Rate, Completed Surveys 41% Page 1 of 12
Demographics Educational Level Education Level N Percent On-the-job training (apprenticeship) 91 13% Certificate program 97 14% Associate's degree 199 29% Bachelor's degree 232 33% Master's degree 39 6% MD 30 4% PhD 5 1% Total 693 100% Table 1. Education -- All Survey Respondents Graphically, the educational level of respondents is represented below. Figure 1. Educational Level Page 2 of 12
Sonographers in Lab The task analysis included a question regarding the number of sonographers that practice in the same lab as the respondent. Below are the results from Table 2. Sonographers in Lab N Percent 0-5 322 46% 6-10 239 34% 11-15 83 12% 16-20 30 4% 21 + 19 3% Total 693 100% Table 2. Sonographers in Lab Figure 2. Sonographers in Lab Page 3 of 12
Studies per Month Below, Table 3. PE Studies per Month shows the number of studies respondents typically conduct per month in their own practices. Pediatric Echocardiography Studies per Month N Percent 0-50 313 45% 51-100 184 27% 101-150 146 21% 151-200 33 5% 201 + 17 2% Total 693 100% Table 3. PE Studies per Month Figure 3. PE Studies per Month Page 4 of 12
Laboratory Studies per Month Table 4, Pediatric Echocardiography Exams in Lab/Month, shows the number of pediatric echocardiography sonography exams conducted in the respondent s laboratory in a typical month Laboratory Studies Per Month N Percent 0-200 319 46% 201-500 144 21% 501-1000 159 23% 1001 + 71 10% Total 693 100% Table 4. PE Studies in Respondent s Laboratory The results from Table 4 are presented graphically below. Figure4. PE Exams in Respondent s Laboratory Page 5 of 12
Experience as a PE Sonographer The number of years the respondents have spent as a Sonographer are tabulated in Table 5. Years as a Sonographer. Experience as a PE Sonographer N Percent 0-5 85 12% 6-10 112 16% 11-15 115 17% 16-20 103 15% 20 + 278 40% Total 693 100% Table 5. Years as a Sonographer Figure 5. Years as a Sonographer Page 6 of 12
Years in Pediatric Echocardiography Practice Table 6. Years in Practice shows the number of years the respondents have been in Pediatric Echocardiography practice. Years in PE Practice N Percent 0-5 128 18% 6-10 157 23% 11-15 134 19% 16-20 121 17% 20 + 153 22% Total 693 100% Table 6. Years in PE Practice Figure 6. Years in PE Practice Page 7 of 12
Survey Topics Listings Below are the complete topic listings as they appeared in the survey. ID PE Survey Tasks 1. Anatomy and physiology 1.1. Apply knowledge of closure of the patent foramen ovale after birth 1.2. Apply knowledge of decreasing pulmonary vascular resistance and pressure after birth 1.3. Apply knowledge of ductal closure after birth 1.4. Apply knowledge of normal chamber motion in systole and diastole 1.5. Apply knowledge of normal great vessel flow in systole and diastole 1.6. Apply knowledge of normal pulmonary venous flow in systole and diastole 1.7. Apply knowledge of normal superior vena cava flow in systole and diastole 1.8. Apply knowledge of normal valve flow in systole and diastole 1.9. Apply knowledge of normal valve motion in systole and diastole 1.10. Identify abdominal aorta 1.11. Identify abdominal situs 1.12. Identify all cardiac valves 1.13. Identify all chambers, atrial and ventricular septa 1.14. Identify aortic arch vessels (i.e., brachiocephalic/strap) 1.15. Identify aortic arch 1.16. Identify arch sidedness (i.e., right versus left) 1.17. Identify atrial situs 1.18. Identify bridging innominate vein 1.19. Identify coronary arteries and proximal branches 1.20. Identify coronary artery origins 1.21. Identify coronary sinus 1.22. Identify inferior vena caval return to the right atrium 1.23. Identify pulmonary artery and branches 1.24. Identify pulmonary venous return to the left atrium 1.25. Identify superior vena caval return to the right atrium 1.26. Identify venous valves (e.g., Eustachian and Chiari) 1.27. Apply knowledge of ductal flow pattern before birth 1.28. Apply knowledge of flow pattern across the patent foramen ovale before birth 2. Pathology 2.1. Analyze left heart inflow and outflow tract obstructions 2.2. Analyze right heart inflow and outflow tract obstructions 2.3. Identify lesions associated with Holt-Oram syndrome 2.4. Identify lesions associated with Patau Trisomy 13 2.5. Identify lesions associated with tuberous sclerosis 2.6. Identify lesions associated with Uhl anomaly Page 8 of 12
2.7. Identify possible echo abnormalities associated with chest pain in children 2.8. Identify possible echo abnormalities associated with hypertension in children 2.9. Identify possible echo abnormalities associated with obesity in children 2.10. Identify possible echo abnormalities associated with syncope in children 2.11. Identify arch anomalies- aberrant LSCA 2.12. Identify arch anomalies - interrupted aortic arch 2.13. Assess right ventricle pressure by IVC/hepatic Doppler flow pattern 2.14. Identify abnormalities associated with constrictive cardiomyopathy 2.15. Identify abnormalities associated with restrictive cardiomyopathy 2.16. Identify anomalous left coronary artery from Pulmonary artery trunk 2.17. Perform pre-op arterial switch assessment for patients with DTGA 2.18. Perform pre-op TOF assessment 2.19. Analyze abnormalities of cardiac situs and position 2.20. Analyze atrial and ventricular septal defects 2.21. Analyze atrioventricular septal defects 2.22. Analyze various abnormalities of the aortic valve 2.23. Analyze various abnormalities of the mitral valve 2.24. Analyze various abnormalities of the pulmonic valve 2.25. Analyze various abnormalities of the tricuspid valve 2.26. Identify abnormal ventriculoarterial connection (e.g., D-TGV and L-TGV) 2.27. Identify arteriovenous fistulas 2.28. Identify azygos continuation of the inferior vena cava to the superior vena cava 2.29. Identify cardiac tumors 2.30. Identify conotruncal defects (e.g., TOF, DORV, Truncus, and AP window) 2.31. Identify discontinuous pulmonary artery branches 2.32. Identify double aortic arch 2.33. Identify left superior vena cava 2.34. Identify lesions associated with muscular dystrophy 2.35. Identify lesions associated with Shone complex 2.36. Identify partial and mixed anomalous pulmonary venous return 2.37. Identify patent ductus arteriosus 2.38. Identify pulmonary artery sling Identify total anomalous pulmonary venous return (e.g., supracardiac, infracardiac, and 2.39. intracardiac) 2.40. Identify anomalous coronary arteries 2.41. Analyze arterial switch repair for transposition of the great arteries 2.42. Analyze atrial switch (Mustard or Senning) repair of transposition of the great arteries 2.43. Analyze Damus-Kaye-Stansel procedure 2.44. Analyze Fontan anastomosis with and without fenestration 2.45. Analyze Glenn anastomosis for univentricular heart 2.46. Analyze modified Blalock-Taussig shunt or central shunt Page 9 of 12
2.47. Analyze Norwood procedure for hypoplastic left heart syndrome 2.48. Analyze patients after balloon dilation of valves and great vessels 2.49. Analyze patients after stenting of great vessels 2.50. Analyze pulmonary artery banding 2.51. Analyze Rastelli repair for double outlet RV 2.52. Analyze repair of anomalous pulmonary venous connection 2.53. Analyze septal defect repairs 2.54. Analyze shunt closure devices 2.55. Analyze surgical repair for coarctation of the aorta 2.56. Analyze Tetralogy of Fallot repair 2.57. Analyze valve repair/replacement 2.58. Analyze Potts repair 2.59. Analyze Ross repair 2.60. Analyze pericardial effusion and severity 2.61. Identify abnormalities associated with dilated cardiomyopathy 2.62. Identify coronary artery abnormalities associated with Kawasaki disease 2.63. Identify echo abnormalities associated with cardiac transplantation rejection 2.64. Identify echo abnormalities associated with hypertrophy cardiomyopathy (IHSS) 2.65. Identify echocardiographic findings associated with post pericardiotomy syndrome 2.66. Identify functional abnormality associated with drug toxicity (e.g., Adriamycin chemotherapy) 2.67. Identify lesions associated with Fetal Alcohol 2.68. Identify lesions associated with Gestational or Maternal Diabetes 2.69. Identify lesions associated with Maternal Rubella 2.70. Identify lesions associated with systemic lupus 2.71. Identify para-aortic abscess associated with infective endocarditis 2.72. Identify thrombus associated with indwelling catheters 2.73. Identify valve regurgitation associated with rheumatic fever 2.74. Identify vegetations associated with infective endocarditis 2.75. Identify echocardiographic findings with paralyzed diaphragm 2.76. Identify echocardiographic findings with pleural effusions 2.77. Identify lesions associated with Trisomy 18 2.78. Identify lesions associated with DiGeorge Syndrome 2.79. Identify lesions associated with Down Syndrome 2.80. Identify lesions associated with Ehlers-Danlos syndrome 2.81. Identify lesions associated with Ellis Van Creveld 2.82. Identify lesions associated with Friedrich's Ataxia 2.83. Identify lesions associated with Marfan syndrome 2.84. Identify lesions associated with Mitochondrial Disease 2.85. Identify lesions associated with Noonan syndrome 2.86. Identify lesions associated with sickle cell anemia 2.87. Identify lesions associated with Turner syndrome Page 10 of 12
2.88. Identify lesions associated with Williams syndrome 3. Protocols 3.1. Obtain a high, left parasternal imaging view 3.2. Obtain a parasternal long-axis view 3.3. Obtain a parasternal short-axis view 3.4. Obtain a right parasternal imaging view 3.5. Obtain a subxiphoid coronal imaging view 3.6. Obtain a subxiphoid longitudinal imaging view 3.7. Obtain a suprasternal long-axis view 3.8. Obtain a suprasternal short-axis view 3.9. Obtain an apical 2-chamber view 3.10. Obtain an apical 4-chamber view apex down 3.11. Obtain an apical long-axis/5-chamber view 3.12. Provide technical assistance during exercise stress echocardiography in children 3.13. Provide technical assistance during intravenous contrast agents 3.14. Provide technical assistance during pharmacologic stress echocardiography in children 3.15. Analyze the severity of aortic regurgitation by diastolic reversal in the descending aorta 3.16. Analyze the severity of pulmonary regurgitation by diastolic reversal in the pulmonary arteries 3.17. Analyze ventricular regional wall motion qualitatively 3.18. Calculate aortic valve area using the continuity equation 3.19. Calculate cardiac output using aortic cross sectional area and Doppler interrogation of flow 3.20. Calculate ejection fraction by 2-D 3.21. Calculate left ventricular mass by 2-D 3.22. Calculate fractional shortening or ejection fraction by M-mode 3.23. Calculate indices of diastolic function (e.g., EA Ratio) 3.24. Calculate left ventricular mass by M-mode 3.25. Calculate maximal pressure gradients using the expanded Bernoulli equation 3.26. Calculate maximal pressure gradients using the modified Bernoulli equation 3.27. Calculate mean pressure gradients of valves 3.28. Demonstrate echocardiographic findings at specific times during the ECG (cardiac) cycle 3.29. Interrogate aortic arch by color and spectral Doppler 3.30. Interrogate atrial and ventricular septum by color and spectral Doppler 3.31. Interrogate four cardiac valves by color and spectral Doppler 3.32. Interrogate pulmonary artery and branches by color and spectral Doppler 3.33. Interrogate pulmonary venous return by color and spectral Doppler 3.34. Interrogate systemic venous return by color and spectral Doppler 3.35. Measure chamber sizes and wall thickness by 2-D 3.36. Measure chamber sizes and wall thickness by M-mode 3.37. Perform linear measurements by 2-D 3.38. Utilize pressure 1/2 time for severity of aortic regurgitation 3.39. Utilize pressure 1/2 time for severity of mitral stenosis Page 11 of 12
3.40. Assess atrial septal shunting gradients 3.41. Assess right ventricular pressure by Tricuspid and pulmonary regurgitant jet velocities 3.42. Assess the isovolumic relaxation time 3.43. Assess VSD gradients 3.44. Perform M-mode recording of ventricles 3.45. Perform M-mode recordings of the cardiac valves 3.46. Perform recordings demonstrating a pulse tracing 4. Physics and Instrumentation 4.1. Perform all the diastolic function assessments 4.2. Assess cardiac assist devices such as VAD's and ECMO 4.3. Assess normal IVC flow in systole and diastole 4.4. Select appropriate transducer(s) for patient size, window, modality 5. Treatment 5.1. Provide technical assistance during an intravascular echocardiography 5.2. Provide technical assistance during echo-guided balloon atrial septostomy 5.3. Provide technical assistance during echo-guided myocardial biopsy 5.4. Provide technical assistance during echo-guided pericardiocentesis 5.5. Provide technical assistance during Transesophageal echocardiography 5.6. Provide technical assistance during intra-cardiac echocardiography (ICE) 5.7. Provide technical assistance during intra-operative epicardial echocardiography 6. Other 6.1. Perform 3-D echocardiography 6.2. Perform Doppler tissue imaging (DTI) 6.3. Perform strain rate imaging 6.4. Identify tip of indwelling catheter 6.5. Identify implantable devices Page 12 of 12