Ogeechee Technical College

OGEECHEE TECHNICAL COLLEGE ECH 240 –Comprehensive Registry Review Course Syllabus Loretta Stanley, RDCS Full-time Office Location: 338-Joe Kennedy Building Phone Number(s): 912.688-6950 (o) [email protected] Office Hours: By Appointment

COURSE ROOM, DAY AND TIME: Hybrid,TBA

COURSE DESCRIPTION: This course will be an overall review of Echocardiography to include demonstration of normal and abnormal cardiac anatomy, cardiac physiology, pathophysiology and hemodynamics/physics in the different types of cardiac disease/dysfunctions. Also included will be a review of clinical non-invasive cardiac diagnostic procedures, laboratory values, pharmacology and test validation and measurements. Topics include: normal and abnormal cardiac anatomy, techniques, pathology, physics/hemodynamics, test validation and measurements, and laboratory values. Emphasis is placed on reviewing information so that the student will successfully pass the ARMDS and/or CCI certification examinations. COMPETENCY AREAS: 1. Normal/abnormal cardiac anatomy 2. Techniques 3. Pathology 4. Physics/hemodynamics 5. Test validation & measurements 6. Laboratory values

Course Objectives: 1. Normal/Abnormal Cardiac Anatomy a. Differentiate coronary sinus versus descending aorta b. Review coronary arteries c. Review normal cardiac pressure and great vessels pressures d. Review the phases of the physical cardiac cycle and the relationship to the timing of events relative to the ECG. e. Review pulmonary veins 2. Techniques a. Review use of Equipment Control b. Review and recognition of technical artifact c. Recognition of setup errors d. Review appropriate approach for Doppler studies e. Review two-dimensional study and M-mode patterns f. Review CPR g. Review use of contrast agents h. Review provocative maneuvers i. Review indications/contraindications of trans-esophageal echocardiography 3. Pathology a. Review the sonographic appearance and various etiologies of valvular heart disease b. Review the sonographic appearance and various etiologies of pericardial disease c. Recognize types of prosthetic valves d. Review Systemic & Pulmonary Hypertensive Heart Disease e. Review the sonographic appearance and various etiologies of cardiomyopathies f. Review the sonographic findings of ventricular function g. Review the various benign and malignant cardiac tumors h. Review the sonographic appearance and clinical indication for endocarditis i. Review the various diseases and etiologies of the aorta j. Review and correlate stress echo performance and indications k. Describe and identify abnormal/normal exercise testing

4. Physics/Hemodynamics a. Review the concepts surrounding transmission of sound through tissues including: 1. Propagation speed a. Stiffness b. Density 2. Compression and rarefaction 3. Angle of incidence 4. Impedance b. Review the principles that govern transmission of sound into patients and the changes affecting the sound beam’s return to the transducer including: 1. Impedance mismatch 2. Reflection/refraction

c. Analyze the following dynamic factors in the role of hemodynamics including: 1. Energy gradient 2. Effects of viscosity, friction, inertia 3. Pressure/flow relationship 4. Velocity 5. Steady flow vs. Pulsatile flow 6. Laminar versus turbulent flow 7. Effects of stenosis on flow characteristics 8. Venous resistance 9. Hydrostatic pressure 10.Pressure/volume relationship 11.Effects of respiration (phasicity) d. Review the method for evaluating instrument performance and the parameters to be evaluated. e. Define the concepts of prudent use (ALARA) in reducing acoustic exposure including: 1. Recite the key points of the following Guidelines and Regulations regarding ultrasound safety 2. American Institute of Ultrasound in Medicine (AIUM) statements (e.g., mammalian, epidemiology, in vitro) 3. National Electrical Manufacturers Association (NEMA) 4. Food and Drug Administration (FDA) f. Discuss the Electrical and mechanical hazards of ultrasound examinations g. Patient susceptibility to electrical hazard equipment components which could present a hazard h. Discuss the primary mechanisms of biologic effect production i. Cavitation mechanisms to include relevant acoustic parameters j. Thermal mechanisms to include: relevant acoustic parameters k. Distinguish the details of the various experimental biological effect studies including: 1. Animal studies 2. In vitro studies 3. Epidemiologic studies l. Analyze the Doppler equation and the factors influencing the magnitude of the Doppler shift frequency m. Discuss the Doppler Effect as it relates to the sampling of red blood cell movement n. List the range of the Doppler shift frequency o. Describe the basic principles of color flow imaging including: 1. Sampling methods 2. Display of Doppler information 3. Reflector direction 4. Average velocity 5. Velocity variance 6. Advantages and limitations p. Discuss the Doppler effect based on the following: 1. Beam angle 2. Transmitted frequency 3. Flow velocity 4. Flow direction 5. Duration 6. Character 7. Magnitude 8. Fast Fourier transform (FFT) q. Define the basic principles and instrumentation associated with duplex ultrasound and spectral analysis r. Identify and diagram Doppler Instrumentation including 1. Receiver 2. Demodulater 3. Wall filter for clutter rejection 4. Directional devices s. Discuss aliasing and the nyquist criteria including range ambiguity t. Compare and contrast continuous wave and pulsed wave Doppler’s listing the advantages and disadvantages of each. u. Diagram and define Instrumentation issues including 1. Autocorrelation 2. Time domain processing 3. Color field size and frame rate a. Ensemble length (packet size, pulse packet) b. Line density c. Maximum depth 4. Color maps, assignment, or coding a. Hue b. Saturation c. Luminance (significance, brightness, intensity) v. Define and analyze Doppler Artifacts a. Compare and contrast the properties, advantages and limitations of Color Power (Energy) Mode. w. Review formulas for measurement including pressure half time method and Bernoulli equation x. Review Doppler Effect: principle as related to sampling red blood cell movement. y. Review and discuss the properties of sound including: 1. The relationship of wavelength, frequency and propagation speed 2. The relationship between amplitude, power, pressure and intensity 3. The factors affecting a. Refection b. Refraction c. Attenuation z. Define and discuss the concept of the piezoelectric effect aa. Define Curie point bb. Compare various piezoelectric materials cc. Discuss the construction and characteristics of ultrasound transducers to include: 1. Thickness resonance of crystal 2. Operating (resonance) frequency a. Crystal thickness b. Speed of sound in crystal material 3. Frequency characteristics (spectrum) a. Bandwidth- i. Quality ii. Effect of damping b. Multi-Hertz: i. Harmonics 4. Damping 5. Matching layer dd. Discuss sound beam formation ee. Compare and contrast transducer Arrays and Image appearance based on the following items: a. Mechanical and/or electronic construction b. Multiple element construction 1. Linear array 2. Curved array 3. Annular array 4. Multi-dimensional array c. Multiple element operation 1. Sequenced 2. Phased 3. Annular 4. Vector 5. Multi-dimensional ff. Evaluate transducer care and maintenance

5. Test Validation & Measurements a. Review and understand the methods of acquiring measurements need for rest validation b. Review Sensitivity, specificity, positive predictive value, negative predictive value c. Review display modes including: 2D, A-mode, B-mode, and M-mode d. Review Effects of abnormal Pressures and loading, Volume Concepts e. Compare and contrast the Methods for Evaluating Instrument Performance including Test objects 1. Phantoms (tissue, Doppler, flow) 2. Parameters to be evaluated 3. Test object 4. Dead zone 5. Axial resolution and lateral resolution (beam width) 6. Depth calibration accuracy 7. TGC characteristics 8. Uniformity 9. System sensitivity

Tissue equivalent (mimicking) phantom 1. Dead zone 2. Depth calibration accuracy 3. Lateral (horizontal) distance measurement accuracy 4. Axial, lateral, and section thickness (elevational) resolution 5. GC characteristics 6. System sensitivity 7. Dynamic range contrast resolution 8. Lesion detection Doppler flow, string, or belt phantoms 1. Maximum depth 2. Pulsed Doppler sample volume alignment (gate position accuracy) 3. Velocity accuracy 4. Color flow penetration 5. Image congruency test f. Review Doppler measurements and calculations

g. Calculate Statistical Indices including: a. Sensitivity/ specificity b. Negative/ positive predictive value c. Accuracy h. Demonstrate the general concepts regarding the need for and nature of a quality assurance program.

6. Laboratory Values a. Phases of the Cardiac Cycle (Electromechanical Events) b. Review Normal Heart Sound Generation and Timing c. Review other Diagnostic tests MR, Angiography, CT, Angiography

PREREQUISITES/CO REQUISITES: CVT 103, CVT 110, CVT 111, ECH 131, ECH 133, ECH 231, COREQUISITE: ECH 237

CONTACT HOURS: 4 Hours per week

CREDIT HOURS: 2

REQUIRED TEXT: Textbook of Clinical Echocardiography, 3rd Edition, Catherine Otto, ISBN-13: 978-0-7216-0789-4 The Echocardiographer’s Pocket Reference, 3rd Edition, Terry Reynolds, ISBN- 0-9635767-9-8 Echocardiography from a Sonographer’s Perspective Notebook, 5th Edition, Susan K. DeWitt, ISBN ULTRA P.A.S.S. Adult Echocardiography Workbook, Patrick Coon, ISBN9781934864166

MATERIALS AND SUPPLIES: 3 ring notebook Pen/Pencil Pocket notebook Computer access CLASSROOM POLICIES AND PROCEDURES:

ATTENDANCE POLICY: As this course is Hybrid, 4 hours lab/class attendance is required per week. On- line attendance will be established by the number of times that you access the course per week. You will be required to login to the course website at least one time per week of the quarter and attend a minimum of 3 campus Adult Echo and Physics registry review labs/mock exams to meet minimum attendance requirements. That is 1 login per week x 10 weeks, which equals 10 total logins. You are allowed to miss up to 10% of the course meeting requirements, which equates to 1 logins and 1 lab class. Any missed time above 10%, could result in your being dropped from the course.

The student WILL be dropped for absence greater than 10%. In this course, one day is 10%; any missed time exceeding this 10% will result in the student being dropped from the course. THERE IS NO ATTENDANCE APPEAL PROCEDURE!

 This course requires class participation of at least 4 hours per week and outside reading along with on-line assignments. Keeping current on homework assignments and problem solving is essential in this type of class. Assigned reading should be done prior to class so as to make proper use of class-time and assigned activities to be completed as directed by the instructor.  Complete assignments on time. Incomplete assignments will NOT be accepted.  Late assignments will NOT be accepted. Due dates are on your calendar and will be adhered to!  To protect the integrity of the course, online quizzes and tests may be password protected and can be accessed as designated by the instructor.  The student will have a timed access for each test/quiz.  All tests/quizzes MUST be taken without the use of textbook, handouts, notes, friends, family, etc.  Make-up test will be scheduled by the instructor and must be taken at the assigned time (after the final exam) or a grade of zero will be given in place of the test. Make up tests will not be allowed to interfere with class, lab or clinical time. No make-up quizzes will be given!

Academic Policies: “The term "cheating" includes, but is not limited to: (1) use of any unauthorized assistance in taking quizzes, tests, or examinations; (2) dependence upon the aid of sources beyond those authorized by the instructor in writing papers, preparing reports, solving problems, or carrying out other assignments; (3) the acquisition, without permission, of tests or other academic material belonging to a member of the Technical College faculty or staff ; or (4) Alteration of any grade sheets / scantrons through changing scores or filling in of blank spaces after being graded. The term "plagiarism" includes, but is not limited, to, the use, by paraphrase or direct quotation, of the published or unpublished work of another person without full and clear acknowledgment. It also includes the unacknowledged use of materials prepared by another person or agency engaged in the selling of term papers or other academic materials.”“Academic misconduct is any act that does or could improperly distort students’ grades or other student academic records. A student enrolls at Ogeechee Technical College to gain technical skills to lead to greater employability. Academic misconduct is not only “cheating” the student of learning the needed skills; it is an offense to the academic integrity of the learning environment. All forms of academic dishonesty will call for discipline.” A student dismissed for cheating or plagiarism will not be eligible for re-entry. Technical College Student Handbook and Planner

Alteration of any grade sheets through changing scores or filling in of blank spaces after being graded is considered cheating. A student dismissed for cheating or plagiarism will not be eligible for re-entry.

“Failure to dress appropriately at all times will result in disciplinary action. Students enrolled in internships and clinical courses are required to dress appropriately according to the requirements of the work for which they are being trained.” Technical College Student Handbook and Planner

SAFETY: Please refer to the Echocardiography Handbook and Clinical Manual

DISTRIBUTION OF GRADES: REGISTRY REVIEW SIMULATION EXAMS 100%

Grading Scale: A: 90-100 B: 80-90 C: 70-79 D: 60-69 F: 59-0

DISABILITY STATEMENT Students with disabilities who believe that they may need accommodations in this class based on the impact of the disability are encouraged to contact Penny Hendrix in the Special Services Office, Room 332C, Kennedy Bldg., 912-486- 7211, to coordinate reasonable accommodations.

WORK ETHICS Students will receive a work ethics grade each quarter for each fundamental and specific course in which they enroll. The work ethics grade of 3, 2, 1, or 0 will not affect the student’s academic grade point average (GPA). Work ethics grades will appear on the student’s quarterly Student Grade Reports and Transcripts. Performance factors and indicators include, but are not limited to, quality of work, ability to follow instructions, productivity, dependability, honesty, reliability, attendance and punctuality, attitude, integrity, enthusiasm, interpersonal skills, and initiative. The work ethics grade descriptions are Exceeds expectations: 3 Meets expectations: 2 Needs improvement: 1 Unacceptable: 0

WARRANTY STATEMENT: The Department of Technical and Adult Education guarantees employers that graduate of State Technical Colleges shall possess skills and knowledge as prescribed by State Curriculum Standards. Should any graduate employee within two years of graduation be deemed lacking in said skills, that student shall be retrained in any State Technical College at no charge for instructional costs to either the student or the employer.

DISCLAIMER The instructor reserves the right to amend or correct this course syllabus as necessary. If the instructor amends or corrects this syllabus, students will be given a revised syllabus or corrections.