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SV: [echocardiography] Positions in Europe

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  • Kjetil Lenes
    ... At least in some countries (Norway, Denmark, Italy, perhaps Great Britain as well) there are no formal requirements for echocardiographers. In Norway, the
    Message 1 of 16 , Dec 30, 2001
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      > Why there are no announcements about positions available for
      > echocardiographers in Europe?
      > Vlad Chubuchny.

      At least in some countries (Norway, Denmark, Italy, perhaps Great Britain as
      well) there are no formal requirements for echocardiographers. In Norway,
      the physicicans usually do the scans themselves. Here, most techs (I think
      we are less than 10 all together) are nurses trained on-site by the doctors.
      In Sweden there are formal training, but one that also encompasses many
      other modalities of physiological testing/measuring, like spirometry and
      Holter.

      Perhaps other european collegaues would like to elaborate/correct me.

      Kjetil

      __________________________________________________________
      Kjetil Lenes
      Echo technician, Pediatric Cardiac Unit, Rikshospitalet, Norway

      Aakebergveien 36A, 0650 Oslo, Norway
      Phone: +47 22 67 71 78 Mobile phone: +47 995 23 733
      E-mail: kjelen@... E-mail work: kjetil.lenes@...
    • Paolo Barbier
      ... As far as Italy is concerned, sonographer positions are still exceptional and experimental . P. Barbier Dr. Paolo Barbier, MD Centro Cardiologico
      Message 2 of 16 , Dec 30, 2001
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        At 12.25 29/12/01 +0000, you wrote:
        >Question for the European part of the Group.
        >Why there are no announcements about positions available for
        >echocardiographers in Europe?
        >Vlad Chubuchny.


        As far as Italy is concerned, "sonographer" positions are still exceptional
        and "experimental".

        P. Barbier
        Dr. Paolo Barbier, MD
        Centro Cardiologico Fondazione Monzino, IRCCS
        20138 Milano, Italy
        Tel: +39 02 58002.567/273 - Fax: +39 02 504667
        Cell.:+39 368 9600928
        email: pbar@...
        website: http://www.echobyweb.com
      • Lehn@kinder-kardiologe.de
        Dear Mr. Chubuchny, as far as Germany is concerned we do not know the profession of an echo technician. Echocardiography is usually performed by the
        Message 3 of 16 , Dec 31, 2001
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          Dear Mr. Chubuchny,

          as far as Germany is concerned we do not know the profession of an echo
          technician. Echocardiography is usually performed by the cardiologist
          herself/himself. This also explains why positions for echo labs are also
          placed differently. Unfortunately, both groups do not communicate much
          between continents. I hope this answers your question.
          Best wishes for the New Year to you and the whole group.
          Martin Lehn
          Pediatric cardiologist from Dortmund Germany

          "Mr. Chubuchny" schrieb:

          > Question for the European part of the Group.
          > Why there are no announcements about positions available for
          > echocardiographers in Europe?
          > Vlad Chubuchny.
          >
          > _________________________________________________________________
          > Send and receive Hotmail on your mobile device: http://mobile.msn.com
          >
          >
          >
          > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
        • euroecho
          ... There is a formal accreditation examination and re-accreditation process every 5 years in the UK for both techs and doctors (the same). Adverts are
          Message 4 of 16 , Jan 2, 2002
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            --- In echocardiography@y..., "Mr. Chubuchny"
            <chubuchny2@h...> wrote:
            > Question for the European part of the Group.
            > Why there are no announcements about positions available for
            > echocardiographers in Europe?
            > Vlad Chubuchny.
            >
            >
            There is a formal accreditation examination and re-accreditation
            process every 5 years in the UK for both techs and doctors (the
            same).
            Adverts are regularly announced in the British Society of
            Echocardiography (BSE) Newsletter. This is available to all
            members.

            Petros Nihoyannopoulos MD FRCP FACC FESC
            President, BSE

            Tel: +44(0)208-383 3948 (sec)
            +44(0)208-383 8156 (office)
            Fax: +44(0)208-383 4392

            Please note new email address: petros@...
          • G.S.Filippatos, MD
            In Greece we don t have positions for echocardiographers. Cardiologists do and interpret the studies. In some big hospitals there are some usually w/o formal
            Message 5 of 16 , Jan 3, 2002
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              In Greece we don't have positions for echocardiographers.
              Cardiologists do and interpret the studies. In some big hospitals there are
              some usually w/o formal training. In our hospital, the biggest in Greece
              (1200 beds)
              we have one.
              Gerasimos Filippatos MD FACC FCCP FESC
              -----Original Message-----
              From: Lehn@... <Lehn@...>
              To: echocardiography@yahoogroups.com <echocardiography@yahoogroups.com>
              Date: ÔåôÜñôç, 2 Éáíïõáñßïõ 2002 6:58 ðì
              Subject: Re: [echocardiography] Positions in Europe


              >Dear Mr. Chubuchny,
              >
              >as far as Germany is concerned we do not know the profession of an echo
              >technician. Echocardiography is usually performed by the cardiologist
              >herself/himself. This also explains why positions for echo labs are also
              >placed differently. Unfortunately, both groups do not communicate much
              >between continents. I hope this answers your question.
              >Best wishes for the New Year to you and the whole group.
              >Martin Lehn
              >Pediatric cardiologist from Dortmund Germany
              >
              >"Mr. Chubuchny" schrieb:
              >
              >> Question for the European part of the Group.
              >> Why there are no announcements about positions available for
              >> echocardiographers in Europe?
              >> Vlad Chubuchny.
              >>
              >> _________________________________________________________________
              >> Send and receive Hotmail on your mobile device: http://mobile.msn.com
              >>
              >>
              >>
              >> Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
              >
              >
              >
              >
              >Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
              >
              >
            • Daniel Vanhercke
              ... I can confirm the same situation for Belgium: 10-20 sonographers for the whole country. Mostly in academic centers and some regional hospitals with busy
              Message 6 of 16 , Jan 3, 2002
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                At 08:40 31/12/01 +0100, you wrote:


                > Why there are no announcements about positions available for
                > echocardiographers in Europe?
                > Vlad Chubuchny.

                At least in some countries (Norway, Denmark, Italy, perhaps Great Britain as
                well) there are no formal requirements for echocardiographers. In Norway,
                the physicicans usually do the scans themselves. Here, most techs (I think
                we are less than 10 all together) are nurses trained on-site by the doctors.
                In Sweden there are formal training, but one that also encompasses many
                other modalities of physiological testing/measuring, like spirometry and
                Holter.

                Perhaps other european collegaues would like to elaborate/correct me.

                Kjetil



                I can confirm the same situation for Belgium: 10-20 sonographers for the whole country.
                Mostly in academic centers and some regional  hospitals with busy echo labs.
                There is no school for sonographers, so, most of them are cardiac nurses with a special interest in echocardiography, with echo training on-site, abroad (Holland has some good training centers like Thoraxcenter Rotterdam), or autodidact (congresses..). Maybe in the future more biomedical engineers (master degree).
                Cardiac sonographers (I don't like the word �tech�) work under the medico-legal responsibility of the head cardiologist of the department. Senior sonographers perform their own echo�s and write their own reports.
                There are no �post hoc� video reading systems by a cardiologist.
                Reimbursement for a complete cardiac echo is  about 60 euro, which is  (correct me if I am wrong) 1/5 of the amount in the US.

                Daniel Vanhercke
                Senior sonographer
                Sint Lucas hospital Ghent.
              • gthomaskochi
                This message is not intended to undermine the services of medical technicians especially sonographers. In the case of medical imaging there has to be a clear
                Message 7 of 16 , Jan 5, 2002
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                  This message is not intended to undermine the services of medical
                  technicians especially sonographers. In the case of medical imaging
                  there has to be a clear demarcation between clinical examination and
                  mere imaging. The former has to be done by the physician and the
                  latter by the technicians. In India most of the echocardiography is
                  done by physicians.

                  In this context it is good to classify imaging into dynamic imaging
                  and static imaging. Dynamic imaging is an extension of clinical
                  examination. Ultrasound examination especially echocardiography is
                  dynamic imaging. Whereas, many common xray studies are static
                  imaging. Here an image is taken by a technician and analysed by the
                  physician later. There is no diagnostic logic involved in the
                  acquisition of such images.

                  Dynamic imaging should be done by physicians and static imaging
                  should be done by technicians. Dynamic imaging involves diagnostic
                  logic in the acquisition of the images. Hence for effective
                  examination echocardiography has to be performed by the physician
                  especially the attending physician. By the same logic it would be
                  unreasonable to leave the clinical examination to the "clinical
                  examination technicians".

                  Dr. George Thomas
                  Kochi, India

                  --- In echocardiography@y..., "Kjetil Lenes" <kjelen@s...> wrote:
                  >
                  >
                  > > Why there are no announcements about positions available for
                  > > echocardiographers in Europe?
                  > > Vlad Chubuchny.
                  >
                  > At least in some countries (Norway, Denmark, Italy, perhaps Great
                  Britain as
                  > well) there are no formal requirements for echocardiographers. In
                  Norway,
                  > the physicicans usually do the scans themselves. Here, most techs
                  (I think
                  > we are less than 10 all together) are nurses trained on-site by the
                  doctors.
                  > In Sweden there are formal training, but one that also encompasses
                  many
                  > other modalities of physiological testing/measuring, like
                  spirometry and
                  > Holter.
                  >
                  > Perhaps other european collegaues would like to elaborate/correct
                  me.
                  >
                  > Kjetil
                  >
                  > __________________________________________________________
                  > Kjetil Lenes
                  > Echo technician, Pediatric Cardiac Unit, Rikshospitalet, Norway
                  >
                  > Aakebergveien 36A, 0650 Oslo, Norway
                  > Phone: +47 22 67 71 78 Mobile phone: +47 995 23 733
                  > E-mail: kjelen@s... E-mail work: kjetil.lenes@r...
                • GersonSL@aol.com
                  Dear Dr. Thomas: While your message starts off by saying, This message is not intended to undermine the services of medical technicians especially
                  Message 8 of 16 , Jan 6, 2002
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                    Dear Dr. Thomas:

                    While your message starts off by saying, "This message is not intended to
                    undermine the services of medical technicians especially sonographers," you
                    later say, "Dynamic imaging should be done by physicians and static imaging
                    should be done by technicians." You seem to say that you do not believe that
                    echocardiographers can perform thorough diagnostic examinations.

                    In fact, dedicated medical professionals who receive proper education can
                    often perform equivalent or even superior echocardiographic examinations to
                    those performed by many physicians whose time and efforts are split between
                    echocardiography and many other functions. The dedicated echocardiographer
                    can develop a deeper understanding of the interaction between ultrasound and
                    the human body as well as a better comprehension of equipment functions and
                    performance.

                    I completely agree that the echocardiographer needs to have a deep
                    understanding of the clinical questions being asked and the therapeutic
                    impact that the examination will have. There should be an open communication
                    between the echocardiographer and the interpreting physicians in any
                    ultrasound examination.

                    Please let me know if I have misunderstood the points that you are making,
                    Dr. Thomas.

                    Gerson S. Lichtenberg, RDCS, APS
                    Cardiology Department
                    Oak Park Hospital
                    Oak Park, Illinois

                    In a message dated 1/6/2002 5:30:55 PM, gthomaskochi@... writes:

                    << This message is not intended to undermine the services of medical
                    technicians especially sonographers. In the case of medical imaging
                    there has to be a clear demarcation between clinical examination and
                    mere imaging. The former has to be done by the physician and the
                    latter by the technicians. In India most of the echocardiography is
                    done by physicians.

                    In this context it is good to classify imaging into dynamic imaging
                    and static imaging. Dynamic imaging is an extension of clinical
                    examination. Ultrasound examination especially echocardiography is
                    dynamic imaging. Whereas, many common xray studies are static
                    imaging. Here an image is taken by a technician and analysed by the
                    physician later. There is no diagnostic logic involved in the
                    acquisition of such images.

                    Dynamic imaging should be done by physicians and static imaging
                    should be done by technicians. Dynamic imaging involves diagnostic
                    logic in the acquisition of the images. Hence for effective
                    examination echocardiography has to be performed by the physician
                    especially the attending physician. By the same logic it would be
                    unreasonable to leave the clinical examination to the "clinical
                    examination technicians".

                    Dr. George Thomas
                    Kochi, India >>
                  • Edens, Erik
                    Gerson, I totally agree that sonographers can be better at echo than physicians. Several of our experienced sonographers are better than any of our physicians.
                    Message 9 of 16 , Jan 7, 2002
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                      Gerson,

                      I totally agree that sonographers can be better at echo than physicians.
                      Several of our experienced sonographers are better than any of our
                      physicians. Much of doing an echo is more art than science and you can't
                      teach that artform except by doing it all day. In academic medicine at
                      least, it's best for physicians to think of this issue as a true team
                      effort, and sonographers are a critical, independent part of that
                      team....it's ok for a sonographer to be better at something than a
                      physician! Several of my physician colleagues couldn't even tell you how to
                      turn the machine on much less do an echo.

                      Thanks for your thoughts,

                      Erik

                      R. Erik Edens MD, PhD
                      Medical Director, Pediatric Heart Transplant Program
                      Divisions of Pediatric Critical Care & Pediatric Cardiology, College of
                      Medicine
                      Division of Medicinal & Natural Products Chemisrty, College of Pharmacy
                      University of Iowa HealthCare
                      Iowa City, Iowa 52242

                      Ph (319)-384-6101 erik-edens@...

                      > -----Original Message-----
                      > From: GersonSL@... [SMTP:GersonSL@...]
                      > Sent: Sunday, January 06, 2002 5:51 PM
                      > To: echocardiography@yahoogroups.com
                      > Subject: Re: SV: [echocardiography] Positions in Europe
                      >
                      > Dear Dr. Thomas:
                      >
                      > While your message starts off by saying, "This message is not intended to
                      > undermine the services of medical technicians especially sonographers,"
                      > you
                      > later say, "Dynamic imaging should be done by physicians and static
                      > imaging
                      > should be done by technicians." You seem to say that you do not believe
                      > that
                      > echocardiographers can perform thorough diagnostic examinations.
                      >
                      > In fact, dedicated medical professionals who receive proper education can
                      > often perform equivalent or even superior echocardiographic examinations
                      > to
                      > those performed by many physicians whose time and efforts are split
                      > between
                      > echocardiography and many other functions. The dedicated echocardiographer
                      >
                      > can develop a deeper understanding of the interaction between ultrasound
                      > and
                      > the human body as well as a better comprehension of equipment functions
                      > and
                      > performance.
                      >
                      > I completely agree that the echocardiographer needs to have a deep
                      > understanding of the clinical questions being asked and the therapeutic
                      > impact that the examination will have. There should be an open
                      > communication
                      > between the echocardiographer and the interpreting physicians in any
                      > ultrasound examination.
                      >
                      > Please let me know if I have misunderstood the points that you are making,
                      >
                      > Dr. Thomas.
                      >
                      > Gerson S. Lichtenberg, RDCS, APS
                      > Cardiology Department
                      > Oak Park Hospital
                      > Oak Park, Illinois
                      >
                      > In a message dated 1/6/2002 5:30:55 PM, gthomaskochi@... writes:
                      >
                      > << This message is not intended to undermine the services of medical
                      > technicians especially sonographers. In the case of medical imaging
                      > there has to be a clear demarcation between clinical examination and
                      > mere imaging. The former has to be done by the physician and the
                      > latter by the technicians. In India most of the echocardiography is
                      > done by physicians.
                      >
                      > In this context it is good to classify imaging into dynamic imaging
                      > and static imaging. Dynamic imaging is an extension of clinical
                      > examination. Ultrasound examination especially echocardiography is
                      > dynamic imaging. Whereas, many common xray studies are static
                      > imaging. Here an image is taken by a technician and analysed by the
                      > physician later. There is no diagnostic logic involved in the
                      > acquisition of such images.
                      >
                      > Dynamic imaging should be done by physicians and static imaging
                      > should be done by technicians. Dynamic imaging involves diagnostic
                      > logic in the acquisition of the images. Hence for effective
                      > examination echocardiography has to be performed by the physician
                      > especially the attending physician. By the same logic it would be
                      > unreasonable to leave the clinical examination to the "clinical
                      > examination technicians".
                      >
                      > Dr. George Thomas
                      > Kochi, India >>
                      >
                      >
                      >
                      >
                      > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                      >
                    • Marty Willow
                      As one who is neither a physician nor a sonographer, but an echocardiography sales/marketing person who has spent thousands of hours (18 years) in all levels
                      Message 10 of 16 , Jan 7, 2002
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                        As one who is neither a physician nor a sonographer, but an echocardiography
                        sales/marketing person who has spent thousands of hours (18 years) in all
                        levels of echocardiography departments across the US, I completely support
                        Gerson Lichtenberg's response. There should be NO question regarding the
                        appropriateness of skilled sonographers to perform dynamic imaging exams.

                        I am sure that I am stating the obvious in the US. However, sometimes the
                        obvious needs to be stated.

                        Performing an echo exam is an art, as well as a science.

                        Marty Willow

                        -----Original Message-----
                        From: GersonSL@... [mailto:GersonSL@...]
                        Sent: Sunday, January 06, 2002 3:51 PM
                        To: echocardiography@yahoogroups.com
                        Subject: Re: SV: [echocardiography] Positions in Europe


                        Dear Dr. Thomas:

                        While your message starts off by saying, "This message is not intended to
                        undermine the services of medical technicians especially sonographers," you
                        later say, "Dynamic imaging should be done by physicians and static imaging
                        should be done by technicians." You seem to say that you do not believe that
                        echocardiographers can perform thorough diagnostic examinations.

                        In fact, dedicated medical professionals who receive proper education can
                        often perform equivalent or even superior echocardiographic examinations to
                        those performed by many physicians whose time and efforts are split between
                        echocardiography and many other functions. The dedicated echocardiographer
                        can develop a deeper understanding of the interaction between ultrasound and
                        the human body as well as a better comprehension of equipment functions and
                        performance.

                        I completely agree that the echocardiographer needs to have a deep
                        understanding of the clinical questions being asked and the therapeutic
                        impact that the examination will have. There should be an open communication
                        between the echocardiographer and the interpreting physicians in any
                        ultrasound examination.

                        Please let me know if I have misunderstood the points that you are making,
                        Dr. Thomas.

                        Gerson S. Lichtenberg, RDCS, APS
                        Cardiology Department
                        Oak Park Hospital
                        Oak Park, Illinois

                        In a message dated 1/6/2002 5:30:55 PM, gthomaskochi@... writes:

                        << This message is not intended to undermine the services of medical
                        technicians especially sonographers. In the case of medical imaging
                        there has to be a clear demarcation between clinical examination and
                        mere imaging. The former has to be done by the physician and the
                        latter by the technicians. In India most of the echocardiography is
                        done by physicians.

                        In this context it is good to classify imaging into dynamic imaging
                        and static imaging. Dynamic imaging is an extension of clinical
                        examination. Ultrasound examination especially echocardiography is
                        dynamic imaging. Whereas, many common xray studies are static
                        imaging. Here an image is taken by a technician and analysed by the
                        physician later. There is no diagnostic logic involved in the
                        acquisition of such images.

                        Dynamic imaging should be done by physicians and static imaging
                        should be done by technicians. Dynamic imaging involves diagnostic
                        logic in the acquisition of the images. Hence for effective
                        examination echocardiography has to be performed by the physician
                        especially the attending physician. By the same logic it would be
                        unreasonable to leave the clinical examination to the "clinical
                        examination technicians".

                        Dr. George Thomas
                        Kochi, India >>




                        Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                      • Hogan, Candy
                        I would love to see your studies? Do you do all necessary measurements, pressures, tissue Doppler, colorflow m-mode, etc. to diagnose your patients or do you
                        Message 11 of 16 , Jan 7, 2002
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                          I would love to see your studies? Do you do all necessary measurements, pressures, tissue Doppler, colorflow m-mode, etc. to diagnose your patients or do you just eyeball it?

                          > -----Original Message-----
                          > From: gthomaskochi [SMTP:gthomaskochi@...]
                          > Sent: Saturday, January 05, 2002 3:34 AM
                          > To: echocardiography@yahoogroups.com
                          > Subject: Re: SV: [echocardiography] Positions in Europe
                          >
                          > This message is not intended to undermine the services of medical
                          > technicians especially sonographers. In the case of medical imaging
                          > there has to be a clear demarcation between clinical examination and
                          > mere imaging. The former has to be done by the physician and the
                          > latter by the technicians. In India most of the echocardiography is
                          > done by physicians.
                          >
                          > In this context it is good to classify imaging into dynamic imaging
                          > and static imaging. Dynamic imaging is an extension of clinical
                          > examination. Ultrasound examination especially echocardiography is
                          > dynamic imaging. Whereas, many common xray studies are static
                          > imaging. Here an image is taken by a technician and analysed by the
                          > physician later. There is no diagnostic logic involved in the
                          > acquisition of such images.
                          >
                          > Dynamic imaging should be done by physicians and static imaging
                          > should be done by technicians. Dynamic imaging involves diagnostic
                          > logic in the acquisition of the images. Hence for effective
                          > examination echocardiography has to be performed by the physician
                          > especially the attending physician. By the same logic it would be
                          > unreasonable to leave the clinical examination to the "clinical
                          > examination technicians".
                          >
                          > Dr. George Thomas
                          > Kochi, India
                          >
                          > --- In echocardiography@y..., "Kjetil Lenes" <kjelen@s...> wrote:
                          > >
                          > >
                          > > > Why there are no announcements about positions available for
                          > > > echocardiographers in Europe?
                          > > > Vlad Chubuchny.
                          > >
                          > > At least in some countries (Norway, Denmark, Italy, perhaps Great
                          > Britain as
                          > > well) there are no formal requirements for echocardiographers. In
                          > Norway,
                          > > the physicicans usually do the scans themselves. Here, most techs
                          > (I think
                          > > we are less than 10 all together) are nurses trained on-site by the
                          > doctors.
                          > > In Sweden there are formal training, but one that also encompasses
                          > many
                          > > other modalities of physiological testing/measuring, like
                          > spirometry and
                          > > Holter.
                          > >
                          > > Perhaps other european collegaues would like to elaborate/correct
                          > me.
                          > >
                          > > Kjetil
                          > >
                          > > __________________________________________________________
                          > > Kjetil Lenes
                          > > Echo technician, Pediatric Cardiac Unit, Rikshospitalet, Norway
                          > >
                          > > Aakebergveien 36A, 0650 Oslo, Norway
                          > > Phone: +47 22 67 71 78 Mobile phone: +47 995 23 733
                          > > E-mail: kjelen@s... E-mail work: kjetil.lenes@r...
                          >
                          >
                          >
                          >
                          > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                          >
                          >
                        • Nicole Horve
                          I think India, like Europe, has a whole different perspective on how medicine is practiced. I would bet if he came and spent any time over here as a
                          Message 12 of 16 , Jan 7, 2002
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                            I think India, like Europe, has a whole different perspective on how medicine is practiced. I would bet if he came and spent any time over here as a Cardiologist in a busy echo lab, he would change his mind about the role of sonographers in imaging. All he would need to see is the quality of work put forth by an experienced sonographer.

                            Nicole Horve RDCS
                            Supervisor Echocardiography Laboratory
                            St. John's Hospital
                            Phone:217-544-6464 ext. 45036
                            Email: NHorve@...

                            >>> erik-edens@... 01/07/02 10:14AM >>>
                            Gerson,

                            I totally agree that sonographers can be better at echo than physicians.
                            Several of our experienced sonographers are better than any of our
                            physicians. Much of doing an echo is more art than science and you can't
                            teach that artform except by doing it all day. In academic medicine at
                            least, it's best for physicians to think of this issue as a true team
                            effort, and sonographers are a critical, independent part of that
                            team....it's ok for a sonographer to be better at something than a
                            physician! Several of my physician colleagues couldn't even tell you how to
                            turn the machine on much less do an echo.

                            Thanks for your thoughts,

                            Erik

                            R. Erik Edens MD, PhD
                            Medical Director, Pediatric Heart Transplant Program
                            Divisions of Pediatric Critical Care & Pediatric Cardiology, College of
                            Medicine
                            Division of Medicinal & Natural Products Chemisrty, College of Pharmacy
                            University of Iowa HealthCare
                            Iowa City, Iowa 52242

                            Ph (319)-384-6101 erik-edens@...

                            > -----Original Message-----
                            > From: GersonSL@... [SMTP:GersonSL@...]
                            > Sent: Sunday, January 06, 2002 5:51 PM
                            > To: echocardiography@yahoogroups.com
                            > Subject: Re: SV: [echocardiography] Positions in Europe
                            >
                            > Dear Dr. Thomas:
                            >
                            > While your message starts off by saying, "This message is not intended to
                            > undermine the services of medical technicians especially sonographers,"
                            > you
                            > later say, "Dynamic imaging should be done by physicians and static
                            > imaging
                            > should be done by technicians." You seem to say that you do not believe
                            > that
                            > echocardiographers can perform thorough diagnostic examinations.
                            >
                            > In fact, dedicated medical professionals who receive proper education can
                            > often perform equivalent or even superior echocardiographic examinations
                            > to
                            > those performed by many physicians whose time and efforts are split
                            > between
                            > echocardiography and many other functions. The dedicated echocardiographer
                            >
                            > can develop a deeper understanding of the interaction between ultrasound
                            > and
                            > the human body as well as a better comprehension of equipment functions
                            > and
                            > performance.
                            >
                            > I completely agree that the echocardiographer needs to have a deep
                            > understanding of the clinical questions being asked and the therapeutic
                            > impact that the examination will have. There should be an open
                            > communication
                            > between the echocardiographer and the interpreting physicians in any
                            > ultrasound examination.
                            >
                            > Please let me know if I have misunderstood the points that you are making,
                            >
                            > Dr. Thomas.
                            >
                            > Gerson S. Lichtenberg, RDCS, APS
                            > Cardiology Department
                            > Oak Park Hospital
                            > Oak Park, Illinois
                            >
                            > In a message dated 1/6/2002 5:30:55 PM, gthomaskochi@... writes:
                            >
                            > << This message is not intended to undermine the services of medical
                            > technicians especially sonographers. In the case of medical imaging
                            > there has to be a clear demarcation between clinical examination and
                            > mere imaging. The former has to be done by the physician and the
                            > latter by the technicians. In India most of the echocardiography is
                            > done by physicians.
                            >
                            > In this context it is good to classify imaging into dynamic imaging
                            > and static imaging. Dynamic imaging is an extension of clinical
                            > examination. Ultrasound examination especially echocardiography is
                            > dynamic imaging. Whereas, many common xray studies are static
                            > imaging. Here an image is taken by a technician and analysed by the
                            > physician later. There is no diagnostic logic involved in the
                            > acquisition of such images.
                            >
                            > Dynamic imaging should be done by physicians and static imaging
                            > should be done by technicians. Dynamic imaging involves diagnostic
                            > logic in the acquisition of the images. Hence for effective
                            > examination echocardiography has to be performed by the physician
                            > especially the attending physician. By the same logic it would be
                            > unreasonable to leave the clinical examination to the "clinical
                            > examination technicians".
                            >
                            > Dr. George Thomas
                            > Kochi, India >>
                            >
                            >
                            >
                            >
                            > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                            >



                            Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                          • GersonSL@aol.com
                            Thanks to both Marty Willow and Dr. Edens for your input. I suspect that we may be encountering some of the international differences in both physician time
                            Message 13 of 16 , Jan 7, 2002
                            • 0 Attachment
                              Thanks to both Marty Willow and Dr. Edens for your input. I suspect that we
                              may be encountering some of the international differences in both physician
                              time management as well as health professional education. It may be difficult
                              for our colleagues in other countries to understand how we are educated here.
                              At the same time, there may be things that we do not know about practice in
                              other countries. I hope that our international colleagues will continue to
                              educate and inform us about their worlds.

                              Gerson S. Lichtenberg, RDCS, APS
                              Cardiology Department
                              Oak Park Hospital
                              Oak Park, Illinois

                              In a message dated 1/7/2002 10:18:34 AM, erik-edens@... writes:

                              << Gerson,

                              I totally agree that sonographers can be better at echo than physicians.
                              Several of our experienced sonographers are better than any of our
                              physicians. Much of doing an echo is more art than science and you can't
                              teach that artform except by doing it all day. In academic medicine at
                              least, it's best for physicians to think of this issue as a true team
                              effort, and sonographers are a critical, independent part of that
                              team....it's ok for a sonographer to be better at something than a
                              physician! Several of my physician colleagues couldn't even tell you how to
                              turn the machine on much less do an echo.

                              Thanks for your thoughts,

                              Erik

                              R. Erik Edens MD, PhD
                              Medical Director, Pediatric Heart Transplant Program
                              Divisions of Pediatric Critical Care & Pediatric Cardiology, College of
                              Medicine
                              Division of Medicinal & Natural Products Chemisrty, College of Pharmacy
                              University of Iowa HealthCare
                              Iowa City, Iowa 52242

                              Ph (319)-384-6101 erik-edens@...

                              > -----Original Message-----
                              > From: GersonSL@... [SMTP:GersonSL@...]
                              > Sent: Sunday, January 06, 2002 5:51 PM
                              > To: echocardiography@yahoogroups.com
                              > Subject: Re: SV: [echocardiography] Positions in Europe
                              >
                              > Dear Dr. Thomas:
                              >
                              > While your message starts off by saying, "This message is not intended to
                              > undermine the services of medical technicians especially sonographers,"
                              > you
                              > later say, "Dynamic imaging should be done by physicians and static
                              > imaging
                              > should be done by technicians." You seem to say that you do not believe
                              > that
                              > echocardiographers can perform thorough diagnostic examinations.
                              >
                              > In fact, dedicated medical professionals who receive proper education can
                              > often perform equivalent or even superior echocardiographic examinations
                              > to
                              > those performed by many physicians whose time and efforts are split
                              > between
                              > echocardiography and many other functions. The dedicated echocardiographer
                              >
                              > can develop a deeper understanding of the interaction between ultrasound
                              > and
                              > the human body as well as a better comprehension of equipment functions
                              > and
                              > performance.
                              >
                              > I completely agree that the echocardiographer needs to have a deep
                              > understanding of the clinical questions being asked and the therapeutic
                              > impact that the examination will have. There should be an open
                              > communication
                              > between the echocardiographer and the interpreting physicians in any
                              > ultrasound examination.
                              >
                              > Please let me know if I have misunderstood the points that you are making,
                              >
                              > Dr. Thomas.
                              >
                              > Gerson S. Lichtenberg, RDCS, APS
                              > Cardiology Department
                              > Oak Park Hospital
                              > Oak Park, Illinois
                              >
                              > In a message dated 1/6/2002 5:30:55 PM, gthomaskochi@... writes:
                              >
                              > << This message is not intended to undermine the services of medical
                              > technicians especially sonographers. In the case of medical imaging
                              > there has to be a clear demarcation between clinical examination and
                              > mere imaging. The former has to be done by the physician and the
                              > latter by the technicians. In India most of the echocardiography is
                              > done by physicians.
                              >
                              > In this context it is good to classify imaging into dynamic imaging
                              > and static imaging. Dynamic imaging is an extension of clinical
                              > examination. Ultrasound examination especially echocardiography is
                              > dynamic imaging. Whereas, many common xray studies are static
                              > imaging. Here an image is taken by a technician and analysed by the
                              > physician later. There is no diagnostic logic involved in the
                              > acquisition of such images.
                              >
                              > Dynamic imaging should be done by physicians and static imaging
                              > should be done by technicians. Dynamic imaging involves diagnostic
                              > logic in the acquisition of the images. Hence for effective
                              > examination echocardiography has to be performed by the physician
                              > especially the attending physician. By the same logic it would be
                              > unreasonable to leave the clinical examination to the "clinical
                              > examination technicians".
                              >
                              > Dr. George Thomas
                              > Kochi, India >>
                              >
                              >
                              >
                              >
                              > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
                              >



                              Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/




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                              Date: Mon, 7 Jan 2002 10:14:36 -0600
                              Subject: RE: SV: [echocardiography] Positions in Europe
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                              >>
                            • gthomaskochi
                              I am happy that my message has generated much lively discussion. This message is specifically replying Candy Hogan and Nicole Horve: India, with a population
                              Message 14 of 16 , Jan 9, 2002
                              • 0 Attachment
                                I am happy that my message has generated much lively discussion. This
                                message is specifically replying Candy Hogan and Nicole Horve:

                                India, with a population of a thousand million has very very busy
                                hospitals. Here the cardiology departments emphasize quality medical
                                care at affordable costs. The physicians do echocardiography as an
                                extension of the clinical examination. Some public hospitals have the
                                echo machine in the physician's office and the transducer is used
                                like a stethoscope! Here 30-40 patients are examined and echoed by
                                the physician in one session and the treatment decisions taken
                                immediately. The trick here is focused examination. Look for what you
                                want to clarify. And there are no fancy reports or flashy printouts
                                in the public hospitals. A normal report is just hand written in one
                                word as "normal". We don't find any need in reporting parameters like
                                the E/A ratio or the aortic VTI in such cases. In such erudite
                                looking reports the key observations gets lost in a jumble of petty
                                annotations.

                                Diagnostic acumen plays an important role in the rapid but thorough
                                echo examination. Quick decision-making is possible by the physician
                                who performs the echo himself. A routine examination would consume
                                less than 5 minutes. A tricky congenital, TEE and stress echoes
                                consume more time. In private hospitals where detailed reports are
                                given, secretarial services are required. In our hospital we use the
                                Vingmed System fiVe which has the echoPAC report generating software.
                                So printed report creation becomes easy.

                                As a rule of thumb, it is important to ask yourself the following
                                questions: Why am I doing a particular investigation? In what way is
                                it going to clarify my diagnosis and affect the line of treatment?
                                This is better than wasting time over `routine' measurements and the
                                so-called `thorough' but rote mechanical examination. It is also
                                important to develop a personal algorithm based diagnostic process to
                                provide effective health care.

                                Finally I wish to record my appreciation to Mr. Gerson for his open
                                mindedness.

                                Dr. George Thomas
                                Kochi, India

                                --- In echocardiography@y..., "Hogan, Candy" <candy.hogan@t...> wrote:
                                > I would love to see your studies? Do you do all necessary
                                measurements, pressures, tissue Doppler, colorflow m-mode, etc. to
                                diagnose your patients or do you just eyeball it?
                                >
                                > > -----Original Message-----
                                > > From: gthomaskochi [SMTP:gthomaskochi@y...]
                                > > Sent: Saturday, January 05, 2002 3:34 AM
                                > > To: echocardiography@y...
                                > > Subject: Re: SV: [echocardiography] Positions in Europe
                                > >
                                > > This message is not intended to undermine the services of medical
                                > > technicians especially sonographers. In the case of medical
                                imaging
                                > > there has to be a clear demarcation between clinical examination
                                and
                                > > mere imaging. The former has to be done by the physician and the
                                > > latter by the technicians. In India most of the echocardiography
                                is
                                > > done by physicians.
                                > >
                                > > In this context it is good to classify imaging into dynamic
                                imaging
                                > > and static imaging. Dynamic imaging is an extension of clinical
                                > > examination. Ultrasound examination especially echocardiography
                                is
                                > > dynamic imaging. Whereas, many common xray studies are static
                                > > imaging. Here an image is taken by a technician and analysed by
                                the
                                > > physician later. There is no diagnostic logic involved in the
                                > > acquisition of such images.
                                > >
                                > > Dynamic imaging should be done by physicians and static imaging
                                > > should be done by technicians. Dynamic imaging involves
                                diagnostic
                                > > logic in the acquisition of the images. Hence for effective
                                > > examination echocardiography has to be performed by the physician
                                > > especially the attending physician. By the same logic it would
                                be
                                > > unreasonable to leave the clinical examination to the "clinical
                                > > examination technicians".
                                > >
                                > > Dr. George Thomas
                                > > Kochi, India
                                > >
                                > > --- In echocardiography@y..., "Kjetil Lenes" <kjelen@s...> wrote:
                                > > >
                                > > >
                                > > > > Why there are no announcements about positions available for
                                > > > > echocardiographers in Europe?
                                > > > > Vlad Chubuchny.
                                > > >
                                > > > At least in some countries (Norway, Denmark, Italy, perhaps
                                Great
                                > > Britain as
                                > > > well) there are no formal requirements for echocardiographers.
                                In
                                > > Norway,
                                > > > the physicicans usually do the scans themselves. Here, most
                                techs
                                > > (I think
                                > > > we are less than 10 all together) are nurses trained on-site by
                                the
                                > > doctors.
                                > > > In Sweden there are formal training, but one that also
                                encompasses
                                > > many
                                > > > other modalities of physiological testing/measuring, like
                                > > spirometry and
                                > > > Holter.
                                > > >
                                > > > Perhaps other european collegaues would like to
                                elaborate/correct
                                > > me.
                                > > >
                                > > > Kjetil
                                > > >
                                > > > __________________________________________________________
                                > > > Kjetil Lenes
                                > > > Echo technician, Pediatric Cardiac Unit, Rikshospitalet, Norway
                                > > >
                                > > > Aakebergveien 36A, 0650 Oslo, Norway
                                > > > Phone: +47 22 67 71 78 Mobile phone: +47 995 23 733
                                > > > E-mail: kjelen@s... E-mail work: kjetil.lenes@r...
                                > >
                                > >
                                > >
                                > >
                                > > Your use of Yahoo! Groups is subject to
                                http://docs.yahoo.com/info/terms/
                                > >
                                > >
                              • GersonSL@aol.com
                                Thank you for your commentary, Dr. Thomas. What you describe certainly makes a great deal of sense in your situation. I certainly agree that reports that
                                Message 15 of 16 , Jan 9, 2002
                                • 0 Attachment
                                  Thank you for your commentary, Dr. Thomas. What you describe certainly makes
                                  a great deal of sense in your situation. I certainly agree that reports that
                                  actually tell the referring physician what he wants to know in simple form
                                  make more sense as well here.

                                  There is nothing thorough about a rote examination. I have always taught
                                  echocardiographers and physicians that we actually should perform 2
                                  examinations: one looking for the answer to the clinician's question and
                                  another looking for the unexpected. Some people's 'focused' examinations
                                  cause them to neglect other possibilities.

                                  The questions that you suggest (Why am I doing a particular investigation? In
                                  what way is it going to clarify my diagnosis and affect the line of
                                  treatment?) are exactly the same ones that skilled echocardiographers are
                                  taught to ask before performing a study.

                                  In the US, we also have a need to document complete studies since we ask the
                                  insurance companies to pay us for them. Trying to derive a reimbursement
                                  structure for 'focused' studies would be impractical. In addition, we have a
                                  need to protect ourselves legally by showing that we checked all appropriate
                                  areas. I am not saying that these are always good things, but that is the way
                                  it is.

                                  Thanks again for your enlightenment, Dr. Thomas. Best wishes!
                                  Gerson S. Lichtenberg, RDCS, APS
                                  Cardiology Department
                                  Oak Park Hospital
                                  Oak Park, Illinois

                                  In a message dated 1/9/2002 10:06:57 AM, gthomaskochi@... writes:

                                  << I am happy that my message has generated much lively discussion. This
                                  message is specifically replying Candy Hogan and Nicole Horve:

                                  India, with a population of a thousand million has very very busy
                                  hospitals. Here the cardiology departments emphasize quality medical
                                  care at affordable costs. The physicians do echocardiography as an
                                  extension of the clinical examination. Some public hospitals have the
                                  echo machine in the physician's office and the transducer is used
                                  like a stethoscope! Here 30-40 patients are examined and echoed by
                                  the physician in one session and the treatment decisions taken
                                  immediately. The trick here is focused examination. Look for what you
                                  want to clarify. And there are no fancy reports or flashy printouts
                                  in the public hospitals. A normal report is just hand written in one
                                  word as "normal". We don't find any need in reporting parameters like
                                  the E/A ratio or the aortic VTI in such cases. In such erudite
                                  looking reports the key observations gets lost in a jumble of petty
                                  annotations.

                                  Diagnostic acumen plays an important role in the rapid but thorough
                                  echo examination. Quick decision-making is possible by the physician
                                  who performs the echo himself. A routine examination would consume
                                  less than 5 minutes. A tricky congenital, TEE and stress echoes
                                  consume more time. In private hospitals where detailed reports are
                                  given, secretarial services are required. In our hospital we use the
                                  Vingmed System fiVe which has the echoPAC report generating software.
                                  So printed report creation becomes easy.

                                  As a rule of thumb, it is important to ask yourself the following
                                  questions: Why am I doing a particular investigation? In what way is
                                  it going to clarify my diagnosis and affect the line of treatment?
                                  This is better than wasting time over `routine' measurements and the
                                  so-called `thorough' but rote mechanical examination. It is also
                                  important to develop a personal algorithm based diagnostic process to
                                  provide effective health care.

                                  Finally I wish to record my appreciation to Mr. Gerson for his open
                                  mindedness.

                                  Dr. George Thomas
                                  Kochi, India >>
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