Expert Consensus Statement
Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography

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Why is a Guideline Needed?

The value of ultrasound as a diagnostic cardiac modality is in many respects unparalleled. It is more portable and less expensive compared with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear perfusion imaging). Unlike methods that expose patients to radiation, there are no known adverse effects of ultrasound used at diagnostic imaging intensities, which allows safe, serial evaluation of patients. Echocardiography permits rapid assessment of cardiac size,

What is FCU?

FCU is a focused examination of the cardiovascular system performed by a physician by using ultrasound as an adjunct to the physical examination to recognize specific ultrasonic signs that represent a narrow list of potential diagnoses in specific clinical settings.

Terminology

There are a variety of terms that have been used to describe a focused ultrasound of the heart. The importance of defining the nomenclature is the recognition that these procedures are distinct from the practice of echocardiography,

Differentiation of FCU and “Limited Transthoracic Echocardiography (TTE)”

The technical requirements for equipment, expertise for image acquisition, and the knowledge base for image analysis and interpretation have been well defined for echocardiography. This permits the appropriate and safe use of echocardiography in an unlimited number of clinical scenarios and permits its users to have a very broad scope of practice. Because of equipment capability, image acquisition training, image interpretation training, and image interpretation knowledge base, the practitioner

Personnel

Rapid evaluation to expedite patient triage and early management is an important role of specialists in emergency medicine. Assessment of critically ill patients after hours or at the bedside after a sudden change in clinical status is a role of critical care physicians. Internists, surgeons, and hospitalists perform serial evaluations of hospitalized adult patients daily. These are all situations when a sonographer or level II/III trained physician in echocardiography are potentially not

FCU Scope of Practice

As with any clinical tool, inappropriate application of FCU beyond a defined scope of practice may have adverse consequences on patient diagnoses, triage, and management. One paradigm is to use FCU routinely as an adjunct to the physical examination with every patient encounter. However, the impact of widespread use of FCU in all patient encounters that involve a physical examination has not been tested. The implications of following up on abnormalities detected by routine use of FCU at the

Training Recommendations

The development of FCU devices offers the opportunity to provide a quick snapshot view of the heart at the bedside. Although the devices and protocols are less complex than standard echocardiography, the training and oversight required to develop the skills necessary to perform and interpret FCU studies must not be minimized. Although specific training requirements (duration, number of studies, etc) are not offered, this document provides a framework from which the medical community can

Notice and Disclaimer

This report is made available by ASE as a courtesy reference source for their members. This report contains recommendations only and should not be used as the sole basis to make medical practice decisions or for disciplinary action against any employee. The statements and recommendations contained in this report are primarily based on the opinions of experts, rather than on scientifically verified data. ASE makes no express or implied warranties regarding the completeness or accuracy of the

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    The following authors reported no actual or potential conflicts of interest in relation to this document: Bruce J. Kimura, MD, Claudia E. Korcarz, DVM, RDCS, FASE, Patricia A. Pellikka, MD, FASE, Kirk T. Spencer, MD, FASE. The following authors reported relationships with one or more commercial interests: Peter S. Rahko, MD, FASE, has received research support from Siemens; Robert J. Siegel, MD, FASE, has served as a speaker for Philips Medical Systems.

    Reprint requests: American Society of Echocardiography, 2100 Gateway Centre Boulevard, Suite 310, Morrisville, NC 27560 (E-mail: [email protected]).

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