Epsilon Imaging introduces new application for right ventricle assessment

Epsilon Imaging, a provider of workflow enhancing solutions for cardiology, has introduced EchoInsight visualization and analysis platform, a new application for right ventricle (RV) assessment.

The EchoInsight visualization and analysis platform offers quick and intuitive strain imaging along with automated cardiac function measurements for improved quality, standardization and workflow in echo interpretation.

The EchoInsight suite of applications now includes cardio oncology for left ventricle (LV) assessment and management, RV and stress echo.

University of Chicago Medicine cardiologist Dr Roberto Lang noted EchoInsight for RV offers quick and reliable visualization and analysis with practical strain imaging for function assessment and comparison over time.

“RV is challenging to assess in 2D imaging, EchoInsight for RV brings robust and intuitive tissue motion analysis along with automated cardiac function measurements to clinical practice.

“This added quantitative data in a practical solution can assist clinicians by improving confidence in interpretation when evaluating RV,” Dr Lang added.

Northwestern Memorial Hospital cardiologist Dr Benjamin Freed noted this newest application from Epsilon Imaging designed specifically for RV function assessment compares well with strain analysis using cardiac MR – the gold standard.

“EchoInsight for RV offers a versatile, efficient and economic approach to thoroughly assess RV and improve management of patients when evaluating the right heart for a variety of indications,” Dr Freed added.

According to the company, the complete EchoInsight suite of applications is now available for sale.

Reference: http://www.medicaldevices-business-review.com/news/epsilon-imaging-introduces-new-application-for-right-ventricle-assessment-181013

Study shows FaceTime with iPhone is successful in teaching Cardiac Ultrasound remotely

Oct 21, 2013 by Farah Moustafa

iphone holder for handheld ultrasound equipmentPocket sized ultrasound devices (PUDs) have  potential to  improve global health care delivery due  to their potential role in areas with limited resources. Although theoretically  they have much promise, their use has been limited due to a lack of imaging protocol and trained users.

This particular study, titled — “Feasibility of remote real-time guidance of a cardiac examination performed by novices using a pocket-sized ultrasound device” looked at the cardiac limited ultrasound exam (CLUE)  to screen for  left ventricular (LV) systolic dysfunction, left atrial (LA) enlargement, ultrasound lung comets, and elevated central venous pressure (CVP).

Previous studies have shown that CLUE not only provides diagnostic and prognostic data, but also confers the potential of wireless transmission of data (unavailable for traditional  bedside cardiac exams).


To determine the feasibility of utilizing low-cost smartphone based  applications that allow wireless video conferencing to guide novice users in using  CLUE.

Study Conclusion:

A novice with limited training can perform CLUE  using PUD when wirelessly guided by an expert (using FaceTime — explained in the Methods section below). This method can increase the use of PUD and help in emergency settings and medical triage.

Commentary and Implication to mHealth:

CLUE screens for signs associated with potentially life-threatening diagnoses. For example, LV systolic dysfunction detected by CLUE occurs acutely in  myocardial infarctions, septic shock, and acute heart failure.  Based on the results of this study, Facetime technology can be used with PUDs to perform CLUE in emergency settings when cardiologists are not on the scene.

Not only would these signs evaluate acute cardiac processes, but the eCVP for example, can help differentiate between different types of shock.  Using tools that allow healthcare providers to communicate with experts and consult specialists can save valuable time and minimize  morbidity and mortality and lead to better patient outcomes. This was a relatively small study and needs further and larger studies that  investigate using other signs  that can be present in emergency situations. Also, as this has implied use as a screening tool in emergency scenarios, one would hope the technology should achieve higher sensitivity (study’s sensitivity was 0.67).

Ipod holder on an ultrasound device



Three trainees in San Diego, California with less than one-hour device orientation and no previous ultrasound experience performed CLUE using a PUD ( either the Vscan, GE Healthcare, or the P10, Siemens Healthcare) attached to an iPhone 4 or iPod using a mount. The mount  enabled the iPhone/iPod’s front facing VGA camera to be facing the PUD display screen using the Apple’s Facetime — data from subjects’ ultrasound was transmitted to an off-site cardiologist’s iPod. The  off-site cardiologist then assessed the quality of the images and trainee’s image acquiring technique  and provided remote audiovisual guidance and interpretation of CLUE signs to  the trainees.

The accuracy and quality of the PUD transmitted images was then compared to the gold standard echocardiograms performed by a registered sonographer. Values such as diagnostic sensitivity, specificity, accuracy, positive and negative predictive value were  derived by using the standard echocardiogram for reference.

Ultrasound and iphones


In all 27 subjects, there was successful transmission of Ultrasound images and guidance from offsite physicians. 2/27 transmissions were dropped and re-initiated. Remotely-guided novice image yielded adequate CLUE views with 90% success versus sonographer imaging which achieved 96% success(p <0.05). Compared to the gold-standard echo thresholds, CLUE had a combined sensitivity of 0.67, specificity  of 0.96, and an accuracy of 0.90 .

Article Name: Feasibility of remote real-time guidance of a cardiac examination performed by novices using a pocket-sized ultrasound device.
Authors:  Mai TV, Ahn DT, Phillips CT, Agan DL, Kimura BJ.
Journal Published:  Emerg Med Int.
Date Published:  August 20, 2013
Citation:  Emerg Med Int. 2013;2013:627230. doi: 10.1155/2013/627230. Epub 2013 Aug 20.


How I got started: Educators in Ultrasound

by Bonnie Starr

Gulfcoast Ultrasound Hands-On
Bonnie Starr Hands-On Instructor at Gulfcoast Ultrasound Institute.

I started out in general radiology in 1971 and worked in that field for about 11 years.  They were performing ultrasound exams at the hospital nearby but we did not have the capability where I worked.  However, what little bit I did get to hear and see of this new field really interested me.  I was taking a class at the junior college at the time and needed to write an article for the program so I decided to accomplish two goals at one time the article was entitled “Ultrasound the New Kid on the Block”.  Surprisingly enough, it won an award and I was asked to present it at a national meeting in Atlanta.  I think it was the research for that article that planted the seed. I was hooked!  I asked my administrator if they would purchase an ultrasound unit if I went back to school to pick up the Ultrasound training and I’m grateful to say they said yes!  We’ve grown into 6 units at two different locations and we stay busy.

I think one of the accomplishments I’m most proud of is having taught myself the echocardiography portion without ever being in a setting where we got to do them on a daily basis.  With being able to shadow next to some excellent echocardiographers in our area and using the Echocardiography and Registry Review products that I got from Gulfcoast Ultrasound Institute, I was able to take the registry and pass it.  Once again, I was grateful!  30 years later I couldn’t be happier working in any other field with the opportunity to participate in the hands-on instruction with Gulfcoast Ultrasound Institute, and hopefully make someone else’s journey a little easier.  I’d recommend the field to anyone!

Bonnie Starr, BA, RDMS, RDCS, RVT


Certifications, Reimbursement and Lab Accreditation Updates

EchocardiographyEver changing certification, lab accreditation and reimbursement standards for echocardiography and vascular ultrasound can be confusing and hard to keep up with. To help out we’ve bundled it up, listed useful links to the right resources and summarized the key points to help answer all those burning questions.


Did you know; if you currently hold a certification from the ARDMS (American Registry of Diagnostic Medical Sonographers) you will not be required to begin taking the recertification exam until 2019 and will not have to pass it until 2022?

This includes all RDMS, RVT and RDCS registered Technologists. For all new certifications earned after January 1, 2012, you will have to take your recertification exams starting 10 years after you have acquired your credential.
* for more information regarding recertification and credentialing, please visit www.ardms.org


Did you know; reimbursement requirements for Medicare varies from state to state?

Several states require either lab accreditation and/or sonographer/physician credentialing for reimbursement. This applies to echocardiography and non-invasive vascular studies.

Full policy details and individual state reimbursement directive can be found on the Centers for Medicare & Medicaid (CMS) website.

To find a payment policy, go to www.cms.gov/mcd/overview.asp and follow these instructions:

  1. Click on Advanced Search
  2. Under Search by Document Type, check Local Coverage Documents
  3. Under What documents types do you want to search for? Check All Policies (LCD) and then Final Policies
  4. Select Geographic Area (State) AND/OR Contractor Criteria
  5. Type the testing area you are searching for (i.e., noninvasive vascular) or the LCD ID # into Enter Keyword(s) box and choose Title
  6. Click Search by Type box
  7. A page will appear asking you to accept the Terms & Conditions, Click Agree
  8. A new page will open with your search results

Additional information on reimbursement for individual states can found on the ICAVL website for vascular reimbursement and the ICAEL website for echocardiography.

Lab Accreditation:

Did you know; by 2017 ICAVL (Intersocietal Commission for the Accreditation of Vascular Laboratories) requires all technical staff to be registered to comply with lab accreditation?

Appropriate credentialing: RVT (Registered Vascular Technologist) from the ARDMS, RVS (Registered Vascular Specialist) from CCI or RT (VS) (Registered Technologist Vascular Sonography) from the ARRT.

Additional information on credentialing can be found at www.ardms.org, www.cci-online.org , or www.arrt.org

Did you know; that ICAEL (Intersocietal Commission for the Accreditation of Echocardiography Laboratories) is changing their physician requirements?

All physicians who do not have level 2 or 3 echocardiography training must pass the NBE (National Board of Echocardiography) by 2015 to comply with ICAEL accreditation. The purpose of the NBE is to establish the domain of the practice of echocardiography for the purpose of certification, assess the level of knowledge demonstrated by a licensed physician practitioner of echocardiography in a valid manner, enhance the quality of echocardiography and individual professional growth in echocardiography, formally recognize individuals who satisfy the requirements set by the NBE, and serve the public by encouraging quality patient care in the practice of echocardiography.

For more information on the NBE please visit www.echoboards.org

Training Level

Cumulative Duration
of Training

Minimum Number of
Examinations Performed

Minimum Number of
Examinations Interpreted

Level 1

3 months



Level 2

6 months

150 (75 additional)

300 (150 additional)

Level 3

12 months

300 (150 additional)

750 (450 additional)

Additional information on reimbursement for individual states can be found on the ICAVL website for vascular reimbursement and the ICAEL website for echocardiography.