Workshops: H.A.R.T.scan®
Haemodynamic echocardiographic Assessment
in Real Time
Click here for The University of Melbourne workshop dates and a copy of the brochure.
Registration Fee for 2012 Workshops = $1300.00 (inclusive of GST) AUD
H.A.R.T.scan® is a registered name.
1. Historical Development of This Course
Echocardiography has seen a meteoric rise in use in ultrasound since the mid-1990s in Australia and around the world. When echocardiography was first introduced, it was predominantly for use in cardiac surgery with transoesophageal echocardiography. In some cases, however, the strong trend is for non-cardiac anaesthesia, ED and ICU physicians to integrate echocardiography into their practice. This requires a goal focused limited scan in the majority of instances.
Limited echocardiography is not a totally new concept. There are publications looking at the use of limited echocardiography to assess volume or systolic function or as a screening tool to rule out severe aortic stenosis. Haemodynamic state assessment is a concept that we have championed through the Postgraduate Certificate/Diploma in Clinical Ultrasound (see www.heartweb.com.au). Our goal is to strike a balance between “too little and too much” by analysing the important information we need for the critical care environment, in order to influence how we will manage patients. Also, a limited study should be non-invasive and brief so that it does not interfere with all the other aspects of providing critical care management whether that is in the OR, ICU or ED.
In ranking the information, Haemodynamic state assessment is really the “bread and butter” of echo information. We will use that information in 90% of clinical situations to change our management. However, it is not enough, because findings of haemodynamically important valve lesions (e.g. severe aortic stenosis) or pericardial effusion will change how we will manage patients. So we struck the dilemma of how much valve assessment we should build into the examination. The problem with echocardiography is that there is such a vast difference in the knowledge base required to perform a limited exam and interpretation versus diagnostic grading of valve lesions using multiple modalities such as 2D, colour flow Doppler and quantitative Doppler. The compromise is to use 2D and colour flow Doppler only, and to grade valve lesions as “ok” or “potentially bad” which will be explained in the tutorials. How to discriminate a valve lesion that could lead to haemodynamic compromise vs. one that does not will be covered. We have placed a special tick box in the report to remind you about referring the patient for a follow up comprehensive echo when you identify a problem.
Remember, this scan is to help you manage patients in real time rather than to make you into a diagnostic echocardiographer – if in doubt refer and follow up!
In this regard, we are promoting the concept of limited transthoracic echocardiography to perform Haemodynamic Echocardiographic Assessment in Real Time, or HEARTscan for short. The study should take about 5 minutes once you have practiced it and it can be repeated as often as required without causing any risk to the patient. We believe this may well be an important future development in perioperative management of patients.
We strongly believe that the entry point to the use of ultrasound in non-cardiac anaesthesia, intensive care medicine, and emergency medicine will be performed using surface ultrasound techniques. As the individual's thirst for knowledge progresses, they may move on to transoesophageal echocardiography and comprehensive echocardiography examinations. This is essentially "round the other way" to what has been done in the last decade.
For those who wish to continue further studies and become expert in echocardiography, there are courses available such as The University of Melbourne Postgraduate Certificate/Diploma in Clinical Ultrasound and Echocardiography. It is designed to provide the knowledge base in a systematic manner to become highly competent in echocardiography and surface ultrasound. Please visit www.heartweb.com.au for more details.
This course is supported by Sonosite, who manufacture small portable echocardiography machines. The same concepts, however, can be performed using conventional ultrasound equipment, (it is simply less portable). It is important that you do not confuse "point of care" with "portable", but you will have the opportunity to evaluate this type of ultrasound equipment which you may not yet have at your institution. This type of equipment does have the advantage of being very robust and relatively drop proof, which is important when you're moving ultrasound equipment from place to place and allowing multiple people to use it. Conventional echocardiography systems are more difficult to drop because they are situated on trolleys, but suffer the disadvantage of being less portable. Ultimately, I envisage that this type of ultrasound equipment will be available as a plug-in module to your conventional monitoring/anaesthetic machines.
This course is therefore designed to provide you with the starting point for ultrasound use, and to give you enough confidence to realise that it is not that hard to do, and to encourage you to start using ultrasound in a limited fashion in your practice. I'm sure you'll soon find that it becomes an invaluable part of your practice and you will be infected with the echocardiography virus!!!
2. The Course Development Team
The course is administered through The University of Melbourne. The University provides an extensive infrastructure that is able to support an educational program of this nature.
The course directors are Professor Colin Royse and Associate Professor Alistair Royse, who head the Ultrasound Education Group and the Human Cardiovascular Research Laboratory in the Cardiovascular Therapeutics Unit, Department of Pharmacology and Department of Surgery, The University of Melbourne.
At the early stage of the development of the workshops and the postgraduate courses, a steering committee was recruited comprising of experienced educators in echocardiography in Australia and New Zealand including David Canty, John Faris, Lenore George, Peter Hebbard, Roman Kluger, Ajay Kumar, Paul Soeding, Michael Veltman, Konstantin Yastrebov, James Lai, Chris Ashley, Alwin Chuan and Clement Fong.
Members of the steering committee were involved in course preparation including setting the educational objectives, coordinating subjects, liaising with individual tutors, and setting examinations. Many of these colleagues conduct some of the hands-on workshops.
We are also indebted to our consultant echocardiographers and the workshop team.
Although this has been a group effort, special acknowledgement must go out to our TTE gurus from Perth, Michael Veltman and John Faris, who have really helped to evolve our concepts of limited TTE into the H.A.R.T.scan?® format.
3. Course overview
The workshop is divided into two components; the theoretical part and the two-day workshop.
Theory
Tutorials will be supplied via a customised software application, further details on how to download the Student App is provided in this document. Please study these tutorials before attendance to the workshop. We will not go over the theory during the workshop as the focus is on the hands-on practice; however having the theoretical knowledge base would be beneficial to your learning.
The aim of the tutorials is to provide a good understanding of echocardiography. There is a lot of information in the tutorials and it is recommended that you spend approximately 20 hours to study prior to the workshop. Please contact us if you have any questions regarding the course content.
Some of you may have enrolled or completed the Postgraduate Certificate/Diploma in Clinical Ultrasound and Echocardiography will notice that some of the tutorials are modified for the workshop.
Workshop
The second part of the course is the two-day workshop where you come to practice on the ultrasound machines. The aim is to obtain enough practice in order to give you the confidence to start doing it yourself.
There will be six bays; each bay will have a demonstrator who performs echocardiography or ultrasound examination on a clinical model. Participants are divided into six groups and be rotated through the six bays in order to cover all aspects of the course.
The Skill Sets are as follows
1. Learn how to acquire the TTE views
2. Understand Haemodynamic Sate Assessment
3. Limited valve assessment using 2D and colour flow Doppler
4. Putting it all together – doing a HEARTscan
5. Writing a H.A.R.T.scan® report. | 
