ASE Board-approved policy statements highlight the scope of issues being addressed in cardiovascular ultrasound. New policies are initially distributed to ASE members via the official journal, JASE and then posted here. Policies have been reviewed that are over ten years and have been phased out should they be contradictory in nature with new policies or not relevant to Society current practices.
10-25-2023 – ASE approves the following statement:
ASE’s AI Policy Statement
The ASE is committed to advancing the field of echocardiography and advocates for the use of artificial intelligence (AI) in cardiovascular ultrasound medicine. Artificial Intelligence systems hold the potential to enhance workflow efficiency and improve patient outcomes through improved disease detection and prediction of future events and the Society supports these positive outputs. AI also has the potential to enhance healthcare delivery by maximizing cost-effectiveness and equity. The Society would like to encourage its use, while noting areas of concern related to creation and implementation of this technology, in order to better guide the field and its development.
Utilize Common Terminology
The lack of clear, standard definitions for AI healthcare and its varied and diverse applications may be a hinderance to innovation and modernization of patient care. ASE advocates for distinctions to be used between assistive, augmentative, and autonomous categories of care, so that the appropriate payment pathways and methodologies are utilized. ASE believes developing and using common AI terminology and its application in healthcare systems will allow patients and clinicians* to better understand coverage and reimbursement of such technologies. We support the American Medical Association Current Procedural Terminology (CPT®) Editorial Panel; Appendix S: AI taxonomy for medical services & procedures definitions and values (Assistive, Augmentative, and Autonomous).
Appropriately Vet the AI Development
An FDA-authorized, rigorously validated process is critical to ensure consistently delivering quality products for patient care. As AI rapidly integrates into routine healthcare, it is important that the way in which the data is collected and used to drive patient care is transparent and in alignment with understanding how diversity and inclusion of patient data could affect appropriate patient care.
Recognize the Role of the Clinician* in Delivering AI Care
Careful design of payment for AI is essential. Current U.S. payment structures are not readily compatible with AI. Most U.S. payment models are predicated on incorporating AI as incremental and supplemental service, but not as a replacement for the clinician*. The underlying assumption of some recent AI payment plans is that AI will reduce the clinician’s* work, which may not always be the case. AI has great potential to support care, but that does not take away the clinician’s* interpretive effort and expertise that is needed. We urge the application of appropriate and different payment pathways for the diverse range of AI services, ranging from assistive to autonomous, when determining AI usage.
Liability Issues Hold Back Innovation in AI
Healthcare providers recognize the value of healthcare AI tools and have made significant investments to integrate these innovative technologies into patient care. However, there is the concern that algorithm inaccuracy could lead to patient injury and medical liability. Indeed, the promise of AI technology comes with a cautionary note: malpractice concerns can impact clinician* decisions to consult AI. To ensure clinicians* are secure in using AI services, liability should be balanced across the entire medical community, avoiding undue burdens on physicians and frontline clinicians*, and promoting safe AI and machine learning (ML) development and integration.
*For purposes of this policy statement, clinician is defined as any individual involved in performance and interpretation of cardiovascular ultrasound and cardiovascular ultrasound-based testing
7-18-2022 – ASE approves the following statement:
The American Society of Echocardiography Position Statement Regarding Dobbs v. Jackson
The American Society of Echocardiography (ASE) is a professional society for all users of cardiac ultrasound. Most ASE members are health care professionals. The mission of ASE is to advance cardiovascular ultrasound and improve lives through excellence in education, research, innovation, advocacy, and service to the profession and the public.
In 1973 the U.S. Supreme Court ruled (Roe v. Wade) that abortion was a constitutional right. Since that decision, abortion has been a federally protected right up to the point of fetal viability – determined in 1973 to be 24-28 weeks. The current Supreme court recently overturned that ruling (Dobbs v. Jackson Woman’s Health Organization) thus allowing individual states to enforce a spectrum of restrictions on access to abortion, including a total ban in some states. For the lay public, and for state and federal policy makers, the profound implications of this court ruling should be emphasized. For states to restrict access to; performance of; or assistance in travel to a therapeutic abortion is an intrusion into a very complex health care decision making process.
Fetal ultrasonography, including fetal echocardiography, are medical procedures routinely used to confirm the gestational age of the fetus; to establish normal or abnormal fetal development; and to specifically characterize the risk to both the fetus and mother. Providers of fetal ultrasound are dedicated to working with the expectant mother and family to achieve the birth of a healthy infant and to permit the development of a well-prepared plan for those infants needing special post-natal care or intervention. However, significant fetal anomalies can be associated with fetal or infant morbidity or demise, as well as substantial risk (including death) for the mother. Even in a planned pregnancy in a healthy mother, an ultrasound exam can detect critical fetal and/or pregnancy related abnormalities that prompt a patient and care-provider discussion about pregnancy termination. In such situations, medical professionals counsel patients and their families about the full spectrum of medical options – including therapeutic abortion.
Another population who will be adversely affected by this court decision are women who have cardiovascular conditions which place them (and the fetus) at high risk for death or morbidity during pregnancy. Diagnosed by cardiovascular ultrasound, these conditions include cardiomyopathies; pulmonary hypertension; complex congenital cardiac anomalies; significant disorders of heart valves, the aorta, or coronary arteries. Some of these conditions may be detected for the first time during a pregnancy – planned or unplanned. If the condition is severe, supportive medical counselling may include consideration of pregnancy termination as a lifesaving maternal therapy.
The ASE does not support a specific political agenda, party affiliation, or candidate. We do, however, support all users of cardiac ultrasound – including our members who are routinely faced with very difficult fetal and maternal diagnoses, complex medical counselling, and difficult choices. The recent ruling by the U.S. Supreme court to abolish federal protection of access to this medical procedure has profound implications for patients, their families, and the medical professionals who provide diagnostic procedures and counselling to these vulnerable patients.
4-11-2022 – ASE approves the following policy:
ASE Statement on a Patient-Centered and Personalized Approach to Imaging
ASE strongly endorses patient-centered and personalized imaging. Rather than an automatic testing default, a personalized approach to testing based on clinical information is better and benefits the patient. Every clinical presentation should be evaluated individually to determine which imaging test is appropriate. Factoring in technical local expertise, quality and availability of equipment, likelihood of cardiovascular disease, and patient preference are all extremely important in deciding the optimal approach. We believe a multi-disciplinary team is best and the patient, patient advocate and their family’s viewpoints are important contributors for shared decision-making. A patient-centered approach may reduce administrative burden, avoid care delays, and support the unique role of the physician/patient interaction. In alignment with personalized imaging, ASE also believes in high-quality testing. The ASE Accreditation Policy Statement published on February 15, 2014, outlines ASE’s commitment to advocating for an environment of excellence in quality and practice of cardiovascular ultrasound.
5-27-2021 – ASE approves the following policy:
ASE Policy Statement on the Adult Cardiac Sonographer Performing Screening Echocardiograms in the Newborn
The American Society of Echocardiography (ASE) is committed to supporting sonographers provide the best care for patients of all ages, newborns through adults. The ASE recognizes that sonographers without specialized pediatric training will be asked to perform transthoracic echocardiograms in newborn infants at institutions without onsite pediatric sonographers and pediatric cardiologists. The primary indication for these neonatal echocardiograms will be to assess for the presence of critical congenital heart disease that may require emergency medical intervention and transfer to a tertiary pediatric cardiac center for further infant care. Realizing the stress and challenges this scenario imposes upon sonographers, the ASE advocates for the universal adoption of the following:
- Availability of additional sonographer training (online or in-person) for sonographers tasked with performing these scans;
- Development of immediately accessible online educational tools;
- Availability of appropriate ultrasound equipment for imaging newborn infants at all institutions performing Obstetrical deliveries and neonatal pulse oximetry screening;
- Information Technology resources to support high bandwidth telemedicine transfer of imaging data; and
- Establishment of formal telemedicine agreements or consultative privileges between hospitals without on-site pediatric cardiology presence and designated pediatric cardiologists available for prompt consultation.
3/21/2021 – ASE approves the following policy:
ASE Statement on Prevention of Work-Related Musculoskeletal Disorders
The American Society of Echocardiography (ASE) advocates for safe and effective working conditions in the field of cardiovascular ultrasound. The rise in the incidence of work-related musculoskeletal disorders (WRMSD) reported in sonographers is concerning and can result in increased costs to the health care system as well as personal costs to the sonographer. All parties including employers, patients, and sonographers benefit from a safe ergonomically sound working environment. Sonographers, employers, and manufacturers should continue working together to create a safe and ergonomic workplace. Manufacturers should produce equipment that is ergonomically designed and allows for height and reach adjustment as well as lightweight and appropriate grip transducers. Employers can contribute to a safe environment by designing lab workflow to include breaks between scans, rotating shifts to reduce repetitive scanning patterns, limiting portable bedside exams, and providing ergonomic equipment. Cardiovascular ultrasound exams should be scheduled with sufficient time for patient and room set up, use of advanced technologies as needed, measurements, post-examination cleaning of room and equipment, and report generation if applicable. Sonographers are responsible for practicing good ergonomics when scanning, using available ergonomic equipment, and actively engaging in exercises (i.e. stretches) before and after exams to decrease the risk for WRMSDs.
11/23/2020 – ASE updates the following policy:
ASE Diversity and Inclusion Policy
The American Society of Echocardiography (ASE) is a global, multicultural, and inclusive organization. Our membership is open to all those invested in cardiovascular ultrasound. We value the variety of approaches and perspectives in healthcare. We recognize that diversity in all aspects (e.g. age, race, ethnicity, gender identity, sexual orientation, religion, nationality, profession, work setting and disability) drives innovation and contributes to building a holistic culture that will, in turn, enhance our ability to care for our patients and eventually benefit those living with cardiovascular disease. Including diverse individuals adds value to our activities by increasing the range of experience, ideas and perspectives. We will strive to build a diverse and inclusive organization at all levels, including leadership, staff, councils, committees, taskforces, faculty, writing groups and other volunteer activities. This pattern of diversity and inclusion will be reflected in all our activities internally and with our vendors and partners.
10/22/2019 – ASE approves the following policy:
ASE Diversity and Inclusion Policy
The American Society of Echocardiography (ASE) is a global, multicultural, and inclusive organization. Our membership is open to all those invested in cardiovascular ultrasound. We value the variety of approaches and perspectives in healthcare. We recognize that diversity in all aspects (e.g. age, race, ethnicity, gender identity, sexual orientation, religion, and disability) drives innovation and contributes to building a holistic culture that will, in turn, enhance our ability to care for our patients and eventually benefit those living with cardiovascular disease. Including diverse individuals adds value to our activities by increasing the range of experience, ideas and perspectives. We will strive to build a diverse and inclusive organization at all levels, including leadership, staff, councils, committees, taskforces, faculty, writing groups and other volunteer activities. This pattern of diversity and inclusion will be reflected in all our activities internally and with our vendors and partners.
8/28/2018 – ASE approves the following statement on TEE.
1/9/2018 – The ASE approved the Recommendations for the Qualifications for Medical Director of an Echocardiography Laboratory. The statement reads: The recent COCATS 4 Training in Echocardiography document carefully recommends criteria for level I, II and III training, but it does not, nor was it intended to, describe the skill sets necessary to qualify to be the medical director of an echocardiography laboratory. Academic teaching centers must be able to provide the necessary components for all COCATS levels of training as well as exposure to new technologies and other advanced forms of imaging. Accordingly, it is generally expected that directors in this setting have expertise in all clinical aspects of echocardiography, familiarity with all other cardiac imaging modalities and a strong background in research and education. Level III training (1) or its experience equivalent and board certification provide an important foundation. However, the services required to meet the demands at non-academic healthcare facilities may differ in scope from that of academic centers. While the degree of training necessary to be successful in these settings will vary, the ASE endorses the notion that the scope of training and maintenance of certification should meet or, even better, exceed the needs of present day practice and conform to the IAC standards for the requirements for medical director (2). Regardless of training, laboratory location or focus, leadership skills, such as the ability to communicate, organize and work well with others are additional important prerequisites. Other important attributes include a commitment to quality, appropriate use, ongoing education and mentorship as well as the ability to manage the finances of the operation. External recognition of quality and expertise from professional societies, such as Fellow of the American Society of Echocardiography designation, or the internal recognitions from individual institutions are desirable. Hence, rather than recommending a specific level of training and experience, it seems more appropriate for the employing institution to assess all of the above and determine the best candidate to serve as director.
11/7/2017 – ASE approves a policy to allow International Alliance Partners to re-publish ASE guidelines either translated, or if in English, after three years once the citation limitation is passed.
11/7/2017 – ASE approves the new terminology “UEA” to be used interchangeably with “contrast agent” as outlined in the ASE Ultrasonic Enhancing Agents in Echo guideline.
2/17/2017–ASE approves the following policy:
ASE recognizes that sonographers are an integral part of the cardiac imaging team and support their active role during the performance of a TEE. However, that role should be limited to their scope of practice. Specifically, ASE supports sonographers using their expertise and skills to optimize images (i.e. adjust gain, contrast, and other machine settings) during the TEE exam. ASE does not advocate for sonographers to perform TEE intubation or manipulation of the probe. The decision was approved unanimously by the Board due to the infrequency of the practice at healthcare institutions, the diversity of laws and regulations per state, and lack of established processes that ensure competency for treating acute complications in performing TEE. The Board believes the field will continue to evolve and that sonographers will continue to need TEE education pertinent to their practice to stay current in this field.
3/23/2016 – ASE affirms the role of live scanning for educational purposes.
2/15/2014 – ASE approves the following statement (amending the statement approved on 11/2013):
ASE Accreditation Policy Statement
ASE is committed to advocating for an environment of excellence in the quality and practice of cardiovascular ultrasound. As such, the Society supports pediatric, vascular and adult lab accreditation as an established method of achieving these goals. ASE recommends that in every laboratory minimum standards be maintained in terms of equipment, quality improvement activities, and lab protocols. An environment of excellence also requires that the entire cardiovascular team engages in continuing education to maintain and improve their skills over time. To address both the quality and appropriateness of cardiac and vascular care, ASE believes that all labs serving adult, vascular or pediatric patients should utilize clear, consistent processes to ensure establishment and continued reassessment of methods for achieving and maintaining standards and excellence.
3/19/2011 – ASE officially affirms that the National Board of Echocardiography (NBE) is the current authority to certify adult echocardiographers in the quality of the performance and interpretation of echocardiography in the United States and its Territories.
11/8/03 – ASE approves the position statement on mandatory sonographer credentialing or lab accreditation. “ASE stands for quality based reimbursement. This is currently best determined by reputable bodies including: 1- Sonographer Credentialing and/or 2- Physician Certification and/or 3- Laboratory Accreditation.”
11/8/03 – ASE approves the position statement on Contrast agents: “the agent is a drug and should be treated as such for reimbursement purposes.”
10/03/01 – ASE adopts a statement of policy that all ASE Guidelines and Standards documents be publicly-accessible on ASE’s website. A nominal charge would be made for mailed and multiple document requests.