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In 1992, the American Society of Echocardiography published a report of the Sonographer Education and Training Committee's recommendations for education of sonographers who perform echocardiographic procedures. Since the publication of the original document, there has been continual progress in technology with the development of more sophisticated diagnostic applications that allow more information to be obtained from echocardiographic procedures. These recent changes in the clinical application of echocardiography should be included in all cardiac sonographer education programs. The American Society of Echocardiography, a professional society that currently represents approximately 2500 cardiac sonographers, provides these updated guidelines.

Occupational health hazards in ultrasonography are becoming more prevalent as the field continues to grow. Eye strain, musculoskeletal pain or injury, carpal tunnel syndrome, repetitive strain injuries, stress, burnout, and other hazards have been addressed as concerns in other studies and surveys. These topics are discussed, as well as the possible preventive measures that may be used to maximize and maintain the ultrasonographer's well-being throughout his or her career. (J Am Soc Echocardiogr 1997;10:363-6.)

This series on contrast echocardiography has previously discussed the value of this technique for the improvement of endocardial border definition in technically challenging patients. The echocardiographic assessment of left ventricular (LV) regional performance can be significantly improved by using LV opacification (LVO) produced by the injection of contrast microbubbles into a peripheral vein. On the basis of years of investigational work, it is now apparent that myocardial contrast echocardiography (MCE) may offer an additional clinical benefit by assessing regional myocardial perfusion. Investigators have recently presented encouraging results using echocardiographic contrast agents for the assessment of myocardial perfusion under optimal imaging conditions. In this final article of the series on contrast, we will provide some basic information on the use of MCE for the assessment of myocardial perfusion. As always, we refer you to more detailed explanations in the listed references. Currently, nuclear imaging that uses thallium or sestamibi scintigraphy is the only clinical technique used to assess myocardial perfusion. In comparison, MCE is less expensive, portable, and does not use ionizing radiation. MCE uses an intravascular tracer and demonstrates better spatial resolution. Contrast microbubbles injected into a peripheral vein, the aortic root, or directly into the coronary arteries are designed to travel through the cardiovascular circulation in a manner similar to red blood cells. These microbubbles not only fill the LV cavity as see during LVO, but they also traverse the epicardial coronary vessels into the myocardial capillaries. The concentration of microbubbles in the myocardial capillary bed is far less than found within the LV cavity after an intravenous injection, so specialized techniques have been developed to detect contrast microbubbles for the assessment of myocardial perfusion. These techniques and the clinical benefits of assessing myocardial perfusion will be discussed in more detail.