To use images or tables from any ASE guideline (or JASE article) you must apply for permission to the JASE publisher, Elsevier. This is done via CCC RightsLink(opens in new tab).

A shortcut is to find the guideline or article you need on JASE (onlinejase.com) and then select the “get rights” link (which looks like a copyright symbol) and it will take you to the CCC RightsLink form for that specific guideline or article.  Note that you may request more than one image/table from a guideline on the same form, but you will need separate forms for each guideline or article.

ASE members may become involved in proposing an ASE Guideline through participation in one of the ASE Councils(opens in new tab) or ASE Specialty Interest Groups(opens in new tab). ASE members may also login to the member portal to download the ASE Guideline Development Manual (updated June 2023) and download the ASE Guideline Proposal Template (see instructions here(opens in new tab)) for more information. Note that guideline proposals are reviewed, prioritized, and approved by ASE leadership depending on topic.

ASE has two guidelines that discuss registration for sonographers in terms of preferred education and credentials.

• November 2005 American Society of Echocardiography Minimum Standards for the Cardiac Sonographer: A Position Paper
• January 2011 American Society of Echocardiography Recommendations for Quality Echocardiographic Laboratory Operations

Not all States/Institutions in the United States require being registered (which ASE recommends) and currently only 4 states require a license.  More information on licensure is available in an ASE FAQ: https://archive.asecho.org/sonographylicensurefaqs/ .  There is also an ASE Sonographer FAQ that addresses specific questions on credentialing: https://archive.asecho.org/clinical-information/sonographer-training/

ASE recommends cardiac sonographers receive credentialing through the American Registry of Diagnostic Medical Sonography (ARDMS) http://www.ardms.org(opens in new tab) or Cardiovascular Credentialing International (CCI) http://www.cci-online.org(opens in new tab). Both organizations have education/training requirements you must meet before you can sit the exam.

ASE does not currently have a Guideline that address the quantity of exams.  We have issued a policy statement on WRMSD (work-related musculoskeletal disorders) that was approved 3/21/2021:

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.

Additionally, the IAC Standards & Guidelines for Adult Echocardiography Accreditation has a few helpful sections you should review.  While they also do not put a limit by quantity, they do have standards for the time allotted for the different types of echo exams along with a separate section on Personnel Safety.

Click here to view the Scope of Practice for Sonographers(opens in new tab)

It is up to your State Department of Health and then your institution to make decisions on who is allowed to administer contrast/UEA.  This is commonly included in the scope of work for Adult Sonographers but check with your State Department of Health and your Institution for any local laws/rules/recommendations.

ASE has multiple guidelines about the admiration and applications of Contrast/UEA’s:

• August 2014 Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography(opens in new tab)
• March 2018 Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update(opens in new tab)
• November 2008 American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography(opens in new tab)

Additionally, the ASE website ContrastZone(opens in new tab) may be helpful.

It is up to your State Department of Health and then your Institution to make decisions on who is allowed to administer agitated saline (aka bubbles, microbubbles).  This is commonly included in the scope of work for Adult Sonographers but check with your State Department of Health and your Institution for any local laws/rules/recommendations.

ASE has multiple guidelines about the administration and applications of Contrast/UEA’s including Agitated Saline/Bubbles:

• August 2014 Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography(opens in new tab)
• March 2018 Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update(opens in new tab)
• November 2008 American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography(opens in new tab)

Additionally, the ASE website ContrastZone(opens in new tab) may be helpful.

It is up to your State Department of Health and then your institution to make decisions on who is allowed to do IV insertion.  Contact you State Depart of Health and Lab Director for clarification of the rules at your Institution.  If IV insertion is allowed for Sonographers at your Institution, ASE discusses training in the following guideline Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update on page 264:

“Previously published 2014 ASE guidelines for cardiac sonographers in the performance of contrast echocardiography support sonographer training in IV insertions for the purpose of UEA administration in hospitals and clinic settings, to improve echocardiographic quality with increased efficiency.³⁸ Personnel qualified to start an IV line and administer contrast will vary by center according to local hospital policies. At the majority of centers in North America, the IV start and contrast administration will be performed by a registered nurse, medicine technician or phlebotomist, or fellow in training, whereas some sites have extended this responsibility to sonographers.³⁸ The training of sonographers in IV line insertion and contrast administration requires hospital approval, knowledge of sterile technique and venous anatomy, and awareness of associated risks. Although serious side effects are exceedingly rare, there should always be a physician present on site when contrast is administered. Two single-center studies in Europe and Canada have demonstrated improved efficiency with sonographer-driven contrast echocardiographic protocols through reductions in time to decision for contrast use and time to administration of contrast, resulting in potential cost savings.^127,128 This also underscores that training in the recognition of need for UEA must be a standard component of sonographer education, complemented by echocardiography laboratory implementation of standing orders for UEA administration. “

The 2014 Guideline for the Cardiac Sonographer in the Performance of Contrast Echocardiography may also be helpful as well as the ASE website ContrastZone.

While not specifically covered in an ASE guideline, Dobutamine is a medication that requires an order and is typically titrated by a trained nurse or physician. This should be considered out of scope of practice for a sonographer, but check with your State Department of Health and your Institution for any local laws/rules/recommendations.

This information is not included in an ASE guideline. However, the IAC Standards & Guidelines for Adult Echocardiography Accreditation has a section about Stress Echocardiography that currently states in section 3.6.4B, “At a minimum, at least two qualified people are required to be in attendance during stress testing. “