This is the second piece of an interview series we did with some of the greatest echo masterminds. You can read the first interview here. Make sure to read until the end of this e-mail because we have some good stuff coming up for you there.
We are really proud of today’s guest: it’s Catherine Otto! Catherine is an internationally renowned echocardiography specialist and author of several best-selling books in the field. We know that many of you own some of her textbooks. She holds the J. Ward Kennedy-Hamilton Endowed Chair in Cardiology at the University of Washington and is the director of the cardiology fellowship program at that institution.
We asked Catherine Otto these three questions:
What’s the best way to become an echo expert for someone who is just at the start of his or her echo career?
What are the most common echo mistakes you see in your daily clinical practice?
What’s the best advice you have ever got from a mentor?
So without further ado, here is the interview…..Enjoy!
123sonography: What would you recommend to someone who is just getting started on echocardiography? How should they go about learning the art of echo?
Catherine Otto: I would say there are basically three core things: read a book, practice and learn from an expert. So to people who want to use my books I would recommend to start with the “Textbook of Echocardiography”. That’s the basic and smaller hardbound book that’s for the person learning echo for the first time. It’s basically everything you need to know, however it’s still a lot. You can supplement that with the “Echocardiography Review Guide”, which is a paperback. It has the same chapters but in a bullet format with self-assessment questions. So the way I would do it is to get the books, start reading the Textbook, do echos and then go back and do the questions in the Review Guide.
And then there is practice. We learn best when we take the theory and use it on the patient. It’s so essential that you get your hands on the patient if you want to become an expert!
123sonography: You also mentioned that it’s important to learn from an expert and get a mentor. What would you recommend to someone who does not yet have a mentor. How should they go about?
Catherine Otto: Ideally if you are in a training program your professor is your mentor. But wherever you are, there should be someone who is more expert than you. So as you are doing your own echos, you can go and ask someone to review them for you. Or when you have a chance, meet with the expert and discuss questions. One other thing for self improvement would be to echo a patient and as the patient goes on and has other imaging procedures or they have a clinical outcome, you should compare your echo to what happened with the patient thereafter. When I am reading echos now, I have the echo open on one screen and I have the medical record on the other screen. So if the person has had a CT scan or MRI, I am pulling that up to look at the echo and the other data at the same time. And as time goes on, I go back and look what happened to these patients. So for example, when the patient has had a cath [angiography] AND a stress echo, I try to compare the two and learn from that.
123sonography: That’s great advice! And what would be the best advice YOU got from a mentor?
Catherine Otto: That’s a tough question. I guess it’s kind of the same thing. It’s to never stop learning and to always go back to the books and to continually look at the outcomes of your patients. You always have to correlate what happens to the patient with what you saw on the echo. Always go back and forth between the three: the teaching materials, what happened to the patient and your echos. That’s the best advice I can give.
123sonography: You probably see a lot of people doing or reviewing echos. What are some of the most common mistakes that could be easily avoided?
Catherine Otto: The most common mistake I see is not being systematic in doing a complete study. Everybody when they do transthoracic or transesophageal echo, they need to make sure that they perform a complete and systematic study so they don’t miss anything. It’s important to have your own protocol and do all the valves, all the chambers, everything you need on all the patients all the time. So one common mistake I see is that there is missing information and the reason for that is that people are not being systematic.
One other mistake I see a lot is that the gain is too high in the Doppler. So when people are measuring high velocities, what they are actually measuring at the top of the signal is noise and not the actual Doppler valve spectrum.
Furthermore, there is one mistake I often see when people are using color Doppler. You should remember to always turn the Nyquist limit to the maximum of that depth so you are not overestimating regurgitation. That certainly is also a common mistake.
123sonography: Thank you so much Catherine for your time!
Catherine Otto: It was a pleasure to speak with you.
An here is a short video of Catherine Otto with some valuable advice for your daily clinical practice of echo…..