Imaging (Echocardiography) —
Training activity: 15

Details

Adapt protocol and report to cater for cardio-oncology

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• Before this activity, what are the potential cardiac complications of cancer therapies (e.g., chemotherapy-induced cardiomyopathy, pericardial effusion)?
• How does the echocardiography protocol need to be adapted to monitor for these complications?
• What specific parameters and measurements are crucial in cardio-oncology imaging?
• What key elements should be included in the echo report when focusing on cardio-oncology patients?

In action

• How are you modifying the standard echo protocol to assess for potential cardiotoxicity related to cancer treatment (e.g., changes in ejection fraction, development of pericardial effusion)? Which specific views and measurements are you focusing on? How are you planning to structure your report to clearly document any findings relevant to cardio-oncology? Are you paying close attention to changes in global and regional systolic function? Are you carefully assessing for the presence and size of any pericardial effusion? Are you deciding which baseline or previous studies to compare the current findings with? Are you familiar with the potential cardiac side effects of common cancer therapies? Are you consciously applying specific guidelines for monitoring cardiotoxicity with echocardiography?

• Are you successfully acquiring the necessary images and measurements to assess for cardiotoxicity? Are you encountering any difficulties in comparing current findings with prior studies? Are you gaining a better understanding of how different cancer treatments can affect the heart? Are you learning to recognise early echocardiographic signs of cardiotoxicity? Are you applying your knowledge of oncology treatments, their potential cardiac effects, and echocardiographic assessment of cardiac function and pericardium?

• Would strain imaging be particularly useful in detecting subtle changes in myocardial function before a drop in ejection fraction? Is there a role for other cardiac imaging modalities in this context? If you are unsure about the significance of certain findings in the context of the patient’s cancer treatment, would you seek advice from a senior colleague or a cardio-oncology specialist? Are the protocol adaptations and the interpretation of findings in the context of cardio-oncology within the scope of your current training?

On action

• Describe the specific considerations for imaging a patient in a cardio-oncology setting. Outline how you adapted the standard echo protocol, including any specific views or measurements taken (e.g., strain imaging). Note the key features you focused on in the report.
• Reflect on your understanding of the role of echocardiography in cardio-oncology. Did you gain a better understanding of the specific imaging techniques used to assess cardiotoxicity? Were there any challenges in adapting the protocol or interpreting the findings? How does this relate to acquiring and interpreting cardiac images for pathological conditions?
• Identify any specific aspects of cardio-oncology imaging where you need to enhance your knowledge of protocols and reporting. How will you approach adapting protocols in the future? What resources will you use to further your understanding?

Beyond action

• Have you encountered patients undergoing or having undergone cancer treatment requiring specific adaptations to the echo protocol and reporting to assess for cardiotoxicity? Have your subsequent experiences broadened your understanding of the echocardiographic manifestations of cancer therapy?
• How has your ability to tailor echo protocols to assess for cardiotoxicity, including parameters such as global longitudinal strain, improved? Are you now more proficient in including relevant information about cancer treatment history in your reports?
• How will your understanding of cardio-oncology inform your role in the multidisciplinary care of cancer patients, working closely with oncologists? How will this experience support your ability to monitor for and detect early signs of cardiotoxicity?

Relevant learning outcomes

#	Outcome
# 1	Outcome Acquire and interpret cardiac images for a range of normal and pathological conditions.
# 2	Outcome Explain imaging results to patients and other health care professionals.
# 3	Outcome Distinguish and justify actions based on clinical and ECG findings.
# 5	Outcome Appraise new guidelines and evidence to inform practice.
# 6	Outcome Demonstrate safe practice in line with local, national and international guidelines and standards.
# 7	Outcome Assess and evaluate a patient’s clinical presentation and make recommendations for cardiac imaging.
# 8	Outcome Evaluate cardiac care pathways.
# 9	Outcome Summarise complex information into a concise and logical reports for specialist and non-specialist audiences.