梶原 克祐¹, 岩瀬 正嗣², 杉本 邦彦¹, 伊藤 さつき¹, 中野 由紀子¹, 鯉江 伸³, 松山 裕宇³, 菱田 仁³

Katsusuke KAJIHARA¹, Masatsugu IWASE², Kunihiko SUGIMOTO¹, Satsuki ITOU¹, Yukiko NAKANO¹, Sin KOIE³, Hiroyuki MATSUYAMA³, Hitoshi HISHIDA³

¹藤田保健衛生大学病院臨床検査部, ²藤田保健衛生大学病院大学短期大学, ³藤田保健衛生大学病院循環器内科

¹Department of Clinical Laboratory, Fujita Hearth University School of Medicine, ²Department of Junior College, Fujita Hearth University School of Medicine, ³Department of Internal Medicine, Fujita Hearth University School of Medicine

キーワード : questionnaire survey, quantitatively estimate, routine echocardiographic examination, sonographers

我国におけるルーチン心エコー図検査の現状を把握するため, 2000年5月に, 全国の循環器領域の超音波検査士748名にアンケート用紙を郵送し, 大規模なアンケート調査を実施した. 総計748名中, 530名(回収率70.9%)の検査士から得た. 機器メーカー所属の18名は除外し新たに機器メーカー所属が明らかになった20名からの回答も除外した. 施設の重複した回答者は1つの回答とした. したがって最終的に436施設について検討した. 回答した施設の77.3%ではルーチン検査の大半ないしはすべてが技師によって実施されていた. 一方, 11.1%の施設では主に医師によって実施されていた. 18.9%の施設では, 検査士あるいは医師の全勤務時間のうち, 80%以上を心エコー図検査に従事していた. これに対して67%の施設では全勤務時間の半分ないしは半分以下であった. 一例当たりの検査の所要時間は30-40分が35.6%(116施設)で最も多く, 10-20分が32.8% (107施設)で次に多かった. 左室径, 壁厚の計測は14.1%(59施設)が全例Mモードによって行なわれ, 74.2%(311施設)は主にMモードから, 問題のある症例では断層画像から計測していた. 左室駆出率は, 55.7%(205施設)が左室内径から算出し, 44.3%(163施設)は左室断面積から算出していた. 視覚的EF評価は57%の施設で実施していた. 壁運動スコアによる評価を常に実施しているのは5.5%(22施設)のみであった. パルスドプラ法による左室流入血流評価については, 65.9%の施設が全症例について行っていた. 逆流や短絡に対する定量的評価を常に行っているのは2%(8施設)のみであった. 画像の良否に関するコメントは, 大多数(98%)の施設が全例ないしは画像の不良なもののみについて記載していた. 大多数(94%)の施設では, 技師が診断に関するレポート記載にも関わっていた. 心エコー図はその他の画像診断法に比べて安価な心臓の検査法であり, その役割は今後益々重要となるものと思われる. 心エコー図検査は熟練した認定超音波検査士および専門医によって実施され, 的確で理解されやすい報告書が速やかに依頼医師に提出されなければならない. したがってこのような調査を今後も継続して行なうことが必要と思われる.

We mailed questionnaires to 748 registered medical sonographers [RMSs (cardiology)] to gather information for a large-scale survey of RMSs in May 2000. We wanted to evaluate the current state of routine echocardiography in Japan. Altogether, 530 (70.9%) of these sonographers responded; 18 respondents employed by equipment manufacturers were excluded from the start of the study, and another 20 responses from later found to be employee by ultrasonographic equipment manufacturers were also excluded. Responses from all personnel at a single institution were treated as a single response; 436 institutions were thus included in the survey. Most or all examinations were carried out by sonographers at 77.3% of the responding institutions but were performed mainly by physicians at 11.1% of the institutions. At least 80% of sonographer or physician working hours were used for echocardiographic examination at 18.9% of the surveyed institutions, whereas up to half the working hours were devoted to echocardiographic examinations at 67.0% of the institutions. The most frequently reported examination time was 30.40 min [35.6% (n=116) of the institutions], whereas 32.8% (n=107) of the institutions indicated durations of 10.20 min per examination. Left ventricular (LV) dimensions and wall thickness were measured on M-mode images in all patients at 14.1% (n=59) of the institutions and mainly on M-mode images but from two-dimensional echocardiography in problematic patients at 74.2% (n=311) of the institutions. The LV ejection frac-tion was calculated from LV dimensions at 55.7% (n=205) of the institutions and from the LV cross-sectional area at 44.3% (n=163) of the institutions. The LV ejection fraction was estimated visually at 57.0% of the institutions. Only 5.5% (n=22) of the facilities always scored the wall motion. Pulsed Doppler echocardiography was used to assess LV inflow in all patients at 65.9% of the institutions; regurgitation and shunting were always assessed quantitatively at only 2% (n=8). Comments concerning image quality were reported in all cases or in cases of poor image quality at 98% of the institutions, and the sonographer was also involved in writing the diagnostic report at 94% of institutions. Echocardiography is less expensive than other diagnostic imaging methods, and its importance is thus likely to continue to increase. Echocardiographic examinations should be carried out by skilled RMSs and physician echocardiographers; and an accurate, readily comprehensible report of the findings should be provided promptly to the referring physician. More such surveys are required to ensure that these practices are adopted.