R. Eugene Zierler, MD
Assumes The ICAVL Presidency

from the May 2003 issue

R. EUGENE ZIERLER begins his term as President having nine years of experience as a member of the ICAVL Board Of Directors, representing the American Association for Vascular Surgery. He has been a member of the ICAVL Board Of Directors' Executive Committee for four years while serving as Treasurer and President-Elect. Dr. Zierler is a Professor of Surgery within the Division of Vascular Surgery at the University of Washington School of Medicine in Seattle.

(Laboratories applying for accreditation in Extracranial and/or Intracranial Cerebrovascular testing with a physician serving as the Technical Director will meet this requirement if the physician has passed the American Society of Neuroimaging's Neurosonology examination.) Laboratories were notified of this impending policy through the Spring 2000 Newsletter and as a revision to the Standards, mailed in February 2000 to each laboratory possessing a copy of the Essentials and Standards. Currently accredited laboratories will be required to meet this requirement upon submission of their reaccreditation applications.

When asked about his career in vascular ultrasonography, Dr. Zierler reflected, "My involvement with the vascular laboratory began in 1978 when I was offered a position as Research Fellow with Dr. Strandness at the University of Washington. At that time the first prototype duplex scanner was just being built, and the scope of noninvasive vascular testing was quite limited. Over the last 25 years, I have had the opportunity to participate in the development of this field and watch it mature into the major clinical resource that it is today."

He added, "One important consequence of the growth of this field and the proliferation of vascular laboratories has been the need for standards to ensure that testing is both helpful for physicians and beneficial to patients."

The ICAVL was formed in 1989 in response to pressure from regulatory agencies and concerns among leaders in the field regarding the quality of work being performed in many vascular laboratories. Dr. Zierler commented on the success of the ICAVL to date stating, "This multidisciplinary organization, with representation from the various medical and surgical specialties with an active interest in vascular testing, has provided a highly effective framework for establishing standards and administering a process for accreditation. The vascular community should be proud of the fact that more than 1600 laboratories have undergone this self study and peer review process to demonstrate the quality of the studies they perform."

Reflecting on the recent ICAVL Customer Survey and the results it gathered, Dr. Zierler stated, "As President, my primary goal over the next two years is to address the concerns expressed through the survey: for example, 40% of respondents felt that the entire accreditation process was too complex and 45% considered the amount of time required to complete the application to be excessive. It is time for the ICAVL to streamline or simplify both the accreditation and reaccreditation processes."

The first steps toward this goal were taken at the ICAVL Board meeting in February 2003 when every item on the current accreditation application was evaluated, and items that were not considered essential were marked for deletion. Care was taken to ensure that any deleted items were not necessary for maintaining the integrity of the program or the mission of the ICAVL. Board and staff members alike anticipate that these changes will greatly simplify the application process and reduce the time required to complete it.

The new version of the Electronic Application on CD-Rom is designed to help streamline both first-time accreditation and reaccreditation. Once a laboratory has used the Electronic Application, subsequent reaccreditation applications should be relatively easy, since previously entered information is retained, and only new information needs to be entered. The ability to embed protocols, policies, and other documents directly in the application also allows the application to serve as a tool to keep track of CME credits, review policies and procedures, and document quality assurance activities. Other innovations, such as laboratories' submission of their case studies on CD are being implemented, and the ICAVL is exploring acceptance of the entire application through electronic transmission.

The ICAVL Essentials and Standards are reviewed and revised every two years, with the next review scheduled to take place in January 2004. As this update will occur during his presidency, Dr. Zierler emphasized, "My goal for this review cycle will be to continue the simplification and streamlining process by updating the standards for each of the testing areas while eliminating those requirements that are not truly essential. As always, the challenge is to accomplish this in a fair and reasonable manner without sacrificing quality."

"These are both good times and challenging times for vascular laboratories. Advances in ultrasound technology have enhanced diagnostic capabilities and provided smaller, less expensive instruments. The current emphasis on noninvasive or minimally invasive diagnostic approaches has increased vascular laboratory utilization. However, declining reimbursement and a shortage of qualified vascular technologists/sonographers have created serious problems for many laboratories. It is essential that the ICAVL recognize these challenges and offer an accreditation process that is realistic and valuable in the current practice environment. As a multidisciplinary organization and the preeminent organization for vascular laboratory accreditation, I believe that the ICAVL is uniquely prepared to accomplish these goals and I look forward to leading the organization as we work to meet these challenges."

In addition to his affiliation with the ICAVL, Dr. Zierler is Secretary-Treasurer of the American Registry of Diagnostic Medical Sonographers, a member of the Joint Council Committee on Vascular Laboratories (Society for Vascular Surgery and American Association for Vascular Surgery), a member of the Vascular Ultrasound Advisory Committee of the American College of Surgeons, a member of the Program Committee of the American Association for Vascular Surgery, and a member of the Ad Hoc Committtee for Noninvasive Vascular Testing of the American Board of Surgery. Dr. Zierler has utilized his expertise in noninvasive vascular diagnosis to author and co-author numerous journal articles and book chapters, along with serving as the editor of three books.

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