By Tanner Lambson 

When you go to the cardiologist, you aren’t seeing just a cardiologist; you’re being cared for by a team of professionals trained in all aspects of heart health care – nurses, imaging specialists, technicians and other support staff. One team member you will likely encounter at your cardiologist’s office is a cardiac sonographer, also known as an echocardiographer.  

An echocardiogram — a procedure that uses sound waves to create pictures of the heart— allows a cardiologist to see how a patient’s heart pumps blood, which is critical for evaluating symptoms and diagnosing heart disease. Echocardiograms are a form of sonography, meaning they do not use any radiation, are painless and come with virtually zero side effects. An echocardiogram is often the first tool a cardiologist will use to gather an understanding of a patient’s cardiovascular health.   

“Echo is a valuable tool that provides real-time diagnostic information that guides treatment plans and expedites cardiovascular care,” said Hem Bhardwaj, M.D., vice chair for cardiology at the VCU Health Pauley Heart Center. “Cardiac sonographers have a very special skillset. They do what I like to call ‘active imaging.’  If they see something that could potentially be abnormal, in real time, they have the critical thinking skills to obtain more images and escalate findings as needed.” 

Such specialization presents a challenge: Because of the unique skillset required for the job, there aren’t enough people trained to perform echocardiograms, in Virginia as well as nationwide.  

The need for this role within health care settings is growing, with the U.S. Bureau of Labor Statistics forecasting that the total number of cardiac sonographer positions will increase by 11% across the country by 2032.  

To learn more about what the role entails, two cardiac sonographers on the Pauley Heart Center imaging team — one with a full career in echocardiography, the other a year and a half into her journey — offer perspective into what drew them to the field, how they approach their work and how it is evolving.  

Voices of experience and commitment 

James “Kent” Fredenberger, RCDS, supervises Pauley’s cardiac sonography team. A longstanding member of the department, he initially chose to enter the field as a challenge to himself.  

“During my research on careers prior to attending college, the description of cardiac sonography as being one of the most challenging forms of ultrasound was very appealing,” Fredenberger said. As a student at the University of Oklahoma Health Sciences Center, he was “immediately captivated by the intricacies of the heart and the amazing ability [of echo] to assess its structure and function.” 

Bhardwaj herself developed her skills under Fredenberger’s mentorship. 

“Kent taught me how to perform echoes as a cardiology fellow here at VCU and is a true expert in the field. It is wonderful to see him in his supervisory role,” Bhardwaj said. 

Johannah Standridge, RCDS, on the other hand, is a relatively new face on Pauley’s echo team. Her interest in the field of sonography is rooted in a childhood experience.  

Echocardiograms are a procedure that allow health care providers to look at images of a patient’s heart. Students at Rappahannock Community College are learning how to take these images as part of a two-year degree program. (Rappahannock Community College)

“I was introduced to echo when my mom was pregnant with my brother,” she said. “At that time, she was diagnosed with peripartum cardiomyopathy, and for decades after, she struggled with heart failure. During that time, I would join her for her echo appointments, both to comfort and to learn more because I didn’t really understand what was going on. I was fortunate that her amazing cardiac sonographers would humor me — they would let me sit and watch and explain what they were doing and walk me through the procedure. That showed me how important cardiac sonographers are to helping people like my mom.”  

When Standridge was a senior in high school, her mother had a quadruple bypass that dramatically improved her quality of life. “I think at that moment, I was like, ‘This is what I want to do. I want to do something that helps patients like my mom,’” she recalled.  

Aspiring cardiographers can choose two paths for their training. Some four-year colleges and universities offer bachelor’s degrees in medical imaging, and many community colleges offer two-year associate degrees.  

However, many of these programs do not offer specific training in heart sonography. That’s why, in 2022, with funding from the Virginia General Assembly, the Pauley Heart Center worked with Rappahannock Community College to establish a new two-year associate degree program in echocardiography.  

Standridge, in addition to her sonography role, has worked within this program as an educator.  

“Johannah was hired right after completing her education and excelled as a new graduate and a highly skilled sonographer,” Bhardwaj said. “It has been exciting to see her growth as a professional but also as an educator working with our Rappahannock Community College sonography students and our new hires.” 

The program is currently admitting its third cohort, and its first graduates are now being hired at hospitals and clinics throughout Virginia – including VCU Health.  

The satisfaction of ongoing challenges 

It’s not, however, the salary that has kept Fredenberger invested in his work year after year. He loves that every day as a cardiac sonographer presents a new challenge.  

“Your patients are always different, so you have to apply different types of techniques to maximize image quality that vary from patient to patient,” he said. “We frequently encounter technically difficult patients, and the fact that exam quality is dependent upon the knowledge, training, skill and dedication of the sonographer ensures that our duties are never mundane. Helping others by producing the highest quality [sonograms] brings me great satisfaction.” 

In terms of how the field may evolve, Fredenberger and Standridge both mentioned artificial intelligence and its appropriate role in cardiac sonography.  

“Over the years,” Fredenberger said, “I have seen enormous changes in so many areas associated with echo and healthcare in general. These include advances in technology ranging from the advent of echo Doppler and 3D imaging, the positive impact of new therapies on echo patients such as advanced thrombolytics, and the routine use of amazing procedures like transcatheter aortic valve replacement. As in so many areas, AI will be integrated into echo for certain tasks.” 

But Fredenberger also believes the integration of AI into cardiac imaging won’t hinder or harm job prospects for aspiring cardiac sonographers — because the human touch is always needed.  

“The profoundly individualized nature of echo requires direct human involvement for the performance of high-quality studies,” he said.  

It’s the human aspect of the work that Standridge finds so fulfilling.  

“It’s integral to my role to really understand that [our patients] are all human beings who deserve our respect and care, and who have family and friends who love them,” Standridge said. “Because my mom was in their shoes once, I try to provide that respect and care the best I can. I enjoy every day because I’m able to come into work and help.” 

Fredenberger agreed: “I am very proud of the fact that we are always focused on providing our patients with the best care possible.”  

Read more heart health stories on the Pauley Heart Center Blog

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