This is above the full performance level for the Medical Instrument Technician (Vascular) requiring specialized advanced knowledge and assignments. The work involves operating or monitoring diagnostic and therapeutic medical instruments and equipment associated with vascular and general sonography duties, to include carotid ultrasound and complex doppler studies, as well as general ultrasound. Basic Requirements: Citizenship: Citizenship of the United States. (Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with chapter 3, section A, paragraph 3g, this part.) Education: There are no specific educational requirements for this occupation. Physical Requirements: See VA Directive and Handbook 5019. English Language Proficiency: Medical Instrument Technicians must be proficient in spoken and written English in accordance with chapter 2, section D, paragraph 5a, this part. GS-09 Qualifications: In addition to the core competencies defined at the GS-8 full performance level listed below, positions at this grade may be lead, supervisory, or non-supervisory with specialized advanced knowledge and assignments. GS-08 Knowledge, Skills, and Abilities Knowledge of cross-sectional and longitudinal vascular anatomy in normal and abnormal vessels, anatomical planes and tissue structures, physiologic effects of disease entities that impact the vascular system, signs and symptoms of acute and chronic vascular disease, and the characteristic appearance of aneurysms, pseudoaneurysms, thromboses, stenoses, occlusions, AV fistulae, and morphology of atherosclerotic plaque formulation. Ability to provide Doppler information of peripheral vessels; demonstrate characteristic differences related to the organs they supply; accurately quantify carotid artery stenoses; and identify and correlate specific waveform analysis, plethysmographic tracings, velocity changes, and pressure gradients characteristic of normal, obstructed, or occluded vessels or grafts. Ability to perform intracranial (transcranial) vascular examinations. Ability to operate the instruments to extract the highest quality image utilizing the appropriate transducer frequency, Doppler angle, focal zones, gain, depth, color map, wall filter, and sample volume. Ability to provide objective data to document progression or regression of disease. Experience: At least 1 year of experience comparable to the next lower grade level, which is directly related to the duties of the position to be filled, and must fully meet the KSAs at that level listed above. Demonstrated Knowledge, Skills, and Abilities: Knowledge of the more complex examination and treatment procedures and techniques in order to provide training and supervision in these procedures, to evaluate and initiate performance improvement projects, and to write policies, procedures, and protocols, that pertain to vascular ultrasonography. Knowledge of JCAHO and other regulatory requirements. Ability to communicate effectively and professionally with employees at varying grade levels. Ability to manage and supervise employees. Ability to provide, or provide for, staff development and training. Certification: Registration by Cardiovascular Credentialing International (CCI) as a Registered Vascular Sonographer (RVS) or by the American Registry of Diagnostic Medical Sonographers (ARDMS) as a Registered Vascular Technologist (RVT) is highly desirable. Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) certifications are also desirable. Qualification Requirement: See VA Handbook 5005/98, Part II, Appendix G27. Supervisory Controls: The GS-09 Medical Instrument Technician (Vascular) will respond to the needs of the Vascular Team. Independent work is an integral part of the position. The technician plans and carries out examinations in line with training and accepted practices, and independently makes recommendations about clinical situations, procedures or changes to procedures in some situations. The providers must be able to accept the technician's assessment without rechecking the work. The technician uses methods, recognizes conditions that cause erroneous results or creates dangerous situations, and may independently troubleshoot clinic problems and complex instruments. The technician resolves most differences that arise with patients, coordinates work with others as necessary and interprets policy such as eligibility for prosthetic devices. The Medical Instrument Technician (Vascular) assists with maintaining an efficient flow of patient care. The Medical Instrument Technician (Vascular) technician is ultimately responsible to the Supervisory Medical Instrument Technician and Chief of Vascular Surgery. Customer Service Requirements: Meets the needs of customers while supporting the Medical Center, Service and national VA priorities. Consistently communicates and treats customers (patients, visitors, volunteers, and all Medical Center staff) in a courteous, tactful, and respectful manner. Provides the customer with consistent information according to established policies and procedures. Handles conflict and veteran complaints constructively and appropriately. Collaborates with other health care staff in a manner that enhances coordination of comprehensive patient care. Maintains confidentiality of patient medical records according to policy. Stays current with required training through the VA TMS related to customer service and interpersonal skills. Age, Development and Cultural Needs of Patients: The focus of these positions is the provision of vascular/general ultrasound services to veterans who are typically between 18 and 80 years of age. This position requires the incumbent to possess or develop an understanding of the needs of these patients, especially those who are visually impaired or who carry the diagnosis of a potentially sight-threatening condition. Sensitivity to the special needs of all patients in respect to age, developmental requirements, and culturally related factors must be consistently achieved. Computer Security Requirements: Incumbent will adhere to all facility required computer security policies and procedures. Incumbent protects printed and electronic files containing sensitive data in accordance with the provisions of the Privacy Act of 1974 and other applicable laws, Federal regulations, VA statutes and policy, and VHA policy. Protects the data from unauthorized release or from loss, alteration, or unauthorized deletion. Follows applicable regulations and instructions regarding access to computerized files, release of access codes, etc. Uses word processing software to execute several office automation functions such as storing and retrieving electronic documents and files; activating printers; inserting and deleting text; formatting letters, reports, and memoranda; and transmitting and receiving e-mail. Uses the Veterans Health Information and Technology Architecture (VistA) to access information in the Medical Center computer system. ["Duties include but are not limited to: Coordinates a variety of technical procedures that require independent judgment, ingenuity, and initiative in the application of non-ionizing high frequency ultrasonic waves to humans for diagnosis of disease in the clinic or on the inpatient unit Portable and emergent examinations are required. Knows and understands the principles of grayscale and color Doppler ultrasound as well as segmental. plethysmography, pulse volume recordings, ankle brachial indices and pre-and post-exercise testing and equipment, and the highly specialized equipment well enough to approve the quality and acceptability or non-acceptability of each examination. Sets up and adjusts all equipment and manually maneuvers the transducer to perform the exam. Receives and identifies patients, explains methods of procedures, assists movement of patients to and from wheelchairs, carts and tables, positions the patient and performs examinations requested. Performs vascular sonography studies, records and prepares the processed media for interpretation by the staff radiologist. Maintains records of patients in the Vista radiology package and any other commercial PACS. Schedules and prepares patients for exams and explains-procedures to patients while performing the studies. Obtains pertinent diagnostic vascular examinations for the physician. Routinely performs vascular studies. Performs ultrasound examinations of the abdomen, neck, chest and extremities, retroperitoneal space, pelvis, OB, and Vascular studies. Differentiates artifacts from normal or pathological processes and recognizes electronic equipment limitations. Recognizes all the elements of a diagnostic ultrasound examination and consults with Staff Vascular Surgeons to determine the proper diagnosis. Knowledge of cross-sectional, coronal, longitudinal and variable plane vascular anatomy in normal and abnormal vessels, anatomical planes and tissue structures, physiologic effects of disease entities that impact the vascular system, signs and symptoms of acute and chronic vascular disease, and the characteristic appearance of aneurysms, pseudoaneurysms, thromboses, stenosis, occlusions, AV fistulae, and morphology of atherosclerotic plaque formulation. Understands the effect of exercise pre-and post-stress as applied to segmental plethysmography, pulse volume recordings and segmental pressure analysis of the upper and lower extremities. Ability to provide Doppler information of central and peripheral arteries and veins; demonstrate characteristic differences related to the organs they supply; accurately quantify central and peripheral arterial vascular stenosis; and identify and correlate specific waveform analysis, plethysmograph tracings, velocity changes, and pressure gradients characteristic of normal, partially obstructed, or occluded vessels or grafts. Ability to operate the instruments to extract the highest quality image utilizing the appropriate transducer frequency, Doppler angle, focal zones, gain, depth, color map, wall filter, and sample volume. Ability to provide objective data to document progression or regression of disease. Performs training of technicians or technologists for any new ultrasound or vascular procedure. Performs routine clerical procedures as necessary to include calling patients the day prior to remind them of their appointments and describe any exam prep required. Reviews new developments in the field and recommends to supervisor those that would improve the operation of the section. Maintains adequate supplies. Reviews related information found in the patient's electronic medical record to correlate lab and x-ray for the radiologist. Provides and sends ultrasound images and related information to the vascular surgeon responsible for the interpretation of the exams. Operates multi-image camera. Assures that preventative maintenance and any required QA is completed in a timely manner. Performs or supervises routine housekeeping duties to assure that the ultrasound area is clean and sanitary. Follows standard operating procedures for disinfection of all transducers utilized. The incumbent must be aware of and practice the safety policies/procedures of the medical center and participate in quality assurance activities as directed. Assists in the development of new protocols, policies and procedure manuals. This includes development of new ultrasound protocols for general applications and updating technical policy and procedure manuals. Ultrasound protocols are updated at least yearly and new examinations are added on a routine basis in order to accommodate expanded service in General, Vascular and Carotid. Assures compliance with accrediting agency and regulatory requirements, and the quality management program, assuring corrective action is initiated as needed. Maintains interdepartmental relations with other services to accomplish medical center goals."]

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