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Pharmacol."],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:p>Intrapulmonary right-to-left shunts (RLSs) are a clinical concern in hereditary hemorrhagic telangiectasia (HHT), contributing to dyspnea, brain abscess, and ischemic stroke. HHT is a genetic disorder characterized by arteriovenous malformations (AVMs), with pulmonary AVMs (PAVMs) being a major source of intrapulmonary shunting. Screening for PAVMs is essential to prevent paradoxical embolization, guide management, and mitigate mortality risk. Agitated saline contrast echocardiography (\u201cbubble echo\u201d) is the recommended method for detecting and grading RLS, as outlined in International HHT Guidelines. Given Western Canada\u2019s large rural population, satellite HHT clinics and affiliated echo labs have been established to improve access to care. This observational cross-sectional study evaluated the written policies governing bubble-echo protocols across Alberta\u2019s accredited echocardiography laboratories. With the help of the College of Physicians and Surgeons of Alberta (CPSA), all CPSA-accredited adult echocardiography laboratories were contacted (as of 15 July 2024) to determine whether they perform RLS assessments and to obtain available written bubble-echo protocols. Of the 62 accredited facilities identified, 12 performed bubble-echo studies. Policy review of participating labs revealed notable variations in injection techniques and shunt grading criteria. 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