TOE Standards

All the standards for transthoracic echocardiography in addition to the following:

View the TOE checklist.

Staffing and training.

1) All centres must have a designated Head of TOE. The TOE lead must have BSE/ACTA or EAE TOE accreditation. In departments accredited before TOE accreditation processes were fully established the TOE lead will be allowed a reasonable length of time (for example 2-3 years) to achieve TOE accreditation or will be given the opportunity to transfer the TOE lead role to a suitably experienced and TOE accredited colleague.

2) Outpatient TOE studies must have an operator with appropriate training, a nurse with experience in managing airways and an HCS.

3) Continuing education must be provided for the operators.

4) Each operator must perform or directly supervise at least 50 studies per annum.

 5) All operators must have, or be working towards, BSE/ACTA or EAE TOE accreditation.

6) A list of indications for TOE must be agreed.


1) Minimum standards for studies must be established and the head of TOE must be responsible for ensuring that all operators adhere to them.

2) A preoperative checklist must be used.

 3) Whenever sedation is used, it must be in accordance with the recommendations given in BSE Recommendations for safe practice in TOE   BSE : Safe Sedation during TOE.

4) The TOE probe must be checked electrically at a frequency dependent on usage. A log of these checks must be kept.

5) The TOE probe must be cleaned regularly as directed in 'BSE TOE Probe decontamination' BSE : Probe Decontamination.

 6) Formal TOE audit processes must be in place. In centres with several TOE operators internal re-reporting of studies and/or comparison against surgical results is adequate. However, departments with few operators must create regional or network links to establish regular re-reporting programmes.

Organisation and equipment

There must be appropriate provision of:

  • Room (should be > 25 m2 in area)
  • Couch with facility for head-down tilt
  • Facilities for cleaning and sterilising the probe
  • Storage cupboard for the probe
  • Resuscitation apparatus and drugs
  • Lockable drug cupboard
  • Suction
  • Oxygen
  • Pulse oxymeter
  • Sphygmomanometer
  • Facilities for recovery of the patient
  • Protocols for patient care