Transthoracic Echocardiography Standards

Staffing and training.

1) All centres must have a designated Head of Department (HoD).  The HoD may be either a Specialist Registered Physician or a Specialist Healthcare Scientist.  The HoD must spend at least 3 sessions each week within the Applicant department.

2) There must be defined leadership roles for both the Medical and Scientific teams within the Department: the 'Medical Lead' and 'Healthcare Scientist Lead'.

3) The Medical lead must be trained in clinical cardiology and specialist echocardiography and be registered with the GMC.  He/she must set up a system for reviewing requests and reports, and urgent clinical review in response to findings at echocardiography.

4) The Healthcare Scientist Lead must hold individual BSE accreditation and be graded at least Band 7.

5) Any HCS who performs and reporting studies unsupervised must have individual BSE accreditation and be graded at least band 6.

Organisation and equipment.

1) Echo rooms used for inpatients on beds must be at least 20 m2 in area.

2) Ventilation, heating, lighting and ancillary facilities must be appropriate (see Appendix of departmental accreditation document ).

3) Echo machines must have second harmonic imaging, stand-alone continuous wave Doppler and tissue Doppler.

4) The machines must be serviced regularly, and be replaced or have a major upgrade at least every 5 years. No machine, in regular use, should have been purchased or last upgraded more than 10 years ago.

5) There must be an electronic report database with facilities for storing and retrieving specific echo studies.

6) There must be appropriate storage space.

7) A patient information leaflet must be available.

Performing studies.

1) A list of indications for echocardiograms must be agreed.

2) Prioritising and filtering of inappropriate requests must be performed by HCSs supported by the Medical Lead.

3) Minimum standards for studies must be established. Study protocols appropriate to specific clinical conditions must be used. All protocols must be reviewed regularly and updated when appropriate. There must be processes in place to update staff of new protocols or protocol updates.

4) A format for reports must be established, including who should issue conclusions and who is qualified to sign reports.

5) The requirements of the Data Protection Act 1998 must be complied with regarding data storage.

6) A mechanism must be in place for reporting cases that require urgent clinical attention.

7) Regular meetings, ideally weekly, must be held to review unusual, challenging or otherwise difficult cases. There must be established processes issuing appropriately revised reports as a result of multi-disciplinary team discussions.

8) A formal quality assurance system must be in place including:

  • Weekly review meetings
  • Regular process audits consisting of blind over reading of selected studies to ensure compliance with departmental minimum standards
  • Regular audit projects to check consistency of interpretation such as requiring all team members to report a set of images
  • Outcome audit against other modalities or surgical results

Indicative Factors.

In addition to the minimum factors set out above, the BSE will consider the following   when considering whether to grant Accreditation to an Applicant seeking Accreditation for Transthoracic Echocardiography:

1) Continuing education should be given (including funding) to fulfil BSE re-accreditation requirements or to a similar level.  There should be a small library of relevant reference textbooks within the Department.

2) The job profile of a HCS should include training, self-education, audit, and quality control in addition to performing echocardiograms.

3) In an institution performing 3000 studies per year, the Medical Lead should have at least one session per week allocated directly to echocardiography.

4) Reports from routine studies should usually be issued on the day of the examination.  For urgent or inpatient studies, at least a preliminary report should usually be issued immediately.

5) The Medical Lead's responsibilities would ordinarily include providing medical input to departmental guidelines and policy, performing studies, training doctors and the Healthcare Scientists, medical audits, medical triage, quality control and providing clinical input at review meetings.

6) The HCS Lead's responsibility would ordinarily include the day to day running of the echo service including first line triage, performing studies, organising audit, service improvement and training doctors. They are usually responsible for the implementation of local occupational health policies, equipment safety and maintenance processes and ongoing risk assessment. They are usually responsible for the maintenance of quality standards and the effectiveness of patient pathways. They should lead the Scientist team on a day-to-day basis.

7) There should be awareness of health and safety issues especially relating to back and eye problems and adequate liaison with occupational health and risk management departments (see Appendix departmental accreditation document ).

8) A single echo machine can ordinarily handle up to a maximum of 2500 studies each year but this figure will be lower if there is a significant ward-based or complex workload.

9) Appropriate consideration should have been given to patient comfort, privacy, dignity and the provision of adequate information.

10) A separate viewing room is recommended for reviewing studies and off-line reporting.

11) A standard transthoracic study (one TTE equivalent) takes 40-45 minutes.  A complex study (e.g. including contrast injection or detailed valve haemodynamic assessment) may take up to 1 hour (1.5 TTE equivalents).  As an ideal, allowing for all aspects of the job profile, an HCS will perform no more than 1800 studies per year.

BSE minimum dataset for TTE
BSE clinical indications for TTE
BSE advice about chaperones

You do not have to use the BSE versions of these documents: you can develop your own or adapt these if you prefer