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Echocardiography: the transition from master of the craft to admiral of the fleet
  1. Catherine M Otto
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, PO Box 356422, Seattle, WA 98195, USA; cmotto{at}u.washington.edu

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Echocardiography has become essential for the diagnosis and management of cardiovascular disease. Over my medical career, cardiac ultrasound has evolved from the blurry wavy lines of M-mode tracings understandable only to a few dedicated practitioners, to real-time intuitive anatomic images accessible to all healthcare providers. In addition, the development and validation of quantitative imaging and Doppler techniques has transformed clinical cardiology with the ability to measure left ventricular ejection fraction and cardiac output, estimate pulmonary pressures, evaluate diastolic function, and quantitate valve and congenital heart disease severity. More advanced imaging modalities including transoesophageal imaging, real-time three-dimensional (3D) and biplane imaging, contrast echocardiography, tissue Doppler, and other modalities have further extended our diagnostic capabilities. There is no question that echocardiography is an accurate and powerful diagnostic tool when performed and interpreted by highly skilled professionals at centres with a high volume of complex cardiac disease. However, the real challenge is ensuring that echocardiographic diagnosis is accurate and reliable, regardless of where or when the study is performed, resulting in improved patient outcomes. Unfortunately, many experts are concerned that the current quality of echocardiography across the clinical community fails to meet this goal.1

Traditional approach “not working”

The traditional approach to improving quality has been to require additional education, training and certification. My view is that this approach is not working. Standards for the content, length and volume of studies performed and interpreted have been established by several professional organisations for the education and training of cardiologists, cardiac anaesthetists and cardiac sonographers.1–3 Both general cardiology and specialised echocardiography board examinations provide certification of competence for individual practitioners.4 ,5 Accreditation of echocardiography laboratories provides an additional layer of quality assurance.6 ,7 Still, despite rigorous training standards, credentialing and accreditation, the quality of echocardiography remains quite variable. …

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