Staffing and training.

1. All centres must have both a specialist Technical and Clinical Head of Department.
2. The Clinical Head should be trained in clinical cardiology and specialist echocardiography and ideally hold individual Accreditation. His/her job description should include setting clinical guidelines and policy, performing studies, training doctors and sonographers, audit, clinical meetings and quality control. He/she should set up a system for reviewing requests and reports, and urgent clinical review in response to findings at echocardiography. In a District General Hospital performing 3000 studies per year, at least one session per week should usually be allocated directly to echocardiography.
3. The Technical Head should be responsible for performing studies, audit, service improvement, training doctors and sonographers and liaising with Occupational Health and the Works Department. The Technical Head hold BSE accreditation and be graded at least Band 7.
4. Sonographers performing and reporting studies unsupervised should be BSE accredited and at least band 6 and typically band 7.
5. Continuing education should be provided (and funded) to fulfil BSE re-accreditation requirements or to a similar level. There should be a small library of relevant reference textbooks within the Department.
6. The job profile of a sonographer includes training, self-education, audit, and quality control in addition to performing echocardiograms.

Organisation and equipment.

1. Echo rooms used for inpatients on beds should be at least 20 m² in area
2. Ventilation, heating, lighting and ancillary facilities must be appropriate
   (see the appendix of departmental accreditation document)
3. Echo machines must have the capacity for imaging including second harmonic imaging, colour mapping, pulsed Doppler and both steerable and stand-alone continuous wave Doppler. Ideally tissue Doppler should also be available.
4. A single echo machine can 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
5. The machine should be serviced regularly, and be replaced or have a major upgrade at least every 5 years
6. There must be consideration of patient comfort, privacy, dignity and provision of adequate information
7. There must 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 the appendix of departmental accreditation document)
8. A report database should exist, with facilities for storing and retrieving specific echo studies.
9. A separate viewing room is recommended for reviewing studies and off-line reporting
10. There should be appropriate storage space
11. A patient information leaflet should be available

Performing studies.

1. A standard transthoracic study (one TTE equivalent) takes 30 minutes. Training may prolong this to 45 minutes (1.5 TTE equivalents). A complex study (e.g. including contrast injection or detailed valve haemodynamic assessment) may take up to 1 hour (two TTE equivalents). As an ideal, allowing for all aspects of the job profile, a sonographer will perform no more than 2000 studies per year
2. A list of indications for echocardiograms should be agreed
3. Prioritising and filtering, of inappropriate requests should be performed by sonographers supported by the Clinical Head
4. Minimum standards for studies should be established. Study protocols appropriate to specific clinical conditions should be established
5. A format for reports should be established, including who should issue conclusions and who is qualified to sign reports
6. The requirements of the Data Protection Act 1998 must be complied with regarding data storage
7. 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.
8. A mechanism must be in place for reporting cases that require urgent clinical attention.
9. Regular meetings, ideally weekly, should be held to review unusual, challenging or otherwise difficult cases.
10. A formal quality assurance system should be in place with regular blind over reading of selected studies to ensure consistency of performance and interpretation. Meetings should take place at least 4 times per year with all echocardiographers attending at least 50%.

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