Introduction
Transesophageal echocardiography (TEE) is an important cardiovascular imaging modality that provides information for both diagnoses of cardiac pathology and guidance for therapeutic interventions1. Complex catheter-based therapies, use of 3D echocardiography, and other advanced echocardiographic techniques have increased the indications and complexity of TEE exams 2. One of the main advantages of TEE is enhanced visualization of intracardiac structures due to closer proximity of the ultrasound probe. Further, 3D-TEE provides additional value of acquiring a full volume image acquisition that can be reconstructed in multiple planes. Operators require a specific skill set in performing TEE examinations and must know the technical steps to safely and efficiently perform the procedure. The Inter-societal Accreditation Commission (IAC) provides a guideline for what constitutes standard views in a complete TEE examination 3. However, operator variability and TEE exam time/duration constraints may affect standard view acquisitions. Thus, the use of protocol-driven exams may reduce such variability and improve exam acquisition efficiency. The American Society of Echocardiography (ASE) and Society of Cardiovascular Anesthesiologists (SCA) have emphasized the need for consistency in training, reporting, and quality of TEE exams1.
Ultrasound (US) imaging, including TTE and TEE, is an operator-dependent modality resulting in variation based on the individual provider or sonographer’s experience, comfort, and skill with the relevant exam and image acquisition. This could be mitigated by providing workflow based training focused on the skillset required to efficiently perform the procedure. A recent study found that even a single-day simulation-based course in critical care TEE improved technical skills and knowledge base when combining case-based image acquisition and image interpretation training 4. It could thus be hypothesized that the procedure-specific workflow protocols describing the steps required for image acquisition might further facilitate TEE performance and efficiency. Evaluation of the use of ultrasound protocols for standardized image acquisition in non-cardiac US modalities has shown a reduction in exam times and repetitive motion injuries and increased consistency in image acquisition 4. Further, both carotid Doppler and complete abdominal exams had shorter scan duration with the use of scanner-based protocol driven US imaging5. Studies in non-US modalities have also pointed to the benefits of the automated modality-specific protocol in achieving higher diagnostic accuracy 6.