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.