Case Study Requirements – Adult Echocardiography

Adult Transthoracic (TTE)

5 or fewer staff = 4 cases per facility (2 AS, 2 LV)*
6 to 8 staff = 6 cases per facility (3 AS, 3 LV)*
9 to 15 staff = 8 cases per facility (4 AS, 4 LV)*
16 to 25 staff = 10 cases per facility (5 AS, 5 LV)*
Greater than 25 staff = 12 cases per facility (6 AS, 6 LV)*

*LV are cases of regional wall motion abnormalities due to coronary artery disease or myocardial infarction, not global LV dysfunction or diastolic dysfunction cases. Cases demonstrating Takotsubo cardiomyopathy (stress cardiomyopathy) with regional abnormalities will also be accepted. AS cases must be native valvular AS with a velocity of at least 2 m/sec.

  • When submitting case studies, try to represent as many CURRENT staff members as possible without duplicating.
  • Cases submitted with the application must not be independently performed by sonographer or physician trainees.
  • One case study must be submitted from the Technical Director.
  • Medical Director must be represented.
  • All cases must be complete examinations; limited exams are not acceptable.
  • All cases must be selected from within the past 12 months from the date of application filing.
  • The same case may not be submitted twice within a testing section.

Adult Stress

The required stress case studies are based on the total number of staff (medical and technical) that perform/interpret stress echo in the applicant facility. The following are the required number of stress case studies per base facility:

5 or fewer staff = 4 cases per facility
6 to 8 staff = 6 cases per facility
9 to 15 staff = 8 cases per facility
16 to 25 staff = 10 cases per facility Greater than 25 staff = 12 cases per facility

  • Any one of the following types of cases is acceptable for submission: (1) abnormal wall motion at rest due to coronary artery disease or myocardial infarction, OR (2) inducible wall motion abnormality due to coronary artery disease or myocardial infarction, OR (3) a stress case using contrast (may be normal or abnormal).
  • When submitting case studies try to represent as many CURRENT staff members as possible without duplicating.
  • Cases submitted with the application must not be independently performed by sonographer or physician trainees.
  • One case study must be submitted from the Technical Director.
  • Medical Director must be represented.
  • All cases must be selected from within the past 36 months from the date of application filing.
  • When studies are uploaded, they are not formatted side by side.
  • The same case may not be submitted twice within a testing section.

Adult Transesophageal (TEE)

  • One complete Adult TEE case (that includes all standard views and Doppler assessments) for each physician that performs TEE.
  • Cases submitted with the application must not be independently performed by physician trainees.
  • TEE representative cases must have an indication or finding of significant mitral regurgitation or suspected cardiac source of embolus. At least one representative case from the facility must have a finding of significant mitral regurgitation.
  • All cases must be selected from within the past 12 months from the date of application filing.
  • The same case may not be submitted twice within a testing section.

Note: Although “limited” or shorter pathology-directed TEE exams may be appropriate in some circumstances, these are not the types of cases that should be submitted for the purpose of facility accreditation review. Intraoperative TEE may be submitted if the facility physician performed the entire study including:

  • Passing the probe
  • Image acquisition and documentation
  • Reporting
  • Imaging archiving on echocardiography laboratory archiving system