Laboratory accreditation
- IAC Echocardiography - primary accrediting body for adult TTE, TEE, stress echo, and adult congenital echo in the US.
- Accreditation is often required by payers.
Personnel qualifications
- Physicians: board-certified/board-eligible in cardiovascular disease or equivalent; specific echo training. National Board of Echocardiography (NBE) certification (ASCeXAM) is common.
- Sonographers: registered by ARDMS or CCI in adult echo. Ongoing CME.
Volume requirements
- Minimum annual case volumes for both physicians and sonographers to maintain proficiency.
- IAC recommends specific minima that vary by testing area.
Quality assurance activities
- Peer review of at least 10 % of studies - image quality, interpretation accuracy, report clarity.
- Structured reporting - consistent format for measurements, findings, and conclusions.
- Written protocols - standardized study performance for each type (TTE, TEE, stress, etc.).
- CME - ongoing echo-specific education.
Reporting best practices
- Preliminary vs final read distinction.
- Comparison with prior study when applicable.
- Report turnaround time metrics.
- Impressions concise and clinically actionable.
- Critical findings communicated directly to the ordering provider.
Equipment maintenance
- Regular preventive maintenance.
- Documentation of QA testing (image quality phantoms).
- Transducer cleaning and disinfection between patients (per manufacturer and society guidelines).
Contrast use best practices
- Sonographer training in contrast infusion.
- Documentation of contrast administration.
- Monitoring for adverse reactions.
Appropriate use criteria (AUC)
- Society-defined criteria (ACC, ASE) to guide test ordering.
- Reduces unnecessary imaging without compromising care.