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INTRODUCTION

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As a clinical tool in cardiovascular medicine, there are few if any techniques that can rival the role of echocardiography. It is a noninvasive (or semi-invasive in the case of transesophageal echocardiography) diagnostic test with no known untoward side effects (including the lack of radiation) that allows for a comprehensive assessment of cardiac anatomy and physiology. It can provide insight into the diagnosis of patients with suspected cardiac disease, help guide management, and provide important prognostic information. Unlike competing imaging methods, echocardiography is portable and can be performed in virtually any clinical setting, including the outpatient clinic, an inpatient echocardiography laboratory, the patient's bedside, the critical care environment, the emergency department, and the operating room.

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Since cardiac disease is so ubiquitous and echocardiography plays such an integral role in its diagnosis and management, most clinicians (not only cardiologists) need to understand the role of echocardiography and its strengths and weaknesses, as well as its limitations. Echocardiography can play a significant role in the diagnosis and management of a broad spectrum of patients. Such patients could include the outpatient presenting to a primary care physician with new physical exam findings such as a murmur or symptoms such as dyspnea, the established cardiac patient with new symptoms, or the hemodynamically unstable ICU patient. The clinical application of echocardiography and guidelines for its use in a variety of clinical situations are addressed in the ACC/AHA/ASE guideline report most recently updated in 2003.1

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Due to its many advantages and capabilities, the utilization of echocardiography in clinical medicine in general and in cardiovascular practice in particular has exploded since its initial description nearly 60 years ago.2 Echocardiography has become by far the most frequently ordered and performed cardiovascular test after the electrocardiogram. It would be quite unusual for a patient with cardiovascular disease not to have had an echocardiogram.

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While echocardiography has many advantages, one would be remiss to ignore its limitations. Challenges with image quality and acquisition due to patient characteristics such as underlying lung disease (eg, COPD) and body habitus, as well as difficulty in appropriately positioning patients, especially in critical care settings may lead to suboptimal images.

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Echocardiography is very "user-dependent," not only in the acquisition of images, but also in its interpretation. Quality improvement in echocardiography has thus become an important aspect of the field. Many professional organizations, including the American Society of Echocardiography (ASE) and the American College of Cardiology (ACC), have formulated guidelines for training in the performance and interpretation of echocardiograms.3,4 The Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) was formed in 1996 to address the need for standardization and quality improvement of echocardiographic laboratories. Now known as the Intersocietal Accreditation Commission (IAC)—Echocardiography, its goal is, "Improving health care through accreditation."5 Echocardiography labs that are accredited by IAC-Echocardiography must be staffed by sonographers and physicians who meet standards for training ...

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