The importance of training in echocardiography: a validation study using pocket echocardiography.

Aims: To investigate the training effect in echocardiography by using recent hand-held ultrasound scanners (HANDs).

Methods: In this prospective study, 320 consecutive patients were scanned with HAND by an inexperienced ultrasonographer over a period of 8 weeks. Imaging studies were compared with high-end echocardiography as gold standard. Segmental endocardial border delineation was scored to describe image quality. Assessment of left ventricular dimensions, regional/global left ventricular function and grading of valve disease were compared.

Results: A significant reduction in examination duration, improvement in image quality, substantial agreement in functional assessment (κ > 0.61, P < 0.01) and wall motion scoring (κ=0.67, P < 0.01) could be observed over time. The correlation in left ventricular measurements was excellent (r > 0.98, P < 0.01). The detection of valve diseases and pericardial effusions was sufficient, but the grading only moderate (κ < 0.6).

Conclusion: Well-grounded training in echocardiography leads to a rapid improvement in image acquisition and interpretation over a period of a few weeks. Basic diagnostic findings could be interpreted with high accuracy after short training. Interpretation of complex findings remained difficult. The time needed to carry out an examination using pocket echocardiography could not be reduced to less than 3-4 min per patient. New educational concepts are warranted.