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Published on: January 27, 2023
A minimum dataset for a Level 1 echocardiogram: a guideline protocol from the British Society of Echocardiography
Rakhee Hindocha1, David Garry2, Nadia Short3
1Brighton and Sussex University Hospitals, Brighton, UK. rakhee.hindocha1@nhs.ne.
Insights
The British Society of Echocardiography introduced the Level 1 echocardiogram for rapid identification of critical cardiac conditions by non-specialists. This protocol supports emergency treatment decisions but does not replace a full transthoracic echocardiogram.
Area of Science:
- Cardiology
- Medical Imaging
- Ultrasound Technology
Background:
- Standard transthoracic echocardiograms (TTE) have established minimum datasets.
- Point-of-care (POCUS) ultrasound protocols exist for non-specialists but have limitations.
- Challenges include limited 2D imaging, lack of structured training support, and 24/7 echocardiography provision.
Purpose of the Study:
- To introduce the Level 1 echocardiogram protocol.
- To facilitate rapid identification of critical cardiac pathology in emergency settings.
- To support non-echocardiography specialists in initial cardiac assessments.
Main Methods:
- Development of a minimum dataset for the Level 1 echocardiogram by the British Society of Echocardiography.
- Focus on rapid identification of critical cardiac pathology.
- Designed for performance by non-specialists in echocardiography.
Main Results:
- A defined minimum dataset for the Level 1 echocardiogram has been established.
- The protocol aims to aid in the urgent identification of life-threatening cardiac conditions.
- Level 1 echocardiograms are intended as a preliminary assessment, not a replacement for full TTE.
Conclusions:
- The Level 1 echocardiogram provides a structured approach for initial cardiac assessment by non-specialists.
- It addresses the need for rapid identification of critical cardiac pathology, especially outside specialized centers.
- Further accreditation processes for Level 1 echocardiography are described separately.
Abstract:
The British Society of Echocardiography has previously outlined a minimum dataset for a standard transthoracic echocardiogram, and this remains the basis on which an echocardiographic study should be performed. The importance of ultrasound in excluding critical conditions that may require urgent treatment is well known. Several point-of-care echo protocols have been developed for use by non-echocardiography specialists. However, these protocols are often only used in specific circumstances and are usually limited to 2D echocardiography. Furthermore, although the uptake in training for these protocols has been reasonable, there is little in the way of structured support available from accredited sonographers in the ongoing training and re-accreditation of those undertaking these point-of-care scans. In addition, it is well recognised that the provision of echocardiography on a 24/7 basis is extremely challenging, particularly outside of tertiary cardiac centres. Consequently, following discussions with NHS England, the British Society of Echocardiography has developed the Level 1 echocardiogram in order to support the rapid identification of critical cardiac pathology that may require emergency treatment. It is intended that these scans will be performed by non-specialists in echocardiography and crucially are not designed to replace a full standard transthoracic echocardiogram. Indeed, it is expected that a significant number of patients, in whom a Level 1 echocardiogram is required, will need to have a full echocardiogram performed as soon as is practically possible. This document outlines the minimum dataset for a Level 1 echocardiogram. The accreditation process for Level 1 echo is described separately.
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