# How Should We Grade the Quality of a Transthoracic Echocardiogram: Results from a Survey from the Association for European Pediatric and Congenital Cardiology (AEPC) Imaging Working Group

## TL;DR

This study surveyed European pediatric cardiologists to understand how to assess the quality of transthoracic echocardiograms and found significant variation in practices, suggesting a need for standardized tools.

## Contribution

The study introduces a matrix of key parameters for quality grading in pediatric echocardiography, based on expert consensus.

## Key findings

- Most participants emphasized the importance of quality standards for trainees in pediatric echocardiography.
- Quantitative or qualitative criteria with formative feedback were ranked as the most useful for quality grading.
- A matrix of eight key parameters was developed to help trainees track their progress.

## Abstract

The aim of this study was to assess the current status about quality grading, resources, and training in pediatric echocardiography, to define gaps in this field, and to develop potential strategies for quality improvement. A structured questionnaire was sent out to pediatric cardiologists within the Association for European Pediatric and Congenital Cardiology (AEPC). The questionnaire contained questions regarding assessment of quality, training and feedback in the field of pediatric echocardiography. Thirty-one European pediatric cardiologists from 17 countries participated. Most participants agreed (n = 28, 90%) that it is important to have standards for echocardiography quality grading for trainees. Objective instruments, however, are largely not available. Among a list of criteria on how to grade quality, quantitative or qualitative criteria with additional formative feedback was ranked highest by the respondents (53%). Although the correct diagnosis, followed by the correct use of two-dimensional (2D) imaging and the correct use of color Doppler across all valves and septae were listed as most important when performing transthoracic echocardiography, a matrix of the eight most important parameters was designed. The results show that quality grading in pediatric echocardiography varies highly among European centers. The matrix provided is a visual instrument whereby trainees can gauge the evolution in their skill as echocardiographers.

The online version contains supplementary material available at 10.1007/s00246-025-03914-5.